What to do if the spine x-ray shows a ---? – Part 2
- 1. Scoliosis Classification: Idiopathic: 80% Infantile <3; Juvenile 4-10; Adolescent: 10-18 Or: Early onset <5; Late onset >5 Congenital: Osteogenic: hemivertebra, fused vertebra Neurogenic: tethered cord, syringomyelia, Chiari Developmental: Achondroplasia NF OI Neuromuscular: Cerebral palsy Tumour: Osteoid osteoma BPNST
- 2. Xray report- there is a mild thoracic scoliosis convex to the left centered at T10.
- 8. 16 F Fit & well Curve noticed 12 yrs of age Left thoracic and right T/L curve O/E Absent abdominal reflex , Brisk lower limb reflexes,? Up going plantars
- 11. Scheuermann's Disease Thoracic pain Kyphosis of greater than 40 degrees Vertebral end plate abnormality Variable wedging of at least 3 consecutive thoracic vertebra
- 12. 16 yr M Chronic cough No pain CXR report- Scheuermann's disease of the thoracic spine is noted.
- 14. 22 yr M Chronic Thoracic Pain Increasing kyphosis
- 17. Nomenclature of disc herniations and spinal stenosis Consistent Reflect common usage where appropriate Surgically relevant ‘Able to visualize over the phone’ 2 morphological characteristics: Nature of disc pathology Location Able to add further descriptors Neural structures Clinical context www.asnr.org/spine_nomenclature/reporting
- 18. Disc Degeneration Annular Tear/Fissure Disc Bulge Disc Herniation – Protrusion -- Extrusion Disc Sequestration
- 19. Annular tear/ fissure ‘Tear’ and ‘fissure’ interchangeable ‘Tear’ more common usage Does not imply trauma
- 20. Disc bulge Generalised extension of disc tissue beyond intervertebral disc space ‘Generalised’ = >50% circumference (>1800) Relatively short distance, <3mm
- 21. Disc Protrusion Involves less than 180% of the disc The base of the herniation is wider than the height. <180 but >90% - broad based <90% - focal
- 22. DISC PROTRUSION: CT & MRI
- 23. Extruded disc Greatest distance in any plane between edges > base T1
- 25. Sequestered disc Extruded disc material that has no continuity with the disc of origin = free fragment Migrated disc: Disc material displaced away from site of extrusion
- 26. T2 T2 T1
- 27. Image interpretation A few cases
- 28. 68M Sudden onset bilateral leg pain and weakness Urinary retention
- 32. Dx: Cauda equina syndrome Cause: massive sequestration Other causes: Tumour Primary of lower cord: ependymoma Primary of nerve: BPNST Primary of dura: meningioma Primary of vertebral body: chordoma, giant cell tumour Secondary Trauma
- 33. Clinical details: 54M. Left leg pain, paresthesia and weakness.
- 36. MR LUMBAR SPINE Clinical details: 54M. Left leg pain, paresthesia and weakness. Sequences: T1, T2 transverse and sagittal Findings: Conclusion: Multilevel disc degeneration. Spondylolisthesis at L5/S1 with associated degenerative changes. The most significant lesion is a broad based left central disc extrusion at L4/5 compressing the left side of thecal sac displacing the left L5 and S1 nerve roots.
- 37. CT LUMBAR SPINE Clinical Details: 57 M. Episodes of feeling both lower limbs being weak and giving way.
- 39. CT LUMBAR SPINE Clinical Details: 57 M. Episodes of feeling both lower limbs being weak and giving way. Findings: Conclusion: Severe facet joint degeneration and disc degeneration at the L4/5 level resulting in moderately severe central canal stenosis and bilateral subarticular stenosis, more marked on the left.
- 40. CT LUMBAR SPINE Clinical Details: 57M. Moderately severe back pain for one year.
- 43. CT LUMBAR SPINE Clinical Details: 57M. Moderately severe back pain for one year. Findings: Conclusion: Bilateral L5 pars defects and L5/S1 spondylolisthesis with secondary degenerative changes as described.