The Roasting of D. r. Kessler

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UNC MSK Course Day 4 Lab XR UNKNOWNS (for self
study)

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Anatomy?
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Anatomy? Odontoid Pedicle Vertebral body Facet
joint Lateral mass Spinous process
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Name of view? What passes through this opening?
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Name of view? Oblique view of cervical
spine. What passes through this opening? Right C5
nerve root
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Name of View? Anatomy?
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Name of View? Open mouth view Anatomy? Lateral
mass of C1 Odontoid C1-2 facet jt.
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Anatomy?
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Anatomy? Odontoid Lateral mass of C1
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Anatomy?
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Anatomy? Vertebral body Pedicle Lamina Spinous
process
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Pathology?
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Pathology? Osteoarthritis C-Spine Healthy
disc Note osteophytes and disc space narrowing
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Name of view?
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Name of view? Swimmers view One arm is up to
allow xray penetration of the junction of the
lower C-spine and upper T-spine
Humerus
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Pathology?
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Normal canal has more room for cord
Pathology? Osteoarthritis again. Vertebral body
osteophytes are encroaching on the spinal canal
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Pathology? Osteoarthritis again. Vertebral body
osteophytes are encroaching on the spinal canal
and on the foramen for the nerve root
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Pathology?
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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
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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
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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).
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Pathology?
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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
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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
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Pathology? C4-5 anterior subluxation Note Facet
subluxation
Normal facet alignment
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Pathology?
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Pathology? Osteoporosis Note preservation of
cortical bone with loss of internal cancellous
bone from vertebrae. C5 C6 have spinous
process fractures
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Pathology? Osteoporosis Note preservation of
cortical bone with loss of internal cancellous
bone from vertebrae. C5 C6 have spinous
process fractures
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Anatomy?
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Anatomy? T-Spine Pedicles (end on) Spinous process
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Anatomy?
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Anatomy? T-Spine Pedicles Spinous
process Vertebral body
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Pathology?
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Pathology? Scoliosis
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Anatomy? Do you see the owl?
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Anatomy? Do you see the owl?
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Anatomy? Do you see the owl? Eyes pedicles Beak
spinous process Ear tufts transverse
processes Cheeks lamina
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Anatomy? Do you see the owl? Eyes pedicles Beak
spinous process Ear tufts transverse
processes Cheeks lamina
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Anatomy?
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Anatomy? Vertebral body Pedicle Pars
Intraarticularis Spinous process
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Anatomy?
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Anatomy? Vertebral body Pedicle Facet
joint Transverse process
Lamina Spinous process
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Abnormality?
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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.
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Anatomy?
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Aorta
Anatomy? Vertebral body Psoas Nerve root Dural
Sac Facet joint
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Pathology?
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Pathology? Herniated Nucleus Pulposus (HNP)
impinging on nerve root
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Pathology?
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More sick discs
Pathology? Degenerated (black) disk, herniating
posteriorly against nerve root.
Healthy discs
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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.
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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.
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Pathology?
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Pathology? Spondylolisthesis or slip of L5 on S1
Posterior edges of L5 and S1
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Normal pars at L4
Pathology? Spondylolisthesis Note break in pars
intraarticularis of L5
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Foggy Carolina Fall morning