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(4) Radiologic Evaluation of the Patient with Low Back Pain
Terms in this set (23)
imaging studies are NOT necessary in the first ___________ wks unless there are progressive neurological findings or a high suspicion of a systemic etiology. A plain ___________, ___________, and ___________ x-ray of the lumbar spine is appropriate if clinical improvement has NOT occurred.
1. 4-6 wks
wouldn't order a CT/MRI until no improvement after 12 weeks!
Degenerative disc disease xray shows?
low back pain
- narrowed or thin disc
- osteophyte (bone spurs)
What is osteopoikilosis? what does it look like on xray?
low back pain from multiple, discrete round/oval radio densities in cancellous bones
XR = a pattern of numerous white densities of similar size spread throughout all the bones
Where is the ossification in Diffuse Idiopathic Skeletal Hyperostosis (DISH)? how are the disk spaces? SI + facet joints? how many bodies are involved?
ossification along the ANTERIOR longitudinal ligament of the T + L spines
disk spaces, SI & facet joints all normal
4+ contiguous bodies involved
What is ankylosing spondylitis? does it involve the SI joints?
low back pain from ossification of the annulus fibrosus in the lumbar spine => formation of syndesmophytes in a gradually ascending pattern (bamboo spine)
yes involves SI joints !
What are schmorl nodes? what can they cause? how do they develop?
low back pain from protrusions of the cartilage of the intervertebral disc thru the vertebral body endplate and into the adjacent vertebra
the protrusions may contact the marrow of the vertebra => leading to inflammation
develop from back trauma !!
How are metastatic vertebral lesions best seen on MRI? (views)
sagittal T1-weighted MRI !
can't see anything in a lateral xray view!
What 2 studies are more sensitive for detecting infection, cancer, disc pathology, + spinal stenosis?
CT + MRI
Bulging discs are seen in what % of asymptomatic pts?
What color should discs be on MRI?
white!! surrounded by a black annulus! (if the annulus is white anywhere, that's an annular tear)
What does a black L5 disc on MRI indicate?
loss of hydration => diseased disc
How do multiple lumbar discs collapse affect the spine?
straightens it -- no more curve
What does an MRI of cauda equina syndrome look like?
usually severe L5 fx w/ complete vertebral collapse; soft tissue component bulges posteriorly causing compression of cauda equina
Axial view of l-spine?
How does lumbar spinal canal stenosis present?
PSEUDOCLAUDICATION => w/ leg pain during ambulation that improves w/ rest; numbness and pain radiating to the foot; muscle cramps/restless leg syndrome at night in bed
What will you see on MRI of lumbar synovial cysts?
hypertrophy of lumbar zygoapophyseal joints
What are sacral perineural cysts (Tarlov cysts)? where do they come from? symptoms?
nerve root cysts found most commonly in the sacral roots, arising between the covering layer of the perineurium and the endoneurium near the dorsal root ganglion
low back pain w/ neurological claudication
look white on MRI!
CT vs x-ray for T/L spine imaging?
CT > xray !
CT is more accurate, and has less radiation
although the CT costs more initially, in the end it's cheaper because there are no follow up images (whereas you usually get many xrays at different times)
CT vs MRI for T/L spine imaging?
CT = vertebral fxs
MRI = ligaments, soft tissues, spinal trauma
What do bone scans help diagnose? (4)
1) cause/location of unexplained bone pain
2) fx not clearly seen on xray
3) damage to bones from infections/conditions (Paget's disease)
4) bone cancer/mets
What does a bone scan image look like?
bright/hot spots = areas of fast bone growth/repair (absorb more of the injected tracer)
but cannot differentiate between a tumor, infection, or fx !
What is an osteoid osteoma?
most common benign tumor of the spine -- usually causes painful scoliosis in teens
How does Paget's disease present?
elevated serum alkaline phosphatase
+ bone scan
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