Transcript The Roasting of D. r. Kessler

UNC MSK Course Day 4 Lab XR
UNKNOWNS
(for self study)
Anatomy?
Anatomy?
Odontoid
Pedicle
Vertebral body
Facet joint
Lateral mass
Spinous process
Name of view?
What passes
through this
opening?
Name of view?
Oblique view of
cervical spine.
What passes
through this
opening?
Right C5 nerve
root
Name of View?
Anatomy?
Name of View?
Open mouth
view
Anatomy?
Lateral mass
of C1
Odontoid
C1-2 facet jt.
Anatomy?
Anatomy?
Odontoid
Lateral
mass of C1
Anatomy?
Anatomy?
Vertebral body
Pedicle
Lamina
Spinous
process
Pathology?
Pathology?
Osteoarthritis
C-Spine
Healthy disc
Note
osteophytes
and disc space
narrowing
Name of view?
Name of view?
“Swimmer’s view”
One arm is up to
allow xray
penetration of the
junction of the
lower C-spine and
upper T-spine
Humerus
Pathology?
Pathology?
Osteoarthritis
again.
Vertebral body
osteophytes
are
encroaching
on the spinal
canal
Normal canal has
more room for cord
Pathology?
Osteoarthritis
again.
Vertebral body
osteophytes
are
encroaching
on the spinal
canal
and on the
foramen for
the nerve root
Pathology?
Note wide space between
odontoid and lateral mass
Pathology?
Fracture of C1 with
extrusion of lateral
masses laterally
Note lateral mass
of C1 overhanging
lateral mass of C2
Note wide space between
odontoid and lateral mass
Coronal plane CT
Fracture of C1 with
extrusion of lateral
masses laterally
Note lateral mass
of C1 overhanging
lateral mass of C2
Pathology?
Fracture of C1 with
extrusion of lateral
masses laterally
Fracture of ring of C1
which allows the
lateral masses to
slide laterally (there
are other fractures in
the ring but only one
is visible on this CT
slice).
Pathology?
Pathology?
C4-5 anterior
subluxation
Note: Wide gap in
C4-5 posterior
elements, break in
smooth alignment
of anterior and
posterior surfaces
of vertebral bodies
Pathology?
C4-5 anterior
subluxation
Note: Wide gap in
C4-5 posterior
elements, break in
smooth alignment
of anterior and
posterior surfaces
of vertebral bodies
C4-5
interspinous
ligament must
be torn to
produce this
large gap
Pathology?
C4-5 anterior
subluxation
Note: Facet
subluxation
Normal facet
alignment
Pathology?
Pathology?
Osteoporosis
Note preservation
of cortical bone
with loss of
internal
cancellous bone
from vertebrae.
C5 & C6 have
spinous process
fractures
Pathology?
Osteoporosis
Note preservation
of cortical bone
with loss of internal
cancellous bone
from vertebrae.
C5 & C6 have
spinous process
fractures
Anatomy?
Anatomy?
T-Spine
Pedicles
(end on)
Spinous
process
Anatomy?
Anatomy?
T-Spine
Pedicles
Spinous
process
Vertebral
body
Pathology?
Pathology?
Scoliosis
Anatomy?
Do you see the
owl?
Anatomy?
Do you see the
owl?
Anatomy?
Do you see the owl?
Eyes = pedicles
Beak = spinous process
Ear tufts = transverse
processes
Cheeks = lamina
Anatomy?
Do you see the owl?
Eyes = pedicles
Beak = spinous process
Ear tufts = transverse
processes
Cheeks = lamina
Anatomy?
Anatomy?
Vertebral body
Pedicle
Pars Intraarticularis
Spinous process
Anatomy?
Anatomy?
Vertebral body
Pedicle
Facet joint
Transverse
process
Lamina
Spinous
process
Abnormality?
Abnormality?
Lumbosacral
transitional vertebra
(on R it is like a
sacral vertebra
while on L it has a
transverse process
like a lumbar
vertebra).
The patient also has a
fracture of the iliac wing.
Anatomy?
Aorta
Anatomy?
Vertebral body
Psoas
Nerve root
Dural Sac
Facet joint
Pathology?
Pathology?
Herniated
Nucleus
Pulposus
(HNP)
impinging on
nerve root
Pathology?
More sick
discs
Pathology?
Degenerated
(black) disk,
herniating
posteriorly
against nerve
root.
Healthy discs
Note the L5 nerve root passing
around the L4-5 disc and
preparing to leave under the L5
pedicle (above the L5-S1 disc)
and the S1 nerve root passing
around the L5-S1 disc and
preparing to leave under the L5
pedicle. Thus the L5 nerve root,
which exits between the L5 and
S1 vertebrae is not pinched by an
L5-S1 HNP (as you might expect),
rather the S1 nerve root is
pinched at that level.
Note the L5 nerve root passing
around the L4-5 disc and
preparing to leave under the L5
pedicle (above the L5-S1 disc)
and the S1 nerve root passing
around the L5-S1 disc and
preparing to leave under the L5
pedicle. Thus the L5 nerve root,
which exits between the L5 and
S1 vertebrae is not pinched by an
L5-S1 HNP (as you might expect),
rather the S1 nerve root is
pinched at that level.
Pathology?
Pathology?
Spondylolisthesis
or “slip” of L5 on
S1
Posterior
edges of
L5 and S1
Pathology?
Spondylolisthesis
Note break in “pars
intraarticularis of L5
Normal pars
at L4
Foggy Carolina Fall morning