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Small Animal Neuroradiology: The Spine Lecture 1 – Radiography and Contrast Techniques, Anomalous Diseases VCA 341 Fall 2011 Andrea Matthews, DVM, Dip.

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Presentation on theme: "Small Animal Neuroradiology: The Spine Lecture 1 – Radiography and Contrast Techniques, Anomalous Diseases VCA 341 Fall 2011 Andrea Matthews, DVM, Dip."— Presentation transcript:

1 Small Animal Neuroradiology: The Spine Lecture 1 – Radiography and Contrast Techniques, Anomalous Diseases VCA 341 Fall 2011 Andrea Matthews, DVM, Dip ACVR Assistant Professor of Radiology

2 Normal Anatomy Canine and feline vertebral formulas VCA 341 – The Spine 2 Matthews Cervical7 Thoracic13 Lumbar7 Sacral3 (fused) CaudalVariable

3 Normal Anatomy – Cervical C1 (or “atlas”)  Central arch and two wide horizontal wings perforated by transverse foramina C2 (or “axis”)  Long, thin spinous process which overlaps the dorsal arch of C1  Odontoid process (dens) C6  Expanded transverse process ventrally VCA 341 – The SpineMatthews 3

4 Cervical Spine VCA 341 – The SpineMatthews 4 C1 C2 C3 C5

5 Cervical Spine VCA 341 – The SpineMatthews 5 C1 C2 C3 C5 atlas axis TUSCVM

6 Normal Anatomy – Thoracic Rib heads articulate with cranial aspect of corresponding vertebral bodies Spinous processes change direction from caudal angulation to cranial angulation at the anticlinal vertebra (usually T11) Accessory processes on last 4-5 thoracic vertebrae T10-11 intervertebral disc space is normally narrow VCA 341 – The SpineMatthews 6

7 Thoracic Spine VCA 341 – The SpineMatthews 7 T10 T11 Anticlinal vertebra Anticlinal disc space is narrow normally Proximal ribs TUSCVM

8 Normal Anatomy - Lumbar Lumbar vertebral bodies are longer than thoracic vertebrae  Especially in cats. Transverse processes are angled cranially, laterally and somewhat ventrally Accessory processes (present on the first four vertebrae) can be especially large in cats “Fuzzy” ventral margin of L3 and L4  Due to attachment of the diaphragmatic crura (especially in large dogs). VCA 341 – The SpineMatthews 8 } Do not mistake for mineralized intervertebral disc material!

9 Lumbar Spine VCA 341 – The SpineMatthews 9 TUSCVM

10 Thoracic Spine VCA 341 – The SpineMatthews 10 Accessory process TUSCVM

11 Lumbar Spine VCA 341 – The SpineMatthews 11 L3 L4 Attachment for diaphragmatic crus TUSCVM

12 Sacral / Caudal Vertebra Sacrum  Lumbosacral angulation can vary significantly between individuals Changes with degree of flexion or extension Caudal Vertebra  Formerly known as coccygeal vertebrae  Vary in number  Hemal arches ventrally VCA 341 – The SpineMatthews 12

13 Sacral / Caudal Vertebra VCA 341 – The SpineMatthews 13

14 Lumbosacral Junction VCA 341 – The SpineMatthews 14 Ilial wings Articular facet joint TUSCVM

15 Lumbosacral Junction VCA 341 – The SpineMatthews 15 Margins of the sacrum TUCSVM

16 Typical Vertebra VCA 341 – The SpineMatthews 16

17 Ligamentous Structures VCA 341 – The SpineMatthews 17 Konig and Liebich, Veterinary Anatomy of Domestic Animals, 3 rd Ed

18 Survey Radiography Lateral and ventrodorsal views Adequate relaxation is required for good positioning  General anesthesia preferred Exception: Suspected fracture and/or luxation Can obtain lateral and horizontal beam Collimation to improve quality VCA 341 – The SpineMatthews 18

19 Survey Radiography VCA 341 – The SpineMatthews 19 Lateral cervical radiograph Ventrodorsal cervical radiograph

20 Survey Radiography VCA 341 – The SpineMatthews 20 Lateral thoracic radiograph

21 Survey Radiography Beware of “pseudonarrowing” of disc spaces  Artifactual narrowing due to divergence of x-rays VCA 341 – The SpineMatthews 21 Kishigami, Y.et al. Vet Radiol Ultrasound 41, 9–18 (2000).

