Radiography of the Spine
2010.09.10.
Radiography of the Spine • Complex anatomy • Vertebrae: 7 cervical, 13 thoracal, 7 lumbal, 3 sacral, n caudal • Thorough neurological examination localization !!! • Restraining tools – Anesthesia • High quality equipment (screen/film/grid)
Radiography of the Spine Attila ARANY-TóTH, DVM
The effect of positioning
Radiography of the Spine PLAIN: • Standard positions: – laterolateral – ventrodorsal
• Other projections: – oblique – stress (flex., ext.)
Radiographic Anatomy
Radiographic Anatomy
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3 4 9 7 10
1 8
Attila Arany-Toth
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Radiography of the Spine
2010.09.10.
Radiographic evaluation of the Vertebral Column
Radiographic Anatomy LL
VD 1. Endplate 2. Transverse proc. 3. Cran. articular proc. 4. Caud. articular proc. 5. Spinous proc. 6. Endplate 7. Spinal canal 8. Vertebral body 9. Intervertebral foramen 10.Intervertebral space
1. Entire vertebral column - deformities - traumatic injuries (fract., lux.)
2. Vertebrae - shape - density - number - articular proc. 5
3. Intervertebral space
3 9 10
- width - change in density
4 7
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Diagnosis: in conjunction with clinical signs!!!
Anatomy
Radiography of the Spine 1. Survey radiograph 2. Contrast studies: • Myelography • Epidurography • (Discography)
Faji különbségek: kutya-macska
Radiography of the Spine 1. Survey radiograph 2. Contrast studies: • Myelography
Myelography • Contrast study of the subarachnoid space • Aim: to reveal compressive processes in the spinal canal vetrebra
• Epidurography • (Discography)
Attila Arany-Toth
Epidural space Spinal cord
dura mater arachnoid Subarachnoid space
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Radiography of the Spine
Myelography • Contrast study of the subarachnoid space • Aim: to reveal compressive processes in the vertebral canal vertebra
2010.09.10.
Myelography • Technique No. 1. „Cysternal Myelography” – general anesthesia – occipital puncture (spatium atlanto-occipitale) – contrast: nonionic, water soluble iodine :Omnipaque (iohexol), Iopamiro (iopamidol) etc. – dose: 0,3 ml/kg (cervical laesion), 0,5 ml/kg (thoracolumbar lesion)
Spinal cord
Myelography
Myelography • Technique No. 2.
Myelography
„Lumbar Myelography” – lumbar puncture (L4-5, L5-6) – in case of unsuccessful cisternal puncture (technical problems, swollen spinal cord (oedema, haematoma) – sometimes the first method of choice
• invasive methode • possible complications: – convulsive seizures – herniation of the cerebellum – medullar puncture: apnoea, exitus
• cisternal puncture: enables CSF examination
Attila Arany-Toth
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Radiography of the Spine
2010.09.10.
Radiography of the Vertebral Column
Epidurography • • • •
CONTRAST STUDIES: • Myelography
Contrast study of the epidural space Puncture: sacro-coccygeal junction or C1-2 Indication: lumbosacral compression Disadvantage: epidural fat→irregular filling
• Epidurography • Discography
Radiography of the Vertebral Column
Compressions in the spinal canal
CONTRAST STUDIES: • Myelography • Epidurography • Discography
Compressions in the spinal canal
L
Compressions in the spinal canal
R Golf-tee sign
Attila Arany-Toth
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Radiography of the Spine
2010.09.10.
Compressions in the spinal canal
Abnormalities Developmental anomalies 1. Spina bifida (spinal cleft 2. Block vertebrae
Abnormalities Developmental anomalies 1. Spina bifida (spinal cleft) 2. Block vertebrae 3. Hemivertebrae („wedge-vertebrae”) „butterfly-shape”
•usually not significant •possible higher risk of disc protrusion • „surely congenital?”
Abnormalities Developmental anomalies 1. Spina bifida (spinal cleft) 2. Block vertebrae sacralization 3. Hemivertebrae („wedge-vertebrae”) 4. Transient vertebrae
•incomplete ossification •bulldogs • sometimes compression
lumbalization
(thoracoization, cervicalization)
Abnormalities 4. Transient vertebra
Abnormalities 4. Transient vertebra
lumbalisation 11
lumbalisation
thoracoization
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Attila Arany-Toth
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Radiography of the Spine
2010.09.10.
