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The Roasting of D. r. Kessler

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Anatomy? T-Spine Pedicles Spinous process Vertebral body Pathology? Pathology? Scoliosis Anatomy? Do you see the owl? Anatomy? Do you see the owl? – PowerPoint PPT presentation

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Title: The Roasting of D. r. Kessler


1

2
UNC MSK Course Day 4 Lab XR UNKNOWNS (for self
study)

3

Anatomy?
4

Anatomy? Odontoid Pedicle Vertebral body Facet
joint Lateral mass Spinous process
5

Name of view? What passes through this opening?
6

Name of view? Oblique view of cervical
spine. What passes through this opening? Right C5
nerve root
7

Name of View? Anatomy?
8

Name of View? Open mouth view Anatomy? Lateral
mass of C1 Odontoid C1-2 facet jt.
9

Anatomy?
10

Anatomy? Odontoid Lateral mass of C1
11

Anatomy?
12

Anatomy? Vertebral body Pedicle Lamina Spinous
process
13

Pathology?
14

Pathology? Osteoarthritis C-Spine Healthy
disc Note osteophytes and disc space narrowing
15

Name of view?
16

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
17

Pathology?
18

Normal canal has more room for cord
Pathology? Osteoarthritis again. Vertebral body
osteophytes are encroaching on the spinal canal
19

Pathology? Osteoarthritis again. Vertebral body
osteophytes are encroaching on the spinal canal
and on the foramen for the nerve root
20

Pathology?
21

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
22

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
23

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).
24

Pathology?
25

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
26

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
27

Pathology? C4-5 anterior subluxation Note Facet
subluxation
Normal facet alignment
28

Pathology?
29

Pathology? Osteoporosis Note preservation of
cortical bone with loss of internal cancellous
bone from vertebrae. C5 C6 have spinous
process fractures
30

Pathology? Osteoporosis Note preservation of
cortical bone with loss of internal cancellous
bone from vertebrae. C5 C6 have spinous
process fractures
31

Anatomy?
32

Anatomy? T-Spine Pedicles (end on) Spinous process
33

Anatomy?
34

Anatomy? T-Spine Pedicles Spinous
process Vertebral body
35

Pathology?
36

Pathology? Scoliosis
37

Anatomy? Do you see the owl?
38

Anatomy? Do you see the owl?
39

Anatomy? Do you see the owl? Eyes pedicles Beak
spinous process Ear tufts transverse
processes Cheeks lamina
40

Anatomy? Do you see the owl? Eyes pedicles Beak
spinous process Ear tufts transverse
processes Cheeks lamina
41

Anatomy?
42

Anatomy? Vertebral body Pedicle Pars
Intraarticularis Spinous process
43

Anatomy?
44

Anatomy? Vertebral body Pedicle Facet
joint Transverse process
Lamina Spinous process
45

Abnormality?
46

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.
47

Anatomy?
48

Aorta
Anatomy? Vertebral body Psoas Nerve root Dural
Sac Facet joint
49

Pathology?
50

Pathology? Herniated Nucleus Pulposus (HNP)
impinging on nerve root
51

Pathology?
52

More sick discs
Pathology? Degenerated (black) disk, herniating
posteriorly against nerve root.
Healthy discs
53

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.
54

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.
55

Pathology?
56

Pathology? Spondylolisthesis or slip of L5 on S1
Posterior edges of L5 and S1
57

Normal pars at L4
Pathology? Spondylolisthesis Note break in pars
intraarticularis of L5
58

Foggy Carolina Fall morning
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