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Radiology
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Radiology
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Written by Dr. Terry R. Yochum, D.C.; D.A.C.B.R.; Fellow, A.C.C.R. and Dr. Chad J. Maola, D.C.
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Thursday, 08 July 2004 21:00 |
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The radiographic signs of vertebral compression fracture are often subtle. Radiographs of optimal quality are necessary in order to adequately demonstrate these fractures. Lateral radiographs best demonstrate the fracture features. Radiographic signs of vertebral compression fracture include a step defect, wedge deformity, a linear zone of condensation, displaced endplate, paraspinal edema and abdominal ileus.
 Step Defect—Note, in the presented image, a compression fracture of the L2 and L4 superior vertebral endplates. There is an anterior step defect at the anterior superior corner of the L2 and L4 vertebral bodies. Since the anterior aspect of the vertebral body is under the greatest stress, the first bony injury to occur is a buckling of the anterior cortex, usually near the superior vertebral endplate. This sign is best seen on the lateral view as a short step off of the anterior superior vertebral body margin along the smooth concave edge of the vertebral body. In several compression fractures, the step defect may be the only radiographic sign of fracture. Anatomically, the actual step off deformity represents the anteriorly displaced corner of the superior vertebral cortex. As the superior endplate is compressed in flexion, a sliding forward of the vertebral endplate occurs creating this radiographic sign. This sign is often gone once the compression fracture heals.
In most compression fractures, an anterior depression of the vertebral body occurs creating a triangular wedge shape. Occasionally, a band of radiopacity may be seen just below the vertebral endplate wedged shaped fracture. This has been referred to as the linear wide band of condensation, or the zone of impaction. The radiopaque band represents the early site of bone impaction following a forceful flexion injury where the bones are driven together.
A sharp disruption in the fractured vertebral endplate may be seen with spinal compression fractures.
Differentiation between old and recent compression fractures is often difficult. This may be definitively detected by the presence of bone marrow edema on magnetic resonance imaging scans (MRI). Bone scans maybe be helpful showing increased uptake with recent fractures undergoing the active repair; however, these fractures may remain active eighteen to twenty-four months following injury, which diminishes its usefulness. TAC
Reference: Yochum TR, Rowe LJ: Essentials of Skeletal Radiology, 2nd ed., Williams & Wilkins, Baltimore, Maryland, 1996.
Dr. Terry R. Yochum is a second-generation chiropractor and a cum laude graduate of the National College of Chiropractic, where he subsequently completed his radiology specialty. He is currently Director of the Rocky Mountain Chiropractic Radiological Center, in Denver, CO, an Adjunct Professor of Radiology at the Los Angeles College of Chiropractic, as well as an instructor of Skeletal Radiology at the University of Colorado School of Medicine, Denver, CO. Dr. Yochum is, also, a consultant to Health Care Manufacturing Company that offers a Stored Energy system. For more information, Dr. Yochum can be reached at: 303-940-9400 or by e-mail at
This e-mail address is being protected from spambots. You need JavaScript enabled to view it
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Dr. Chad Maola is a 1999 Magna Cum Laude graduate of National College of Chiropractic.
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Radiology
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Written by Dr. Terry Yochum D.C.; D.A.C.B.R.; Fellow, A.C.C.R.
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Saturday, 03 April 2004 16:10 |
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In the pre-antibiotic era, the only treatment for pulmo-nary tuberculosis was rest and or lung resection of the diseased segment. Secondary or re-infection tuberculosis most commonly occurs in the lung apices. This patient had surgery with resection of her right upper lung due to pulmonary tuberculosis. To fill space left empty by the resected lung tissue and to avoid huge mediastinal shifting of the trachea, opposite lung and heart, this open space was filled with a foreign substance. The substance was “lucite balls” and was packed in the open space. Its appearance on standard radiographs was quite striking, leaving the impression of “ping pong” balls in the lung. This “plombage” procedure is no longer used today with the advent of antibiotic therapy for pulmonary tuberculosis; however this may still be encountered on radiographs of the geriatric patient population.
