Recognition of serious spinal
pathology
Learning Objectives
• Trauma
– Fractures
– Dislocations/subluxations
• Infection
– Tuberculous
– Pyogenic
• Tumours
– Primary
– Metastasis
The normal spine x-ray
• Name / location / date / type
• A good x-ray?
• Alignment
• Soft tissue
• Bone
• Density - Abnormal calcification
Name / location / date / type
A good x-ray?
Alignment
Soft tissue
Bone
Density - Abnormal calcification
Name / location / date / type
A good x-ray?
Alignment
Soft tissue
Bone
Density - Abnormal calcification
Name / location / date / type
A good x-ray?
Alignment
Soft tissue
Bone
Density - Abnormal calcification
Signs of fractures and dislocations
• Changes in alignment
• Abnormalities of bone shape
• Soft tissue injury
– Swelling
– Ligamentous rupture
Signs of infection
• Soft tissue swelling
– Inflammation
– Abscess
• Thoracic paravertebral
• Lumbar psoas
• Anterior cervical
• Disc space destruction
• TB - bony ankylosis
• Pyogenic - fibrous ankylosis
Signs of malignant tumour
• Loss of pedicle shadow
• Bone destruction
• Multiple level involvement
• Skip lesions
• Soft tissue lesion – late