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The spine
The spine
The spine
The spine
The spine
The spine
The spine
The spine
The spine
The spine
The spine
The spine
The spine
The spine
The spine
The spine
The spine
The spine
The spine
The spine
The spine
The spine
The spine
The spine
The spine
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The spine
The spine
The spine
The spine
The spine
The spine
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The spine
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The spine
The spine
The spine
The spine
The spine
The spine
The spine
The spine
The spine
The spine
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The spine

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  • 1. The Spine Imarzen V. Elepano MD FPCR FUSP FCT-MRISP CCD Dept of Radiology UP-PGH
  • 2. Normal anatomy
  • 3.  
  • 4. X-RAY
  • 5. MRI
  • 6. CT …. SCAN ……
  • 7.  
  • 8. <ul><li>Spine </li></ul><ul><li>I. Trauma </li></ul><ul><li>II.Degenerative Diseases </li></ul><ul><li>III.Infectious Diseases </li></ul><ul><li>IV.Inflammatory Diseases </li></ul><ul><li>V.Primary Tumors </li></ul><ul><li>VI.Vascular Disorders </li></ul>
  • 9. I. Spinal Trauma <ul><li>A. Upper cervical fracture </li></ul><ul><li>1. C1 </li></ul><ul><li>a. Jefferson fx </li></ul><ul><li>i. burst fx of C1 </li></ul><ul><li>ii. Axial loading with bilateral outward displacement of lateral masses of C1 </li></ul>
  • 10. Jefferson fx
  • 11. <ul><li>b. isolated fx of the posterior arch of C1 </li></ul><ul><li>i. hyperextension with impaction of the posterior arch of C1 </li></ul>
  • 12. isolated fx of the posterior arch of C1
  • 13. <ul><li>c. isolated fx of the anterior arch of C1 </li></ul>
  • 14. <ul><li>2. C2 </li></ul><ul><li>a. fx of the dens </li></ul><ul><li>i. Type I- avulsion of the tip of the dens </li></ul><ul><li>ii. Type II- fx through the base of the dens at its jxn with the body of C2 </li></ul><ul><li>iii. Type III- extends through the upper body of C2 </li></ul>
  • 15. fx of the dens
  • 16. <ul><li>b. C2 spondylosis </li></ul><ul><li>i. Hangman’s fx (MC) </li></ul><ul><li>ii. Hyperextension with bilateral fx of the pars interarticularis </li></ul>
  • 17. Hangman’s fx
  • 18. <ul><li>B. Lower cervical spine fx </li></ul><ul><li>1. hyperextension injuries </li></ul><ul><li>- caused by impact on the face/ neck </li></ul>
  • 19. <ul><li>a. hyperextension dislocation </li></ul><ul><li>i. disruption of the ligaments between adjacent vertebrae, including the ALL, annulus fibrosus and facet capsular ligament </li></ul><ul><li>ii.usually normal findings; thickened prevertebral soft tissue, hematoma formation, disruption of ligaments </li></ul>
  • 20. hyperextension dislocation
  • 21. <ul><li>b. hyperextension teardrop fx </li></ul><ul><li>i. avulsion fx of the antero-inferior margin of the vertebral body 2’ to an excessive stress on the ALL (MC- C2) </li></ul>
  • 22. hyperextension teardrop fx
  • 23. <ul><li>2. hyperflexion injuries </li></ul><ul><li>- caused by impact to the top of the head or base of the head with neck flexion </li></ul>
  • 24. <ul><li>a. hyperflexion sprain </li></ul><ul><li>i. disruption of the posterior ligamentous attachment between vertebrae </li></ul><ul><li>ii. Widened space between posterior elements and cervical kyphosis </li></ul>
  • 25. hyperflexion sprain
  • 26. <ul><li>b. wedge fx </li></ul><ul><li>i. impaction fx of the superior endplate of the affected vertebral body and posterior ligament disruption </li></ul><ul><li>ii. intact inferior endplate </li></ul>
  • 27. wedge fx
  • 28. <ul><li>c. bilateral interfacet joint dislocation </li></ul><ul><li>i. disruption of the PLL, ALL, annular fibrosus of the intervertebral discs and complete bilateral dislocation of the facet joints </li></ul>
  • 29. bilateral interfacet joint dislocation
  • 30. <ul><li>d. hyperflexion teardrop fx </li></ul><ul><li>i. disruption of the PLL and a triangular fx fragment arising from the anterior and inferior margin of the upper vertebral body </li></ul>
  • 31. hyperflexion teardrop fx
  • 32. <ul><li>e. Clay shoveler’s fx </li></ul><ul><li>i. obliquely transverse avulsion fracture of spinous process </li></ul>
  • 33. Clay shoveler’s fx
  • 34. <ul><li>3. Vertical compression fx </li></ul><ul><li>-caused by impact to the top of the head with the spine straight </li></ul><ul><li>a. Jefferson fx </li></ul><ul><li>b. burst fx of the lower cervical spine </li></ul>
  • 35. burst fx of the lower cervical spine
  • 36. <ul><li>C. Thoracic </li></ul><ul><li>1. wedge fx </li></ul><ul><li>a. simple- anterior vertebra only </li></ul><ul><li>b. severe- anterior + posterior </li></ul><ul><li>2. flexion fx dislocations </li></ul>
  • 37.  
