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Lumbar Spine CT

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1. Evaluation of the Thoracic and Lumbar Spine in Blunt Trauma

in both of these patients. For the first patient, you are planning to get a CT of his head, face, and cervical spine, and are considering a CT of the chest, abdomen, and pelvis as well, based purely on the mechanism of injury. You wonder if you even need to consider imaging of the thoracic and lumbar spine, given his lack of physical exam findings, and if so, wonder if you should get CT reconstructions or if plain films would suffice. In the second case, in addition to imaging of the pelvis and left (...) hip, you are planning to get plain films of the lumbar spine. Again, you wonder if this is sufficient, or if you need to get more advanced imaging (such as a CT) to evaluate for fracture. The first patient gets a “pan-scan” and is found to have isolated facial bone fractures, for which he is evaluated by ENT and eventually discharged home. The second patient is found to have no fractures on plain films, feels much better after ibuprofen, and also goes home. You still have questions about your

2019 Washington University Emergency Medicine Journal Club

2. Is Focused MRI Adequate for Treatment Decision-Making in Acute Traumatic Thoracic and Lumbar Spine Fractures seen on Whole spine CT? (PubMed)

Is Focused MRI Adequate for Treatment Decision-Making in Acute Traumatic Thoracic and Lumbar Spine Fractures seen on Whole spine CT? To assess whether a focused magnetic resonance imaging (MRI) limited to the region of known acute traumatic thoracic or lumbar fracture(s) would miss any clinically significant injuries that would change patient management.A multicenter retrospective clinical study.Adult patients with acute traumatic thoracic and/or lumbar spine fracture(s).Pathology identified (...) on MRI (ligamentous disruption, epidural hematoma, and cord contusion), outside of the focused zone, an alteration in patient management, including surgical and nonsurgical, as a result of the identified pathology outside the focused zone.Records were reviewed for all adult trauma patients who presented to the emergency department between 2008 and 2016 with one or more fracture(s) of the thoracic and/or lumbar spine identified on computed tomography (CT) and who underwent MRI of the entire thoracic

2018 The Spine Journal

3. CT for thoracic and lumbar spine fractures: Can CT findings accurately predict posterior ligament complex injury? (PubMed)

CT for thoracic and lumbar spine fractures: Can CT findings accurately predict posterior ligament complex injury? This study aims to determine whether secondary CT findings can predict posterior ligament complex (PLC) injury in patients with acute thoracic (T) or lumbar (L) spine fractures.This is a retrospective study of 105 patients with acute thoracic and lumbar spine fractures on CT, with MRI as the reference standard for PLC injury. Three readers graded CT for facet joint alignment (FJA (...) ), widening (FJW), pedicle or lamina fracture (PLF), spinous fracture (SPF), interspinous widening (ISW), vertebral translation (VBT), and posterior endplate fracture (PEF). Univariate and multivariate logistic regression analyses were performed separately for each reader to test for associations between CT and PLC injury, and diagnostic performance of CT was calculated.Fifty-three of 105 patients had PLC injury by MRI. Statistically significant predictors of PLC injury were VBT, PLF, ISW, and SPF. Using

2018 European Spine Journal

4. ACR–ASNR–ASSR–SPR Practice Parameter for the Performance of Computed Tomography (CT) of the Spine

utility. If there is a clinical concern for spinal injury, MRI (by itself or in conjunction with clinical observation) should be considered in pediatric patients as an alternative or complement to a targeted CT of the area of concern. 3. Degenerative conditions and osteoarthritis evaluation. CT is often used to study the spine for conditions such as lumbar stenosis or in evaluating disc degeneration and is the primary evaluation technique when MRI is contraindicated (eg, the presence of cardiac (...) plain radiographs, CT of the entire lumbar spine from T12 down is not necessary. This is particularly important in pediatric patients [33]. Caution should be applied in the presence of a transitional anomaly. 1. Cervical spine Evaluation of the craniocervical junction (skull base structures including sella and clivus) and cervical spine requires thin sections for definitive diagnosis. The reconstructed scan width should be no greater than 3 mm. Primary evaluation for the effects of cervical disc

