Basic three images for cervical spine
Lateral include T1
Open Mouth AP
3 Lines of lateral view
Ant Vertebral Body
Post Vertebral Body
Bases of Spinous Processes
Advantages of Lateral View
Visible Odontoid Peg
70% of pathologies are detected from it
Normal distance between bones
3 mm in adults, 5 mm in kids
What r u looking for in Long AP?
Spinous Processes align (look out for Bifid)
No single space should be 50% wider than once immediately above (unless pt is in spasm which will pull column one way and it will be less than 50)
Where are injuries most common in cervical region?
Lower - C5-C7 and at C1-C2 articulation
CT vs MRI
CT - Hard tissue
MRI - Soft tissue
What\\\'s seen in the Atlas Axial - Axial CT
Psoas major significance in AP XRay?
If you can\'t see it there could be a hematoma or anuerism thats clocking the shadow
Saral Indentation - Post Sup Iliac Spine (about S2 level) - where sacroiliac joint
Where is inf angle of scapula at rest? Sup angle?
Floor Int oblique, Lat Dor, Ext Obliqu, Iliac Crest
Intervertebral Foramen dynamics
Nerves and radicular arteries sit high
A lateral protrusion at L4-5 would be detected how? L5-S1?
a) Touch at lateral calf because it\\\'s the L5 dermatome - a prolapse only affects those down from it.
b) Touch at lateral ankle or middle calf
Where do the majority of prolapses occur?
L4-5 and L5-S1
Why a lumbar and not a thoracic puncture/spinal tap and where is it done?
Because plexuses create a bulge or cystern of fluid. Done between L2-S2 because conus medularis is approx at top of L2 and so only subarachnoid space and not chord exists. Perhaps best at L4, the top of which is even with Iliac crest.
Kyphosis, Lordosis, Primary and Secondary curves?
Kyphosis - hunchback, Lordosis - increase curvature of the lumbar region
Primary curves - cervical and lumbar
Secondary curves - thoracic
Pelvic tilt spectrum
Normal - Ant Sup Iliac spine flush Pubic tubercle
Ky-Lordosis posture - spine ant of tubercle
Flat-back - spine most post of tubercle
Sway-back - spine post of tubercle
Spina bifida types
Occulta - spinal cord doesn\\\'t protrude, tuft of hair
Meningocele - Meninges forced through gap
Meningomyelocele - Membranes covering spinal cord emerge out of skin
Jefferson fracture is from what?
Burst fracture of C1 due to compression (head injury in football)
Hangman\\\'s fracture? Wedge fracture?
a) C2 axis b) Vertebral bodies narrow anteriorly due to compression
Forced hyperflexion= disc rupture and nuclueus pulposes compressing spinal roots.
\"listhesis\" - sliding forward
a) Fracture pars interarticularis
b) Anterior displacement of L5 vertebra (forced hyperextension)
Prolapsed Intervertebral Disc - Nucleus pulposus pushes through annulus fibrosis thus pressuring nerve
Where do we do Bone marrow biopsy?
PSIS is the landmark
Venous Plexus of Column - Batson
External (outside vertebral canal) Plexuses anastomose with the internal (inside vertebral canal) plexuses. The basivertebral vein emerges from post foramena of the vertebral bodies to the internal plexus. No valves, so flow can be reversed by raised intra-abdominal pressure or postural alterations. (Cancer (especially prostate) can spread). Anastomoses to cavae and Azygous (which takes blood to vena cavae) leads to spread of cancer
Why a rectal exam in pts over 50 with low back pain?
Matrix of connective tissue connecting periosteum to bone
\"Shingles\" - Infects a dorsal root ganglion and you won\'t know which until it manifests itself at the corresponding dermatome
Pulling of the spinal cord at the base of the spinal canal - it\'s taut