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Radiology #2 exam
Cervical, Thoracic, Lumbar, and Sacral
| Question | Answer |
|---|---|
| What are the three cervical views? | APOM, APLC, NLC |
| What are the five cervical views? | APOM, APLC, NLC, Cervical Oblique or Flex/Ext. |
| What are the seven cervical views? | APOM, APLC, NLC, Cervical Ext, Cervical Flex, Right Obl, Left Obl |
| What are the normal values for atlantoaxial alignment? | Child - 1-5 mm, Adult - 1-3 mm |
| What is normal for a cervical gravity line? | Should pass through the body of C7. Anterior to C7 then anterior head carriage |
| What is the normal cervical lordosis angle? | Normal is 35-45 degrees. Decreased = hypolordosis and increased = hyperlordosis |
| What is normal for Georges line? | The posterior body corners should be in alignment with the segment above and below. |
| What is anteriorlistesis? | Anterior displacement of the vertebral segment. |
| What is Retrolisthesis? | Posterior displacement of the vertebral segment. |
| What is normal for a posterior cervical line? | Line should be fairly smooth and continuous. |
| What is normal for the sagittal dimension of the cervical spine? | C1 - 16 mm C2 - 14 mm C3 - 13 mm C4-C7 - 12 mm |
| What is normal for the prevertebral soft tissue measurement? | C1 - 10 mm C2 - 5 mm C3 - 7 mm C4 - 7 mm C5 - 20 mm C6 - 20 mm C7 - 20 mm |
| What is normal for the cervical stress line? | Flexion intersect at C5/C6. Extension intersects at C4/C5 |
| What is occipitalization? | Failure of segmentation of C0/C1. Complications can be small spinal canal and lax transverse lig. |
| What is Spondyloschisis? | Spina Bifida Occulta at C1. Complication can be lax transverse ligament |
| What is agensis of the posterior arch of C1? | Agenetic cartilage. Complication can be megaspinous at C2 and lax transverse ligament. |
| What is partial agenesis of the posterior arch at C1 | Partial formation of arch with posterior tubercle present. |
| What is ponticus posticus? | Calcification within the oblique atlanto-occipital lig. Check for vertebral basilar insufficiency prior to any forceful upper cervical adjusting. |
| What is Os Terminale? | Ununited secondary center of ossification at the tip of the dens. Downs syndrome have increased incidence and may contribute to atlanto-axial instability. |
| What is Os Odontoidium? | Failure of the base of the dens to form an osseous union with C2 body. Contraindication!!! |
| What is hypoplastic & agenesis of the dens? | <12 mm in vertical = hypoplasia. |
| What is a nuchal bone? | Calcification/ossification within the nuchal ligament. Forms after 40 yoa. |
| What is an Intercalary bone? | Calcification within the other annular rings of the IVD (mc) or ALL. Common with degenerative disc disease. |
| What is a cervical rib? | Pieces of bone that articulates with the cervical TVP. Mc at C7 and in females. May cause neurovascular compression syndrome. |
| What is hyperplastic TVP's at C7? | Where C7 TVP is larger than T1's TVP. May have same complications as cervical ribs. |
| What is a congenital block vertebra? | Nonsegmentation of 2 or more spinal segments. Can occur at any vertebral level. Mc is C-spine (C5/C6, C2/C3) Prone to hypermobility above and below. ****Concave deformity of anterior bodies "wasp waist". |
| What are the radiographic views of the thoracic spine? | A-P Lateral |
| What are some of the rib anomalies? | Partial or complete agenesis Articulation between 2 ribs Bifurcated or forked ribs Foramen Supernumerary Hypoplasia Agenesis |
| What is costal cartilage calcification? | Usually seen after 30 yoa. May occur earlier and be of no clinical significance. Has been associated with hyperthyroidism in young children. |
| What is Hahn's venous cleft? | Residual nutrient canal within a vertebral body. Mc seen in the thoracic spine. |
| What is pectus excavatum? | Inward bowing/depression of the sternum. Mc involves lower 1/2 - 2/3 of sternum. 1/5 scoliosis also. Lateral view is the best. May displace the heart posterior and lateral left. |