Dr. Terry R. Yochum is a second-generation chiropractor and a cum laude graduate of the National College of Chiropractic, where he subsequently completed his radiology specialty. He is currently Director of the Rocky Mountain Chiropractic Radiological Center, in Denver, CO, an Adjunct Professor of Radiology at the Los Angeles College of Chiropractic, as well as an instructor of Skeletal Radiology at the University of Colorado School of Medicine, Denver, CO. Dr. Yochum is, also, a consultant to Health Care Manufacturing Company that offers a Stored Energy system. For more information, Dr. Yochum can be reached at: 303-940-9400 or by e-mail at
This e-mail address is being protected from spambots. You need JavaScript enabled to view it
.
Dr. Chad Maola is a 1999 Magna Cum Laude graduate of National College of Chiropractic.
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Radiology
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Written by Dr. Terry R. Yochum, D.C.; D.A.C.B.R.; Fellow, A.C.C.R. and Dr. Chad J. Maola, D.C.
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Saturday, 28 February 2004 00:00 |
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Considerations
Diffuse idiopathic skeletal hyperostosis (DISH) is a generalized spinal and extraspinal articular disorder that is characterized by ligamentous calcification and ossification. The most prominent radiographic expressions of this disease are encountered in the spine involving predominantly the anterior longitudinal ligament. It is a distinctive disease and does not represent ankylosing spondylitis or degenerative joint disease. An incidence of 12% of middle-aged individuals in the United States has been estimated.1 
Clinical Features
Complaints by the patient are similar to those of degenerative joint disease, involving the fifth or sixth decade of life, with morning stiffness and low-grade musculoskeletal pain, especially of the spine and its related articulations. An additional complaint is approximately 20% of DISH patients have dysphagia due to anterior proliferative bone growths from the cervical spine.
Radiographic Features
The definitive criteria for the diagnosis of DISH are as follows:2
- The presence of flowing calcification or ossification along the anterolateral aspect of at least four contiguous vertebral bodies.
- The relative preservation of intervertebral disc height of the involved segments and lack of other associated signs of disc degeneration.
- Absence of apophyseal and von Luschka joint ankylosis.
Target Sites of Involvement
Statistically, the most common spinal region affected is the thoracic spine, particularly from T7 through T11. The flowing thick hyperostosis is a classic radiological appearance. The cervical spine is the second most common site with exuberant anterior vertebral body hyperostosis occurring from C4 through C7. Lumbar involvement is the third most common site and most prominently in the upper three segments. Initially, the hyperostosis begins from the middle and anterosuperior vertebral body margin, extending upward and tapering at its distal extent, simulating a candle flame.3
Differential Diagnosis
The most difficult differential exclusion includes ankylosing spondylitis. The syndesmophytes of ankylosing spondylitis are fine and delicate in their appearance while in DISH the spondylophytes are very large, thick and irregular. The lack of extensive sacroiliac joint disease is also a helpful differential point since only rarely in DISH will the SI joints show ankylosis and when this occurs it is in the upper one-third of these joints (fibrous portion) rather than the lower two-thirds (synovial portion), which is classically affected by ankylosing spondylitis. TAC
Dr. Terry R. Yochum is a second-generation chiropractor and a cum laude graduate of the National College of Chiropractic, where he subsequently completed his radiology specialty. He is currently Director of the Rocky Mountain Chiropractic Radiological Center, in Denver, CO, an Adjunct Professor of Radiology at the Los Angeles College of Chiropractic, as well as an instructor of Skeletal Radiology at the University of Colorado School of Medicine, Denver, CO. Dr. Yochum is, also, a consultant to Health Care Manufacturing Company that offers a Stored Energy system. For more information, Dr. Yochum can be reached at: 303-940-9400 or by e-mail at
This e-mail address is being protected from spambots. You need JavaScript enabled to view it
.
Dr. Chad Maola is a 1999 Magna Cum Laude graduate of National College of Chiropractic.
References
- Yochum TR, Rowe LJ: Essentials of Skeletal Radiology, ed 2.Baltimore, Williams & Wilkins, 1996.
- Resnick D, et al: Comparison of radiographic abnormalities of the sacroiliac joint and degenerative joint disease and ankylosing spondylitis. AJR 128:189, 1977.
