Your SlideShare is downloading. ×
  • Like
The spine
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×

Now you can save presentations on your phone or tablet

Available for both IPhone and Android

Text the download link to your phone

Standard text messaging rates apply

The spine

  • 1,703 views
Published

 

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to comment
No Downloads

Views

Total Views
1,703
On SlideShare
0
From Embeds
0
Number of Embeds
0

Actions

Shares
Downloads
169
Comments
0
Likes
2

Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide

Transcript

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