| What is pectus carinatum? | Outward bowing of the sternum. Due to overgrowth of cartilage. Mc in males (75%) Has been seen in some inherited connective tissue disorders (Marfans, Ehlers-Danlos, Morquios) Possible complications. |
| What is straight back syndrome? | Decreased thoracic kyphosis & decreased A-P (sagittal) diameter of the chest. < 13 cm males < 11 cm females Heart shifts left and cardiac compression. Altered hemodynamics may create a heart murmur. |
| Describe the parts of the scotty dog? | Ears - Superior AP Nose - TVP Eyes - Pedicle Neck - Pars Foreleg - Inferior AP Tail - Superior AP Body - Lamina & SP Hindleg - Inferior AP |
| What "dog" do you see with and anterior lumbar oblique? | Marker is posterior to the spine and you see opposite dog. |
| What "dog" do you see with a posterior lumbar oblique? | Marker is anterior to the spine and you see the same dog. |
| What is Knife Clasp Syndrome? | Elongation of L5 spinous. Spina bifida occulta of S1 also. |
| What is facet syndrome? | Once facet is in the coronal plane and the other is in the sagittal plane. Mc in lumbar spine (L5/S1) Best seen on a A-P radiograph |
| What is a schmorl's node? | Small defect in the vertebral end plate that is due to herniation of the nucleus pulposus. Mc in thoracic/lumbar spine. May be in more than 1 vertebra. Development or pathological weakness in the endplate, subchondral bone, trauma, idiopathic. |
| What is a giant schmorl's node? | > 6 mm Decreased disc space and may have increased A-P vertebral body size. |
| What is a nuclear impression? | Cup shaped defect within a vertebral endplate. Commonly called a "cupids bow". Mc in lumbar area. |
| What is a limbus bone? | Small ossicle of bone adjacent to the corner of the vertebral body, due to a migration of disc material through the vertebral endplate, prior to fusion. Mc anterior-superior endplate. |
| What is a butterfly vertebra? | Deformity in which the vertebral endplate indent toward the center of the body. This is due to the placement of the blood vessels in the body. Mc in thoracic and lumbar spine. ***Pedicles may enlarge or have an increased distance between them. |
| What is a hemivertebra? | Failure of one of the ossification centers in the vertebral body to develope. |
| What is a lateral hemivertebra? | Most common type. Decrease in lateral vertebral body height. Normal discs. Can have 2 pedicles and/or 2 TVP's on one side. 1 level - structural scoliosis. |
| What is a dorsal hemivertebra? | Decreased anterior vertebral body height. |
| What is a ventral hemivertebra? | Decreased posterior vertebral body height. |
| What is a transitional segment? | Have features of both segments. Cervicothoracic Thoracolumbar Lumbosacral (mc) |
| What is sacralization? | L5 has characteristics of S1 Large TVP's - or > 19 mm vertical (spatulization) Uni or bilateral syntostosis of TVP's to the sacrum. Hypoplastic of agenetic disc (missing) |
| What is lumbarization? | S1 has characteristics of L5 Rudimentar disc between S1/S2 |
| What is spondylolisthesis? | Anterior displacement of a vertebra, with or without a defect in the neural arch. Congenital (dysplastic) elongated pars or other congenital abnormality or arch of sacrum. |
| What is spondylolysis? | Acute break in the pars or stress fracture |
| When is spondylolysis most commonly occur? | 10-15 yoa 90% are at L5 L5 = stress fracture of pars L4 = pathological |
| What are the possible exam findings for spondylolysis? | Low back pain tight hamstrings Weak abdominal muscles Stretch marks over the area. |
| What is Wilkinson's syndrome? | Unilateral spondylosis with sclerosing of the opposite pedicle. Mc cause of sclerotic pedicle. Generally more radiopaque and bigger than the other. Cause is from repetitive hyperextension |
| What are the causes of a sclerotic pedicle? | Spondylolysis Congenital - agenesis/hypoplastic pedicle or facet on the opposite side, facet anomalies also. |
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