  • 38. <ul><li>D. Thoracolumbar and Lumbar spine </li></ul><ul><li>1. wedge fx- fx of the vertebral body w/o involvement of the posterior elements </li></ul>
  • 39. wedge fx
  • 40. <ul><li>2. burst fx- vertically oriented fx with lateral dispersion of fragments </li></ul>
  • 41. burst fx
  • 42. <ul><li>3. Chance fx- horizontally oriented fx through the spinous process, laminae and body </li></ul><ul><li>i. seat belt injury </li></ul><ul><li>ii. 50% intraperitoneal injury </li></ul>
  • 43. Chance fx
  • 44. Insufficiency fx <ul><li>E. Sacrum </li></ul><ul><li>1. Insufficiency fx </li></ul><ul><li>- linear sclerosis along the sacral ala, parallel the SI joint </li></ul>
  • 45.  
  • 46. <ul><li>F. Pathologic fxs and secondary tumor </li></ul><ul><li>1. metastasis to the spine is most commonly 2’ to hematogenous spread </li></ul><ul><li>2. MC areas are the TL spine </li></ul><ul><li>3. MC 1’ tumor are breast, lung, prostate and kidneys -> lymphoma </li></ul>
  • 47. II. Degenerative Spine Disease <ul><li>A. Introduction </li></ul><ul><li>1.Most result from degenerative changes of the bone, ligaments or soft tissue components </li></ul><ul><li>2. Disc degeneration </li></ul><ul><li>a. Triad </li></ul><ul><li>i. disc bulge </li></ul><ul><li>ii. loss of height </li></ul><ul><li>iii. loss of water </li></ul><ul><li>b. reliable indicator is gas in the disc-vacuum phenomenon </li></ul>
  • 48. Normal disc
  • 49.  
  • 50.  
  • 51. <ul><li>B. Disc Herniation </li></ul><ul><li>1. Disc bulge- smooth circumferential extension of the disc margin beyond the boundary of the adjacent vertebral end plates in greater than 50% of the disc circumference </li></ul>
  • 52. Disc bulge
  • 53. <ul><li>2. Disc herniation- focal, incomplete extension of the contents of the nucleus pulposus through an incomplete tear of the annulus fibrosus in less than 50% of the circumference of the disc </li></ul><ul><li>a. protrusion </li></ul><ul><li>b. extrusion </li></ul>
  • 54. <ul><li>a. protrusion- when the greatest distance between the edges of the disc material beyond the disc space is less than the distance of the edges at the disc base in all planes </li></ul>
  • 55. protrusion
  • 56. <ul><li>b. extrusion- extrusion of disc contents through complete tears of annulus fibrosus and the PLL resulting in anterior epidural mass </li></ul>
  • 57. extrusion
  • 58. <ul><li>i. migrated disc- if disc material is displaced in any direction away from the site of extrusion </li></ul><ul><li>ii. Sequestered fragment- if disc has no continuity with the disc of origin </li></ul>
  • 59. Sequestered fragment
  • 60. <ul><li>C. Spinal stenosis </li></ul><ul><li>1. reduction in the caliber of the spinal canal </li></ul><ul><li>2. etiology </li></ul><ul><li>a. MC is degenerative changes (disc space, facet joints and lateral foramina) </li></ul><ul><li>b. epidural lipomatosis, ossification of the PLL &/or LF </li></ul>
  • 61.  
