View
12
Download
0
Category
Preview:
Citation preview
ESSENTIALS OF PLAIN
FILM INTERPRETATION:
SPINE
DR ASIF SAIFUDDIN Consultant Musculoskeletal Radiologist
Royal National Orthopaedic Hospital Stanmore,UK.
RCR 2012: SPINAL
RADIOGRAPHY 2
INTRODUCTION
RCR 2012: SPINAL
RADIOGRAPHY 3
INTRODUCTION
RCR 2012: SPINAL
RADIOGRAPHY 4
INTRODUCTION
Spinal alignment
Vertebral morphology
Bone density
Vertebral end-plates/enthesis
Vertebral cortex
Disc space
Neural arch
Para-spinal soft tissues
RCR 2012: SPINAL
RADIOGRAPHY 5
SPINAL ALIGNMENT
NORMAL
Cervical lordosis
C1-T2 30-400
Thoracic kyphosis
T2-T12 20-400
Lumbar lordosis
L1-L5 20-400
RCR 2012: SPINAL
RADIOGRAPHY 6
SPINAL MALALIGNMENT
Sagittal plane
Spondylolisthesis
Retrolisthesis
Kyphosis
Coronal plane
Scoliosis
Axial
Translation
Rotation
RCR 2012: SPINAL
RADIOGRAPHY 7
SPONDYLOLISTHESIS
Anterior slip of one
vertebra on vertebra
below
Assess
Aetiology (lumbar)
Types 1-6
Degree
Grades 1-3 or 1-4
spondyloptosis Grade 1 L3/L4 Grade 2 L5/S1
Degenerative Lytic
RCR 2012: SPINAL
RADIOGRAPHY 8
RETROLISTHESIS
Posterior slip of one
vertebra on vertebra
below
Usually mild
Aetiology
Almost always
degenerative
Pathological
Traumatic
RCR 2012: SPINAL
RADIOGRAPHY 9
KYPHOSIS
Increased curvature of
thoracic spine
Generalised
Young- Scheuermann’s
Old- osteoporosis
Focal
Congenital
Acquired
Pathological collapse
Trauma
RCR 2012: SPINAL
RADIOGRAPHY 10
KYPHOSIS
Osteoporosis TB Post-traumatic
RCR 2012: SPINAL
RADIOGRAPHY 11
SCOLIOSIS
Lateral curvature of spine in
coronal plane
Cobb angle >100
Side described by convexity
Aetiology (paediatric)
Idiopathic
Osteogenic
Neuromuscular
Syndromic/developmental
Reactive
RCR 2012: SPINAL
RADIOGRAPHY 12
SCOLIOSIS
Osteogenic
Look for vertebral
anomalies
Failure of fusion
Failure of
segmentation
Complex
Hemivertebra Bony bar
RCR 2012: SPINAL
RADIOGRAPHY 13
SCOLIOSIS
Degenerative
Lumbar
Commonly
associated with
lateral vertebral
subluxation at
apex of curve
RCR 2012: SPINAL
RADIOGRAPHY 14
AXIAL MALALIGNMENT
LATERAL
TRANSLATION
Uncommon
Degenerative
spondylolisthesis
Traumatic
RCR 2012: SPINAL
RADIOGRAPHY 15
AXIAL MALALIGNMENT
ROTATION
Idiopathic scoliosis
Traumatic
Unilateral facet
dislocation
RCR 2012: SPINAL
RADIOGRAPHY 16
VERTEBRAL MORPHOLOGY
Vertebral collapse
Flattened vertebrae (platyspondyly)
Vertebra plana
Vertebral enlargement
Abnormalities of shape Bullet -Hurlers/Morquio’s/achondroplasia
Tower -SSD
Reduced AP dimension -JRA
RCR 2012: SPINAL
RADIOGRAPHY 17
VERTEBRAL COLLAPSE
OP collapse
Trauma
WC fracture
Burst fracture
Look at PVBL
Wedge fracture Burst fracture
RCR 2012: SPINAL
RADIOGRAPHY 18
VERTEBRAL COLLAPSE
Pathological
Tumour
Infection
Myeloma TB
RCR 2012: SPINAL
RADIOGRAPHY 19
VERTEBRA PLANA
Severe vertebral
body collapse
LCH
RCR 2012: SPINAL
RADIOGRAPHY 20
PLATYSPONDYLY
Multilevel
flattening of the
vertebral bodies
Many causes
Idiopathic
osteoporosis
RCR 2012: SPINAL
RADIOGRAPHY 21
VERTEBRAL ENLARGEMENT
Paget’s disease
Associated
Involvement of neural
arch
Medullary sclerosis
Trabecular thickening
RCR 2012: SPINAL
RADIOGRAPHY 22
BONE DENSITY
Reduced
Osteopenia
Increased
Sclerosis
Either can be focal or diffuse
RCR 2012: SPINAL
RADIOGRAPHY 23
FOCAL OSTEOPENIA
Any cause of focal
vertebral body
destruction
Tumour
Infection
ABC Early osteomyelitis
RCR 2012: SPINAL
RADIOGRAPHY 24
DIFFUSE OSTEOPENIA
Osteoporosis
Metabolic bone
diseases
Neoplastic
Myeloma
Acute leukaemia
Picture frame Vertical striations
RCR 2012: SPINAL
RADIOGRAPHY 25
FOCAL SCLEROSIS
Within vertebral body
Tumours Osteoma
Osteoblastic metastasis
Multiple
