Pseudotrauma of the spine; the osseous variants

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Information about Pseudotrauma of the spine; the osseous variants
Health & Medicine

Published on January 11, 2014

Author: fernferretie

Source: slideshare.net

Description

The imaging of pseudotrauma of the spine; the osseous variants

I n t e g r a t i ve I ma g i n g • R e v i ew Imaging of Trauma: Pseudotrauma of the spine OSSEOUS VARIANTS THAT MAY SIMULATE INJURY AJR 2012; 199:1200–1206 Robert B. Carr, Kathleen R. Tozer Fink, Joel A. Gross Department of Radiology, University of Washington, Harborview Medical Center, Seattle, WA. Reviewed by Thorsang Chayovan

OBJECTIVE Anatomic variants Incomplete ossification/fusion Erroneous diagnosis Common imaging findings that may present as pseudotrauma—focus on CT.

Outline • Injuries to the spinal column • Normal development of the spine • Variants—the pseudotrauma – C1 – C2 – C3 – L5 – Miscellaneous; motion artifact • Summary

Injuries to the spinal column • Common in blunt trauma • Up to 15% of blunt trauma patients have a TL-spine fracture • Initial evaluation: radiography and CT • Errorneous diagnosis => Anatomic variants => Incomplete development

Normal Development C1-2 Lower Vertebrae

Normal Development C1-2 Lower Vertebrae Unique pattern of ossification

Normal ossification of atlas 3 Primary ossification centers

Normal ossification of axis 5 Primary ossification centers

Normal ossification of axis Secondary ossification center: os terminale

C3-L5 3 Primary ossification centers

C1 VARIANTS C2 C3-L5 Miscellaneous

ATLAS C1

Atlas C1 Incomplete fusion

Atlas C1 Cleft Fracture

Atlas C1 Anterior midline cleft

Atlas C1 Ossified posterior atlantooccipital membrane “Arcuate foramen”

Atlas C1 Partially ossified posterior atlantooccipital membrane

AXIS C2

Axis C2 Incomplete fusion

Ossific density at cranial aspect of odontoid process Os terminale Os odontoideum Odontoid fracture

Axis C2 Os terminale Persistent os terminale

Axis C2 Os odontoideum Odontoid fracture

Axis C2 Pseudosubluxation of C-spine in children

Axis C2 Pseudosubluxation of C-spine in children

C3 – L5

C3 Anterior wedging

C3 – L5 Cleft in transverse foramen

C3 – L5 Fracture VS Secondary ossification center

C3 – L5 Fracture VS Secondary ossification center

C3 – L5 Disc herniation between ring apophysis and vertebra => Limbus vertebra >> Common in L-spine

Schmorl node

C3 – L5 Clefts

C3 – L5 Clefts

MISCELLANEOUS CONDITION

Motion artifacts

Summary Atlas C1 • Incomplete fusion – Symmetric, non-displaced • Partially ossified post. Atlantooccipital mb. Axis C2 • Incomplete fusion – Linear sclerotic line with surrounding lucency • Persistent os terminale • Os odontoideum • Ant. Pseudosubluxation of C2-3 in children

Summary C3 – L5 • Ant. Wedging of C-vertebrae in children • Clefts in transverse foramen • Incomplete fusion • Limbus vertebrae—L-spine • Schmorl node • Clefts – – – – Spinous process Pars interarticularis Pedicle Lamina Miscellaneous • Motion artifact

Conclusion Recognition of the normal developing spine and variants can prevent an incorrect diagnosis of injury and inappropriate treatment. THANK YOU

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