22 Pseudonarrowing VCA 341 – The SpineMatthews 22

23 Radiography and Contrast Techniques VCA 341 – The Spine 23 Matthews

24 Myelography Introduction of contrast into subarachnoid space  Water soluble, iodinated, non-ionic contrast media Sites of injection  Cisterna magna More likely to seizure Difficult to get flow caudally in some cases  Lumbar (L5-6, L4-5) Possible epidural leakage More difficult technically Fewer complications Better flow of contrast typically VCA 341 – The SpineMatthews 24

25 Myelography VCA 341 – The SpineMatthews 25 Diaz, F. In Practice 27, (2005). Site for cervical injection Site for lumbar injection

26 Myelography Indications  Neurologic signs with no lesion on survey rads  Multiple lesions seen on survey rads  Single lesion seen on survey rads not consistent with clinical signs  Abnormality on survey rads which needs further characterization VCA 341 – The SpineMatthews 26  Contraindications  Inflammatory disease (meningitis)  Bleeding diatheses  Evidence of vertebral instability (could increase spinal cord damage)

27 Normal Myelogram VCA 341 – The Spine 27 Matthews Courtesy Dr. L. Pack

28 Extradural Lesion VCA 341 – The Spine 28 Matthews L4 L3 Extruded intervertebral disc material

29 Intradural/Extramedullary Lesion VCA 341 – The Spine 29 Matthews Golf tee sign

30 Intramedullary Lesion VCA 341 – The SpineMatthews 30 Courtesy Dr. L. Pack Widening of spinal cord due to spinal cord tumor (glioma)

31 Anomalous Diseases VCA 341 – The Spine 31 Matthews

32 Hemivertebra Failure of vertebral body to develop fully  Persistence of sagittal membrane (notochord) Most commonly in thoracic spine  May have focal kyphosis Often incidental finding Bulldogs, Boston terrier and pugs (“screw-tailed” breeds) VCA 341 – The SpineMatthews 32

33 Hemivertebra VCA 341 – The Spine 33 Matthews Butterfly vertebra TUCSVM

34 Block Vertebra Fusion of two or more adjacent vertebrae  Involve bodies, laminae and pedicles or entire vertebrae  Incomplete development of intervertebral disc Can occur at any location in spine Incidental  Differentiated from healing fractures, luxations, discospondylitis VCA 341 – The SpineMatthews 34

35 Block Vertebra VCA 341 – The Spine 35 Matthews TUCSVM

36 Transitional Vertebra Vertebra at the junction between two spinal regions that assumes the characteristics of both regions  Thoracolumbar, lumbosacral and sacrocaudal junctions Usually incidental findings  Important when identifying surgical site  Make positioning of VD pelvis difficult  Can be associated with lumbosacral instability VCA 341 – The SpineMatthews 36

37 Transitional Vertebra VCA 341 – The Spine 37 Matthews Sacralization of L7

38 Spina Bifida Part of general defect called Spinal Dysraphism  Failure of neural arch to close during embryogenesis Two types 1. Spina bifida occulta No spinal cord or meningeal involvement No clinical signs typically 2. Spina bifida manifesta Protrusion of the meninges (meningocele) or meninges and spinal cord (meningomyelocele) Associated clinical signs VCA 341 – The SpineMatthews 38

39 Anomalous Diseases VCA 341 – The Spine 39 Matthews  Common in screw-tailed breeds Bulldogs, Boston Terriers, Pugs, Manx cats Failure of fusion of spinous processes

40 Other Anomalies Scoliosis  Lateral bowing as seen on a VD or DV view Lordosis  Ventral bowing as seen on a lateral view Kyphosis  Dorsal bowing as seen on a lateral view VCA 341 – The SpineMatthews 40 Scoliosis (from Radiographic Interpretation for the Small Animal Clinician 2nd Ed)

41 The End VCA 341 – The SpineMatthews 41


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