- Dilhmann W: Current radiodiagnostic concept of ankylosing spondylitis. Skeletal Radiol 4:179, 1979.
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Radiology
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Written by Dr. Terry R. Yochum, D.C.; D.A.C.B.R.; Fellow, A.C.C.R. and Dr. Chad J. Maola, D.C.
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Sunday, 30 November 2003 00:00 |
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Description. When two adjacent vertebrae are osseously fused from birth, this joined unit is called a congenital block vertebra. Embryologically, this is the result of failure of the normal segmentation process of the somites during the period of differentiation at 3-to-8 fetal weeks.1 The block vertebra, by itself, is clinically insignificant. As there is no motion allowed at the fused level, there is no potential for degenerative disease of the disc or posterior apophyseal joints. The foramina at the blocked level may be smaller than normal, normally sized, or enlarged, but have not been shown to cause nerve compression. However, because of the lack of a motion segment, the free articulations above and below the block segment are stressed and usually result in premature degenerative discogenic spondylosis and arthrosis at the fully articulated levels, especially below the fusion site. Fusions are partial (i.e., do not completely involve the anterior and posterior spinal units) and may result in abnormal spinal curvature, usually scoliosis, because of a unilateral bar. Block vertebrae are most commonly found at C5-C6, C2-C3, T12-L1, and L4-L5, in decreasing order of incidence.1,2 
A recent report suggests that long-standing congenital or acquired fusion of upper cervical vertebrae may lead to stretching and laxity of the ligaments between the occiput and the atlas, resulting in excessive motion and brainstem or cord compression.2
Radiologic Features. A typical congenital block vertebra will demonstrate the following roentgen signs: a diminished AP diameter of the vertebral body; a hypoplastic or rudimentary disc space that may show faint calcification; possible fusion of the apophyseal joints (50% of cases); and possible malformation or fusion of the spinous processes.
The anterior margins of the involved vertebrae form a concave surface, because of the decreased AP diameter at the fusion that is visible on plain film and MRI. This “wasp waist”3,5 or “C” shape can serve as a mnemonic device, to indicate that this fusion is “congenital.” Another helpful sign of this congenital anomaly is osseous fusion of the neural arches, that is almost never associated with infectious, traumatic processes or other causes of block vertebrae. 4,5 TAC
Dr. Terry R. Yochum is a second-generation chiropractor and a cum laude graduate of the National College of Chiropractic, where he subsequently completed his radiology specialty. He is currently Director of the Rocky Mountain Chiropractic Radiological Center, in Denver, CO, an Adjunct Professor of Radiology at the Los Angeles College of Chiropractic, as well as an instructor of Skeletal Radiology at the University of Colorado School of Medicine, Denver, CO. Dr. Yochum is, also, a consultant to Health Care Manufacturing Company that offers a Stored Energy system. For more information, Dr. Yochum can be reached at: 303-940-9400 or by e-mail at
This e-mail address is being protected from spambots. You need JavaScript enabled to view it
. Magna Cum Laude graduate of National College of Chiropractic.
Dr. Chad Maola is a 1999
Magna Cum Laude graduate of National College of Chiropractic.
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Radiology
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Written by Dr. Terry R. Yochum, D.C.; D.A.C.B.R.; Fellow, A.C.C.R. and Dr. Chad J. Maola, D.C.
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Tuesday, 30 September 2003 00:00 |
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HISTORY
This active adolescent athlete sprained his foot while playing tennis. Radiographs revealed a large radiolucent lesion in the calcaneus. What is this?
DIAGNOSIS: SIMPLE BONE CYST
The geographic lytic expansile lesion in the floor of the calcaneus is well circumscribed and has all the characteristic appearances of a benign lesion. Benign lytic lesions of the calcaneus are most commonly simple bone cysts (unicameral); however, the possibility of an aneurysmal bone cyst, giant cell tumor, or other benign tumors cannot be ruled out.
