MUSCULAR SKELETAL

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MUSCULAR SKELETAL

• LAMINECTOMY
• DISKOGRAPHY
• VERTEBROPLASTY

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INTRATHECAL IMAGING(MYELOGRAM)

• IMAGING WITHIN
• THE SPINAL CANAL

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MYELOGRAM

• Spinal cord extends from where to where?
• Longer in male or female?
• Shrinks as we age
• sensory and motor nerves attached
  posterolaterally and pass through?
• CSF located where?

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Pia

• arachnoid
• dura mater
• subarachnoid space continues below L1 to second
  sacral segment
• Cauda equina?

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LAMINECTOMY

• WHERE ARE LAMINA?
• WHAT ARE LAMINA?
• WHERE ARE PEDICLES?
• FAILURE OF LAMINA IS CALLED?

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• LAMINA (2)
• BROAD FLAT PLATE
• POST/MED FROM PEDICLE
• MEET IN BACK COMPLETE ARCH
• SPINA BIFIDA

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LAMINECTOMY

• Removal of lamina
• relieve symptoms of herniated disc
• Herniated portion of pulposis removed
• Bone grafts for fusion of adjacent vertebra
  performed to stabilize area

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DISKOGRAPHY

• Controversial
• CT MRI preferred

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PROCEDURE

• Direct injection into the vertebral disc (annulus
  fibrosis and nucleus pulposis)

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INDICATIONS

• Determine morphology
• reproduce pain to determine which disc is the
  problem
• reproduce pain caused by disc disease
• internal disc lesions
• pre-spinal fusion necessity assessment

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• NONIONIC CONTRAST USED ONLY. WHY?

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PROCEDURE

• Lt. Lat. Decub
• needle enter posteriorly through dura
• Contrast injected
• Pt asked to note pain

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CT(CT MYELO) MRI

• Faster
• less expensive
• more accessible
• demonstrates
• degenerative disc disease
• cauda equina
• spinal stenosis

• No bone producing artifact
• visualization on any plain

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CT

• Disadvantages
• varying bone densities challenging
• transverse axial cuts only
• large doses of radiation
• intrathecal imaging difficult

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CT MYELOGRAPHY

• Done after myelogram (2-4 hrs)
• CT has higher sensitivity requires lower
  concentration of contrast
• Lumbar puncture (3-5ml) diluted contrast if no
  myelogram

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MRI

• Disadvantage
• pt motion
• expensive
• not always accessible

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VERTEBROPLASTY (PVP)

• Interventional/.nonsurgical
• Injection of fast drying acrylic cement into
  compression fracture of vertebra
• contraindication compressed more than 70

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EQUIPMENT

• biplane fluoroscopy
• sterile technique
• local
• intravenous antibiotics to prevent infection of
  vertebral body

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PROCEDURE

• Prone
• fracture localized fluoroscopically.
• Sterile technique now assumed
• needle placement AP fluoro-follows pedicles
  laterally to vertebral body.
• Anterior and middle third portions-where max.
  movement of fracture and area of greatest
  compression

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INJECTION OF CEMENT

• QUICK SETTING (4-8 minute window)
• Mixed with barium powder
• lateral fluoro monitors flow and position
• AP fluoro monitors for leaks

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Post procedure

• Patient remains prone until UNUSED CEMENT IS
  HARDENED
• Placed on stretcher- non-weight bearing and under
  observation 3-5 hours-discharged

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RESULTS

• Immediate pain relief for many
• 1/3 resume normal activities without aid of
  braces/walkers/canes