2.1. Spinal conditions: indications ... - Home



Advanced Musculoskeletal Physiotherapy Self-directed Learning Modules: Screening /Soft Tissue Review Clinic 2014Module 2: Spinal ImagingPrepared by Melbourne Health and Alfred Health on behalf of the Victorian Department of Health 2014Module 2: Spinal ImagingContents TOC \o "1-3" \h \z \u 2.1. Spinal conditions: indications for Spinal ImagingLEARNING OBJECTIVES:To identify indications for different spinal imaging modalitiesTo identify pathology on different imaging modalities and how that may relate to patient symptomology.ASSUMED KNOWLEDGE:Appropriate knowledge of radiation protection in regards to medical imagingAppropriate knowledge of spinal pathology and their symptomologyAppropriate knowledge on the assessment and management of spinal pathologiesKNOWLEDGE:What are the indications for an urgent spinal imaging? 1, 2, 3, 4, 5, 6, 7, 8What classifies as an unstable fracture of the spine? 2, 3, 4, 5What are the indications for spinal CT? 3, 4, 5, 8What is the grading for a spondylosis and Meyerding grading for spondylolisthesis? 7, 9, 10What is meant by ‘vacuum phenomenon’ on x-ray and CT of the spine? 11What are the indications for spinal MRI? 6, 8, 12, 13, 14, 15When would you use additional STIR or added contract to sequences? 6, 8, 16What is meant by the terms disc bulge, protrusion, extrusion and sequestration? 6, 7, 8, 17, 18, 19What is the difference between a focal, broad-based and circumferential disc herniation? 6, 7, 8, 17, 18, 19What is the Pfirrmann classification for nerve root compression? 20What are the grades for spinal stenosis? 8, 18, 23What are the grades of ‘modic changes’? What is their relationship to symptoms? 8, 21What is meant by the term ‘high intensity zone’ within the disc on MRI? What is their relationship to symptoms? 8, 22What are Baastrup and Bertolotti syndromes? 8What is meant by the term ‘schmorls nodes’ in the spine? What is their relationship to symptoms? 33What is meant by the term ‘haemangioma’ and ‘osteiod osteomas’ in the spine? 8, 26What is meant by the terms ‘syrinx’ and ‘tranverse myelitis’? 23, 24, 25What are the indications for bone scan in spinal patients? 8, 26, 27What are the indications for SPECT/CT of the spine? 8, 26, 28What is the incidence of spinal ‘abnormalities’ in asymptomatic populations? 8, 29-39What is the relationship between disc morphology on MRI and symptoms? 40-42What is the correlation between spinal cord signal changes and symptoms in cervical myelopathy? 43, 44What is the Modified Dallas Classification? 45RECOMMENDED RESOURCESStreitwieser D, et al (1983) Accuracy of standard radiographic views in detecting cervical spine fractures. Annuals of Emergency Medicine; 12:538-542, A and Hockberger, R (2014) Spinal column injuries in adults: definitions, mechanisms and radiographs. UpToDate, A and Hockberger, R (2014) Evaluation of thoracic and lumbar spinal column injury. UpToDate, G and Gummerson, N (2014) Thoracolumbar spinal fractures: review of anatomy, biomechanics, classification and treatment. Orthoapedics and Trauma; 28(2): 70-78, A and Hockberger, R (2014) Evaluation and acute management of cervical spinal column injuries in adults. UpToDate, B and Jarvik, J (2010) Lumbar spine MRI for low back pain: indications and yield. America Journal of Roentgenology; 195: 550-559., T et al (2014) A review of the value of MRI signs in low back pain. Diagnostic and Interventional Imaging [InPress] , T (2010) Imaging the back pain patient. Physical medicine and rehabilitation Clinics of North America; 21: 725-766, J et al (2013) Spondylosis and Spondylolisthesis. Orthopaedics and Trauma; 27(4): 195-200, P et al (2012) Spondylolysis and isthmic spondylolisthesis: impact of vertebral hypoplasia on the use of the Meyerding classification. The British Journal of Radiology; 8: 358–362, B (2004) The Spectrum of vacuum phenomenon and gas in spine. JBR–BTR, 2004, 87: 9-16, J et al (2005) Lumbar MRI part 1: normal imaging appearance of the lumbar spine. Clinical Chiropractic; 8:205-215(05)00078-7/abstractGrenier, J et al (2006) Lumbar MRI part 2: common pathological conditions. Clinical Chiropractic; 9:39-47(05)00108-2/abstractVideman, T et al (2003) Associations between back pain history and lumbar MRI findings. Spine; 28(6): 582-88., T et