Abnormalities Formal deviations of the vertebral column
Abnormalities Degenerative disease of the intervertebral disc 1. Types „Hansen I.”: - chondrodystrophic breeds - nucl. pulp.: calcification - anulus fibr.: rupture - „extrusion” - rapid deterioration
1. Lateral: Scoliosis 2. Dorsal: Kyphosis 3. Ventral: Lordosis Causes: - developmental - metabolic - spasm, pain
Abnormalities
Abnormalities
Degenerative disease of the intervertebral disc
Degenerative disease of the intervertebral disc
1. Types „Hansen II.”: - other (large) breeds - nucl. pulp.: fibrotisation - anulus fibr.: intact - „protrusion” - chronic process
2. Consequences: spinal cord compression, pain, loss of neural function 3. Localisation: - cervical→four limb symptoms - thoracolumbar→ hind limb symptoms
Degenerative disease of the intervertebral disc 1. Clinical examination, neurological localisation
Determines the region
2. Radiology
Determines the exact site
Attila Arany-Toth
Abnormalities Degenerative disease of the intervertebral disc 4. Radiographic signs: - calcified disc is not pathognostic
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Radiography of the Spine
2010.09.10.
Abnormalities
Abnormalities
Degenerative disease of the intervertebral disc
Degenerative disease of the intervertebral disc
4. Radiographic signs: - calcified disc is not pathognomistic - narrowed intervertebral space (!) (phys: C2-3, C7-Th1,Th1011)
4. Radiographic signs: - calcified disc is not pathognomistic - narrowed intervertebral space (!) (phys: C2-3, C7-Th1,Th10-11) - calcified disc in the canal (deformed„horse-head”)
Abnormalities
Abnormalities
Degenerative disease of the intervertebral disc
Cervical Spondylopathy - Wobbler Syndrome
4. Radiographic signs: - calcified disc is not pathognomistic - narrowed intervertebral space (!) (phys: C2-3, C7-Th1,Th10-11) - calcified didc in the canal - myelography: „extradural compression”
• Deformity, instability of cervical vertebrae (C4-7), malarticulation, narrowed spinal canal spinal cord compression
ataxia, paresis Predisposition: dobermann
Abnormalities
Abnormalities
Cervical Spondylopathy - Wobbler Syndrome
Cervical Spondylopathy - Wobbler Syndrome
• Types of the compression:
• Radiography: – survey:
dynamic: worsening by extension of the neck (lig. flavum hypertrophy) static: the same degree in every position (deformed vertabrae)
Attila Arany-Toth
• deformed, wedge-shaped vertebra • narrowed intervertebral space
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Radiography of the Spine
2010.09.10.
Abnormalities
Abnormalities
Cervical Spondylopathy - Wobbler Syndrome
Cervical Spondylopathy - Wobbler Syndrome
•
•
Radiography: – myelography: compression of the spinal cord due to
Radiography: – myelography: compression of the spinal cord due to
1. deformed vertebra 2. disc protrusion
1. deformed vertebra 2. disc protrusion 3. hypertrophy of lig. flavum (multiple location !!,extended wiev)
Abnormalities
Abnormalities
Lumbosacral Stenosis Cauda Equina Compression Syndrome
Lumbosacral Stenosis Cauda Equina Compression Syndrome
• Lumbosacral instability -stenosis • German shepherd, large breeds • Hindlimb weakness, painful palpation of LS region
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Plain radiographic signs: 1. 2.
collapsed LS intervertebral space sclerotic endplates
3. 4.
LS spondylosis deformans LS subluxation
1 2 3
normal
Abnormalities
Abnormalities
Lumbosacral Stenosis Cauda Equina Compression Syndrome
Lumbosacral Stenosis Cauda Equina Compression Syndrome
• Myelography: – sometimes not informative (too short dural sack)
• Myelography: – sometimes not informative (too short dural sack) – stress projections (flex., extended ext.)
flexed
Attila Arany-Toth
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Radiography of the Spine
2010.09.10.
Abnormalities
Abnormalities Lumbosacral Stenosis Cauda Equina Compression Syndrome Epidurography
Spondylosis (Deformans) • Osteophyte formation on the vertebral body • It may fuse („bamboo spine”→boxers!!) • Generally no clinical relevance !!!
Abnormalities
Abnormalities
Spondylarthritis
Discospondylitis
• Inflammation of the intervertebral joints • May cause pain without neurological signs • Radiologic sign: DJD signs in the small joint
• • • •
Septic inflammation of the intervertebral disc Pyrexia, painful palpation of the affected area Neurological deficiencies Radiology: osteolytic end plates rounded by sclerotic zone
Abnormalities
Abnormalities
Discospondylitis
Neoplasia of the Vertebrae • Primary (osteosarcoma, chondrosarcoma) or metastatic • Osteolytic - osteogenetic signs • Ventral aspect of vertebral body, spinous proc. (end plates are usually not affected)
Attila Arany-Toth
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Radiography of the Spine
2010.09.10.
Abnormalities
Abnormalities
Neoplasia of the Spinal Cord
Traumatic injuries of the Vertebral Column
• Painful spine, neurological deficiencies
1. Vertebral luxation / subluxation (30%!)
• Survey radiograph is usually negative • Myelography: intramedullary lesion
Abnormalities Traumatic injuries of the Vertebral Column 1. Vertebral luxation / subluxation (30%!) 2. Fractures
Attila Arany-Toth
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