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CT bone density
- 1. loss of density
- 2. osteophytes
- 3. reactive sclerosis (certain CAs)
- 4. appearance of trabeculae – thin, coarsened, smudged
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CT Cartilage
- Joint space
- Subchondral bone (osteophytes)
- Epiphyseal plate fx
-
Bone scan advantages and disadvantages
- High sensitivity, low specificity
- Poor anatomy
- Radiation
-
Advantages of US
- 1. low cost
- 2. portable
- 3. can image w hardware
- 4. can do w/ dynamic movement
- 5. can compare sides
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Disadvantages of US
- 1. Operator dependent
- 2. Bad of obese pts
- 3. *** cannot cross bone (cant see in SC)
- 4. time consuming
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Radiograph cartilage
Loss of disc space
-
Radiograph soft tissue
- Lung cancer
- Paravertebral fort tissue widening
- Retropharyngeal soft tissue
-
Spinal 5 step check list
- 1. count the vertebrae
- 2. alignment: 4 lateral lines
- 3. irregularity of vertebral body (schmorl node, fx, OP, osteophyte)
- 4. is the disc space maintained? Usual tissue densities?
- 5. examine the parts of the vertebrae
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examine the parts of the vertebrae
- 1. vertebral body
- 2. pedicle and laminate
- 3. pars interarticularis
- 4. superior/inferior facets
- 5. DJD
- 6. SP, TP
- 7. intervertebral disc space/foramen
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High risk factors that mandates a radiograph
- 1. age >= 65
- 2. Dangerous mechanism
- ----fall down stair
- ----axial loading
- ----high speed auto accident
- ----RV
- ----bike collision
- 3. Paraesthesia C/S stenosis
- ----compress SC
- ----B/B changes
- ---- weakness, tingling in legs
-
Low risk factors for radiograph
- 1. simple rear end MVA (whiplash)
- 2. sitting position in ED
- 3. ambulatory at any time
- 4. delayed onset of neck pain
- 5. absence of midline C/S tenderness
-
Odontoid fx
- Due to violent upper C/S flexion
- Possible breach of transverse or alar ligaments
- May demonstrate torticollis, hoarseness, c2 NR
- Odontoid view radiograph
-
Lateral recess stenosis
- Stenosis at beginning of foramen
- LMN symptoms, many have weakness
-
Cervical myelopathy causes
- Spondylitis (arthritis)
- Spondylolisthesis
- Disc lesion
- Tumor
- Congenital
- Hypertrophy of ligamentum flavum or post long lig
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