  • 62. <ul><li>D. Spondylolisthesis and spondylolysis </li></ul><ul><li>1. spondylolisthesis- malalignment 2’ to spinal instability 2’ to degenerative changes of the disc and facet joints </li></ul>
  • 63.  
  • 64. <ul><li>Meyerding's scale:       Amount of Grade subluxation       </li></ul><ul><li>1     <25%       </li></ul><ul><li>2     25-50%       </li></ul><ul><li>3     50-75%       </li></ul><ul><li>4     75-100%       </li></ul><ul><li>5     >100% </li></ul>
  • 65. <ul><li>2. spondylolysis- 2’ to repeated minor trauma leads to stress fxs of the pars interarticularis </li></ul>
  • 66.  
  • 67. III. Infections of the spine <ul><li>Intervertebral disc- MC etiol are Staph, enterobacteria and Pseudomonas </li></ul><ul><li>Vertebral body first- Tuberculosis and Brucella </li></ul><ul><li>Lateral radiographs of the spine usually will reveal disc space narrowing with erosion of the vertebral end plates of the contiguous vertebrae </li></ul>
  • 68.  
  • 69. IV. Inflammatory spinal disorders <ul><li>A. Rheumatoid arthritis </li></ul><ul><li>1. MC areas- cervical and craniocervical jxn </li></ul><ul><li>2. imaging findings- erosions, destruction of the dens, anterior atlantoaxial subluxation and vertical subluxation </li></ul>
  • 70.  
  • 71. <ul><li>B. Ankylosing spondyloarthritis </li></ul><ul><li>1. MC areas- SI joints and bone insertions of ligaments </li></ul><ul><li>2. findings- bamboo spine, osteopenia, squaring of the vertebral body margins, symmetric sacroiliitis, marginal syndesmophytes and fusion of facet joints </li></ul>
  • 72.  
  • 73. IV. Primary Bone tumors of the spine <ul><li>A. Hemangioma </li></ul><ul><li>1. vertebral body </li></ul><ul><li>2. thoracic or lumbar spine </li></ul>
  • 74.  
  • 75. <ul><li>B. Aneurysmal bone cyst (ABC) </li></ul><ul><li>1. neural arch </li></ul><ul><li>2. cervical and thoracic spine </li></ul>
  • 76.  
  • 77. <ul><li>C. Osteoblastoma </li></ul><ul><li>1. neural arch </li></ul>
  • 78.  
  • 79. <ul><li>D. Osteoid osteoma </li></ul><ul><li>1. neural arch </li></ul><ul><li>2. lumbar </li></ul>
  • 80.  
  • 81. <ul><li>E. Giant Cell tumor (GCT) </li></ul><ul><li>1. vertebral body </li></ul><ul><li>2. sacrum </li></ul>
  • 82.  
  • 83. <ul><li>F. Chordoma </li></ul><ul><li>1. sacrum (S4-S5) </li></ul>
  • 84.  
  • 85. <ul><li>G. Langerhans Cell histiocystosis (LCH) </li></ul><ul><li>1. vertebral body </li></ul><ul><li>- causing vertebral plana </li></ul>
  • 86.  
  • 87. <ul><li>H. Multiple myeloma and plasmacytoma </li></ul><ul><li>1. vertebral body </li></ul><ul><li>2. thoracic and lumbar spine </li></ul>
  • 88.  
  • 89. V. Spinal Vascular Disorders <ul><li>A. Vascular malformations </li></ul><ul><li>1. radiculomeningeal vascular malformations </li></ul><ul><li>- fistula between the radicular (radiculomeningeal) arteries and veins </li></ul><ul><li>-spinal dural arterial-venous fistulae (SDAVF) (MC in the lower thoracic spine) </li></ul>
  • 90.  
  • 91. <ul><li>B. Epidural hematoma </li></ul><ul><li>1. MC etiol is trauma </li></ul><ul><li>2. upper thoracic </li></ul>
  • 92.  
  • 93. Questions ?
  • 94. The End
  • 95.  

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