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Diagnostic Imaging I Exam Two > Degenerative Disc Disease > Flashcards

Degenerative Disc Disease Flashcards

1
Q

What is the most common location of DDD in the cervical and lumbar spine?

A 
Cervical = C5/C6
Lumbar = L4/L5
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2
Q

What is the clinical term for DDD that affects the outer disc? Inner disc?

A 
Outer = spondylosis deformans
Inner = intervertebral chondrosis
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3
Q

What radiographic feature marks spondylosis deformans (DDD of the outer disc)?

A

Osteophytes

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4
Q

What radiographic feature marks intervertebral chondrosis (DDD of the inner disc)?

A

Reduced IVD space

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5
Q

Knutson’s vacuum phenomenon is associated with what condition?

A

IVD ostechondrosis

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6
Q

What is IVD osteochondrosis?

A

Primary degeneration of the nucleus pulposus

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7
Q

What is the underlying cause of an osteophyte?

A

Breakdown at site of attachment of outer annular fibers of the disc to the vertebral margin (disc bulging)

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8
Q

What is the vacuum (Knutson’s phenomenon) seen with DDD?

A

Radiolucent collections of nitrogen gas within annular fibers

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9
Q

Where is the vacuum phenomenon best seen?

A

Anterior margin of IVD on extension films

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10
Q

What change to the endplate is seen with DDD?

A

Subchondral sclerosis

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11
Q

What can subchondral endplate sclerosis due to DDD become confused with?

A

Infection or blastic tumor

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12
Q

What are the 4 major radiographic signs of DDD?

A

1 decreased disc height
2 osteophytes
3 end plate sclerosis
4 vacuum

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13
Q

Type One medic end plate changes are more common in what are of the spine?

A

Cervicals

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14
Q

Which type of modic end plate changes is more common in the lumbar spine?

A

Type Two

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15
Q

What color is CSF fluid on T1 MRI? T2?

A 
T1 = black
T2 = white
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16
Q

Which modic end plate change of DDD is associated with sclerosis?

A

Type III

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17
Q

Which modic end plate change of DDD is associated with inflammation?

A

Type I

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18
Q

Which modic end plate change of DDD is associated with fat?

A

Type II

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19
Q

Describe the MRI parameters for each modic end plate type.

A

Type I = dark T1, bright T2
Type II = bright T1, bright T2
Type III = dark T1, dark T2

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20
Q

What is an important differential diagnosis to considered with Modic Type One?

A

Infection (presence of end plate destruction with increased signal intensity of the disc)

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21
Q

What other condition can appear similar to DDD but only present on one side of the disc?

A

Chordoma

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22
Q

What is the easiest way to tell if a compression fracture is acute?

A

Presence of marrow edema

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23
Q

At what age do most pars fractures occur?

A

8-12 years

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24
Q

What is usually the cause of pars fractures from 8-12 years of age?

A

Stress fractures (not injury)

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25
Q

About how long of a time span off away from stressors is necessary to allow for pars fracture healing?

A

6 months

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26
Q

What is becoming the gold standard for imaging pars interarticularis stress fractures?

A

MRI

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27
Q

Posterior joint arthritis is associated with subluxation in which direction?

A

Anterior

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28
Q

Degenerative disc disease is associate with subluxation i which direction?

A

Posterior

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29
Q

What is the most common location for a degenerative spondylolisthesis? Second more common?

A 
#1 = L4/L5
#2 = L5/S1
30
Q

What is the gender bias associated with degenerative spondylolisthesis?

A

Females

31
Q

At what age is a degenerative spondylolisthesis most likely?

A

Over 40

32
Q

What is the most common location for DDD of the cervical spine? Second most common?

A 
#1 = C5/C6
#2 = C4/C5
33
Q

Which Roentgenometric is seen at the levels where DDD is more common in the cervical spine?

A

Ruth Jackson stress lines

34
Q

What is the term for the chucks of bone formed in the outer annular fibers that are seen with DDD of the cervical spine?

A

Intercalary ossicles

35
Q

What radiographic sign appears on a lateral view when uncinate hypertrophy due to degeneration of the cervical spine?

A

Pseudo fracture through vertebral body due to lateral projection

36
Q

What is the most common location for a pseudofracture sign to appear due to uncinate hypertrophy following DDD of the cervical spine?

