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