Osteopoikilosis
Osteoma Prostate metastasis
RCR 2012: SPINAL
RADIOGRAPHY 26
FOCAL SCLEROSIS
Sub-Chondral
Degenerative
DHVS
20 Hyperparathyroidism
Multilevel T + L regions
‘rugger-jersey’ spine
RCR 2012: SPINAL
RADIOGRAPHY 27
DIFFUSE SCLEROSIS
Ivory Vertebra
Paget’s disease
Reactive
OO/OB
Schmorl’s node
Neoplastic
Osteoblastic
metastasis
Lymphoma
OB Ca bronchus met
RCR 2012: SPINAL
RADIOGRAPHY 28
VERTEBRAL END-PLATES
Abnormal morphology
Focal defect
Irregularity
Scheuermann’s
Degenerative disc disease
Erosion
Bi-concave
OP compression fractures
RCR 2012: SPINAL
RADIOGRAPHY 29
FOCAL DEFECTS
Multilevel T/L spine
Normal variant
Degenerative
Schmorl’s nodes
Traumatic
WC or burst fracture
Neoplastic
plasmacytoma
‘Pincer-type’ burst#
RCR 2012: SPINAL
RADIOGRAPHY 30
FOCAL DEFECTS
Anterior limbus lesion
T/L junction
Physically active
adolescents
RCR 2012: SPINAL
RADIOGRAPHY 31
END-PLATE EROSION
Spondylodiscitis
Usually combined
with loss of disc
height
RCR 2012: SPINAL
RADIOGRAPHY 32
VERTEBRAL ENTHESIS
Insertion of Sharpey’s
fibres of disc annulus
into end-plate
Erosion
Ossification
Avulsion
RCR 2012: SPINAL
RADIOGRAPHY 33
VERTEBRAL ENTHESIS
Erosion
Manifestation of
spondyloarthropathy
‘Shiny corner’
Associated with
‘squaring’ of vertebral
body
Ankylosing spondylitis
RCR 2012: SPINAL
RADIOGRAPHY 34
VERTEBRAL ENTHESIS
Ossification of
annulus
Bamboo
Spine
RCR 2012: SPINAL
RADIOGRAPHY 35
VERTEBRAL ENTHESIS
Disc marginal
osteophytes
DDD
DISH
RCR 2012: SPINAL
RADIOGRAPHY 36
VERTEBRAL CORTEX
Displaced
PVBL
Differentiates WC
from burst fracture
Scalloped
Eroded
Wedge fracture Burst fracture
RCR 2012: SPINAL
RADIOGRAPHY 37
SCALLOPED CORTEX
Multilevel
NF
Marfan’s
Single level
Neural tumour
Nerve sheath cyst
RCR 2012: SPINAL
RADIOGRAPHY 38
ERODED CORTEX
Anterior
Pre-vertebral tumour
lymphoma
Pre-vertebral infection
TB
Sub-ligamentous
spread
RCR 2012: SPINAL
RADIOGRAPHY 39
DISC SPACE
Normal
Reduced height
Increased height
OP collapse
Calcified
Thoracic DDD
Vacuum
RCR 2012: SPINAL
RADIOGRAPHY 40
REDUCED DISC HEIGHT
Generalised
End-plate intact
DDD
End-plate eroded
discitis
Vacuum phenomenon
RCR 2012: SPINAL
RADIOGRAPHY 41
REDUCED DISC HEIGHT
Generalised
End-plate intact
LSTV
RCR 2012: SPINAL
RADIOGRAPHY 42
REDUCED DISC HEIGHT
Focal Anterior
Anterior limbus lesion
Do not mistake for
infection
NEURAL ARCH
Pedicle
Lamina
SAP
IAP
Transverse process
Pars interarticularis
Spinous process
Absent
Enlarged
Sclerotic
Interpediculate
distance
Interspinous distance
RCR 2012: SPINAL
RADIOGRAPHY 44
ABSENT PEDICLE
Congenital
Acquired
Tumour
infection
Metastasis TB
RCR 2012: SPINAL
RADIOGRAPHY 45
ENLARGED PEDICLE
Tumour
OB
RCR 2012: SPINAL
RADIOGRAPHY 46
ENLARGED PEDICLE
Trauma
Bony Chance
fracture
Increased height
of pedicle
RCR 2012: SPINAL
RADIOGRAPHY 47
SCLEROTIC PEDICLE
Reactive due to
underlying
Tumour
Pars stress
fracture
L3 OO
Lt L5 stress fracture
RCR 2012: SPINAL
RADIOGRAPHY 48
INTERPEDICULATE DISTANCE
Normal
Increases
distally
Reduced
Congential
canal stenosis
Short pedicles
on lateral
radiograph
RCR 2012: SPINAL
RADIOGRAPHY 49
INTERPEDICULATE DISTANCE
Increased
Burst fracture
RCR 2012: SPINAL
RADIOGRAPHY 50
INTERPSPINOUS DISTANCE
Increased
flexion-
distraction
injuries
RCR 2012: SPINAL
RADIOGRAPHY 51
PARASPINAL SOFT TISSUES
Swelling
Tumour
Infection
Trauma
Calcification
TB
spondyloarthropathy
Gas
Infection
Post-operative
RCR 2012: SPINAL
RADIOGRAPHY 52
CONCLUSIONS
There is potentially a lot in a spinal radiograph
Systematic approach to assessment will reduce
misses
Normal radiography excludes NOTHING!
Recommended