A

C3-C7 (mid to lower cervicals)

37
Q

What is the major issue with uncinate hypertrophy?

A

May invade IVF and affect nerve roots

38
Q

Why is it possible for and enlarged uncinate to invade the IVF but not affect the nerve root?

A

Nerve exits from only superior aspect

39
Q

Degeneration of the zygapophyseal joints is most common in what areas of the spine?

A

Lower lumbar, middle cervical, and upper and middle thoracic spine

40
Q

What is the cause of an intercalary ossicle?

A

Annulus degeneration (NOT fracture osteophytes)

41
Q

What condition could an intercalary ossicle get confused with?

A

Limbus vertebra

42
Q

What is the criteria for Scheuermann’s disease?

A

Decreased disc space and endplate irregularities at at least 3 contiguous vertebrae each with wedging of 5 degrees or more

43
Q

What is the age of onset for Scheuermann’s disease?

A

13-17

44
Q

Why is Scheuermann’s disease an issue?

A

Can lead to premature DDD, pain, cosmetic deformity

45
Q

What is another name for Scheuermann’s disease?

A

Juvenile Discogenic Disease, Thoraco-lumbar Scheuermann’s disease

46
Q

How frequent is Scheuermann’s disease?

A

Up to 20-40% of those presenting to MRI with back pain will have it

47
Q

What causes Scheuermann’s disease?

A

Failure of embryologic vascular channels, centrum defects, notochord clefts to disappear leaving the endplate defects

48
Q

What kind of change to the curvature of the thoracic spine is seen with Scheuermann’s disease?

A

Hyperkyphosis

49
Q

In what population do Schmorl’s nodes usually occur?

A

Young children (insignificant)

50
Q

When can the occurrence of Schmorl’s nodes become worrisome?

A

In adults indicating endplate fractures

51
Q

Where in the thoracic spine do osteophytes usually form?

A

Mostly anterior and right sided

52
Q

In what area of the spine do the disc rarely calcify?

A

Thoracics

53
Q

What is the term for very dense nucleus pulposus calcification?

A

Ochronosis

54
Q

What part of the disc calcifies with CPPD, hypervitaminosis D, or hemochromatosis?

A

Annulus fibrosis

55
Q

Transient intervertebral disc calcification that usually spontaneously regresses is common with what population and at what spinal area?

A

Children in the cervical spine

56
Q

What is the most severe way in which pain is felt from degeneration?

A

Direct press on subchondral bone

57
Q

What is the eponym for DISH?

A

Forestier’s disease

58
Q

What ligament is primarily involved with Diffuse Idiopathic Skeletal Hyperostosis?

A

Anterior longitudinal ligament (ALL)

59
Q

What is the age and gender bias for DISH?

A

Males over 50

60
Q

What underlying metabolic condition is associated with the presence of DISH?

A

Diabetes (13-49%)

61
Q

What GI issue is associated with DISH?

A

Dysphagia (20%)

62
Q

How common is OPLL with DISH patients?

A

40%

63
Q

Where in the spine is DISH most commonly seen?

A

Middle/lower thoracics, upper lumbars, and lower cervicals

64
Q

What is an enthesopathy?

A

Pathological osseous proliferation at tendon ligament insertion

65
Q

The absence of what radiographic feature when viewing DISH rules out the diagnosis of ankylosing spondylitis (AS)?

A

Bilateral sacroilitis (also preservation of disc height)

66
Q

The “flowing candle wax appearance” is seen with what condition?

A

DISH

67
Q

What is unique about the discs involved with DISH?

A

Height is preserved (minimal evidence of degeneration)

68
Q

Which ALL ossification is thicker: that in AS or DISH?

A

DISH (AS presents as thin line)

69
Q

Why is OPLL more severe than DISH?

A

Can put pressure onto cord inducing neurological symptoms (myelopathy)

70
Q

What kinds of cord symptoms can be present with severe OPLL?

A

Anterior cord syndrome: sensory/motor disturbances of the legs, difficulty walking, paresthesia and diminished tactile senses

71
Q

What is a common treatment for OPLL?

A

Laminectomy (to decrease pressure and create more room for cord)

Diagnostic Imaging I Exam Two (7 decks)

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