al (2011) Appropriate use of diagnostic imaging in low back pain: a reminder that unnecessary imaging may do as much harm as good. Journal of Orthopaedic and Sports Physical Therapy; 41(11); 838-46, D and Stark, P (2013) Principles of magnetic resonance imaging. UpToDate., P (2000). Classification, Diagnostic Imaging and Imaging Charactersization of a Lumbar Herniated Disk. Radiologic Clinics of North America; 38(6): 1-35 Fardon, D et al (2014) Lumbar disc nomenclature: version 2. The Spine Journal; Article InPress DOI: 10.1016/j.spinee.2014.04.022 Pfirrmann, C et al (2001) Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine; 26(17): 1873–1878, C et al (2004) MR image-based grading of nerve root compromise due to disk herniation: reliability study with surgical correlation. Radiology; 230:583–588 , Y et al (2008) Modic changes: a systemic review of the literature. European Spine Journal; 17:1289-1299., I et al (2014) The lumbar high-intensity zone: 20 years on. Clinical Radiology; 69:551-58, Y et al (2011) New MRI grading system for cervical spine stenosis. American Journal of Roentgenology; 197: 134-140. , W et al (2014) Spinal cord tumours. UpToDate., A (2014) Disorder affecting the spinal cord. UpToDate., H and Hoffe, S (2014) Overview of epidemiology, clinical presentation, diagnosis and management of adult patients with bone metastasis. UpToDate., M (2014) Approach to imaging modalities in the setting of suspected osteomyelitis. UpToDate., V et al (2013) 99mTc-MDP SPECT/CT of the spine and sacrum at a multispecialty institution: clinical use, findings and impact on patient management. Nuclear Medicine Communications;34(11):1097-106 , S et al (1984) A study of computer-assisted tomography. The incidence of positive CAT scans in an asymptomatic group of patients. Spine; 9(6):549-51., M et al (1998) MRI of cervical intervertebral discs in symptomatic subjects. Journal of Bone and Joint Surgery [Br]; 80-B:19-24, M et al (2010) Age-related changes of thoracic and cervical intervertebral disc in asymptomatic subjects. Spine; 25(14): 1359-1364, S et al (2002) MRI changes of cervical spine in asymptomatic and symptomatic young adults. European Spine Journal; 11: 358-363., K et al (2009) Prevalence and pattern of lumbar magnetic resonance imaging changes in a population study of one thousand forty-three individuals. Spine; 34(9): 934-940., M et al (1994) Magnetic resonance imaging of the lumbar spine in people without back pain. New England Journal of Medicine; 331(2): 69-73, S et al (1990) Abnormal magnetic resonance scans of the lumbar spine in asymptomatic subjects: a prospective investigation. Journal of Bone and Joint Surgery [Am]; 72A: 403-408, D et al (1998) MRI of the lumbar spine: prevalence of intervertebral disc extrusion and sequestration, nerve root compression and plate abnormalities, and osteoarthritis of the facet joints in asymptomatic volunteers. Radiology; 209: 661-666, D et al (2001) The value of magnetic resonance imaging of the lumbar spine to predict low-back pain in asymptomatic subjects: a seven year follow-up study. Journal of Bone and Joint Surgery [Am]; 83-A(9): 1306-11., J et al (2009) Prevalence of degenerative imaging findings in lumbar magnetic resonance imaging among young adults. Spine; 34(16): 1716-21, E et al (2007) Disc degeneration in low back pain: a 17-year follow-up study using magnetic resonance imaging. Spine; 32(6): 681-684, R et al (1995) Magnetic resonance imaging findings 10 years after treatment for lumbar disc herniation. Spine; 20(6): 710-714, T et al (2005) Natural history of patients with lumbar disc herniation observed by magnetic resonance imaging for minimum 7 years. Journal of Spinal Disorders and Techniques; 18(2):121-126., T et al (2006) Natural course of disc morphology in patients with sciatica: an MRI study using a standardized qualitative classification system. Spine; 31(14): 160-1612, J et al (2010) Cervical myelopathy: a clinical and radiologic evaluation and correlation to spondylotic myelopathy. Spine; 35(6): 620-624, J et al (2009) Prevalence of physical signs in cervical myelopathy. Spine; 34(9):890-895, W (2005) Provocative discography: current status. Biomedical Imaging and Intervention Journal; 1(1): e2 ................
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