 GENERAL CONSIDERATIONS
Simple bone cyst (SBC), sometimes referred to as a unicameral bone cyst (UBC), solitary bone cyst, or juvenile bone cyst, is not a true neoplasm of bone, but rather a fluid-filled cyst that is lined with a thin layer of fibrous tissue. Nonetheless, it is frequently classified under the heading of primary bone tumors. Jaffe and Lichtenstein1, who described the first cases in 1942, clearly delineated this cyst as a distinct disease entity, naming it unicameral bone cyst. The term unicameral, meaning one house, has actually created some confusion, since many lesions present with a bubbly or chambered appearance; it is not single chambered at all. All of the cases that Jaffe and Lichtenstein originally reported were of the single-chamber cystic variety, which led them to use the term unicameral initially. However, many multichambered lesions have been reported since, which are better termed simple bone cysts rather than unicameral. In fact, histologically, they are the same lesion.
INCIDENCE
SBC’s represent slightly more than 3% of biopsied primary bone tumors.2
An SBC most commonly occurs between the ages of 3 and 14 years (80% of cases). They have been reported in a 2-month-old infant3, and in patients over 50.3 Males predominate, 2:1.
SIGNS AND SYMPTOMS
Most lesions are totally asymptomatic until a pathologic fracture occurs, not uncommonly in athletic activities.4,5 Approximately two-thirds of the SBC’s eventually undergo pathologic fracture.6
TREATMENT AND PROGNOSIS
The traditional treatment of choice has been surgical curettage with cauterization of the cyst. Packing of the hollow cavity with bone chips following surgery is necessary. However, recurrence rates with this technique have been high, approximately 30 to 40%.7 More recently, the injection of steroids has significantly reduced the recurrence rates, thus providing effective treatment for the cyst.5,8-11
Dr. Terry R. Yochum is a second-generation chiropractor and a cum laude graduate of the National College of Chiropractic, where he subsequently completed his radiology specialty. He is currently Director of the Rocky Mountain Chiropractic Radiological Center, in Denver, CO, an Adjunct Professor of Radiology at the Los Angeles College of Chiropractic, as well as an instructor of Skeletal Radiology at the University of Colorado School of Medicine, Denver, CO. Dr. Yochum is, also, a consultant to Health Care Manufacturing Company that offers a Stored Energy system. For more information, Dr. Yochum can be reached at: 303-940-9400 or by e-mail at
This e-mail address is being protected from spambots. You need JavaScript enabled to view it
.
Dr. Chad Maola is a 1999 Magna Cum Laude graduate of National College of Chiropractic.
References
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Jaffe HL, Lichtenstein L: Solitary unicameral bone cyst, with emphasis on the roentgen picture, the pathologic appearance and the pathogenesis. Arch Surg 44:104, 1942.
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Mirra JM: Bone Tumors—Diagnosis and Treatment. Philadelphia, JB Lippincott, 1980.
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Jaffe HL: Tumors and Tumorous Conditions of the Bones and Joints, Philadelphia, Lea & Febiger, 1958.
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Garceau GJ, Gregory CF: Solitary unicameral bone cyst. J Bone Joint Surg (Am) 36:267, 1954.
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Rowe LJ, Brandt JR: Simple bone cysts in athletes. Chiro Sports Med 2:33, 1988.
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Wilner D: Radiology of Bone Tumors and Allied Disorders, Philadelphia, WB Saunders, 1982.
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Smith RW, Smith CF: Solitary unicameral bone cyst of the calcaneus. J Bone Joint Surg (Am) 56:49, 1974.
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Capanna R, Albisinni U, Campanacci M, et al: Contrast examination as a prognostic factor in the treatment of solitary bone cyst by cortisone injection. Skeletal Radiol 12:97, 1984.
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Capanna R, DalMonte A, Campanacci M: The natural history of unicameral bone cyst after steroid injection. Clin Orthop 166:204, 1982.
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Scaglietti O, Marchetti PG, Bartolozzi P: Final results obtained in the treatment of bone cysts with methylprednisolone acetate (depo-medral) and a discussion of results achieved in other bone lesions. Clin Orthop 165:33, 1982.
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Yochum TR, Rowe LJ: Essentials of Skeletal Radiology, ed. 2. Baltimore, Williams & Wilkins, 1996.
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