2019 American Society of Neuroradiology

5. Value of standard radiographs, CT and MRI of the lumbar spine in detection of intraoperatively confirmed pedicle screw loosening - a prospective clinical trial. (PubMed)

Value of standard radiographs, CT and MRI of the lumbar spine in detection of intraoperatively confirmed pedicle screw loosening - a prospective clinical trial. Pedicle screw loosening is common after spinal fusion and can be associated with pseudoarthrosis and pain. With suspicion of screw loosening on standard radiographs, CT is currently considered the advanced imaging modality of choice. MRI with new metal artifact reduction techniques holds potential to be sensitive in detection of screw (...) loosening. The sensitivity and specificity of either of the imaging modalities are yet clear.To evaluate the sensitivity and specificity of three different image modalities (standard radiographs, CT, and MRI) for detection of pedicle screw loosening.Cross-sectional diagnostic study.Forty-one patients (159 pedicle screws) undergoing revision surgeries after lumbar spinal fusion between August 2014 and April 2017 with preoperative radiographs, CT, and MRI with spinal metal artifact reduction (STIR WARP

2018 The Spine Journal

6. Clinical and CT Analysis of Lumbar Spine Arthrodesis: β-Tricalcium Phosphate Versus Demineralized Bone Matrix (PubMed)

Clinical and CT Analysis of Lumbar Spine Arthrodesis: β-Tricalcium Phosphate Versus Demineralized Bone Matrix Bone graft substitutes have been developed to circumvent donor site morbidity associated with iliac crest bone graft, but sparse literature compares the efficacy of various substitutes. Two commonly used bone graft substitutes used in lumbar fusion are β-tricalcium phosphate (BTP) and demineralized bone matrix (DBM).A retrospective review of patients who underwent instrumented (...) posterolateral lumbar fusion was conducted by a single surgeon from January 2013 to December 2016. Patients were divided into two groups based on whether DBM or BTP as graft in conjunction with local autograft. Clinical outcomes scores were collected at a minimum of 1-year follow-up. Postoperative CT scans were evaluated to assess fusion.Forty-one patients (DBM, 21 and BTP, 20) were reviewed. No significant differences were found in terms of age, sex, body mass index, smoking, diabetes, steroids

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2018 JAAOS Global Research & Reviews

7. Radiation dose reduction in thoracic and lumbar spine instrumentation using navigation based on an intraoperative cone beam CT imaging system: a prospective randomized clinical trial. (PubMed)

Radiation dose reduction in thoracic and lumbar spine instrumentation using navigation based on an intraoperative cone beam CT imaging system: a prospective randomized clinical trial. Spine surgery still remains a challenge for every spine surgeon, aware of the potential serious outcomes of misplaced instrumentation. Though many studies have highlighted that using intraoperative cone beam CT imaging and navigation systems provides higher accuracy than conventional freehand methods for placement (...) of pedicle screws in spine surgery, few studies are concerned about how to reduce radiation exposure for patients with the use of such technology. One of the main focuses of this study is based on the ALARA principle (as low as reasonably achievable).A prospective randomized trial was conducted in the hybrid operating room between December 2015 and December 2016, including 50 patients operated on for posterior instrumented thoracic and/or lumbar spinal fusion. Patients were randomized to intraoperative

2017 European Spine Journal

8. Percutaneous screw placement in the lumbar spine with a modified guidance technique based on 3D CT navigation system (PubMed)

Percutaneous screw placement in the lumbar spine with a modified guidance technique based on 3D CT navigation system Several guidance techniques have been employed to increase accuracy and reduce surgical time during percutaneous placement of pedicle screws (PS). The purpose of our study was to present a modified technique for percutaneous placement of lumbar PS that reduces surgical time. We reviewed 23 cases of percutaneous PS placement using our technique for minimally invasive lumbar (...) surgeries and 24 control cases where lumbar PS placement was done via common technique using Jamshidi needles (Becton, Dickinson and Company, Franklin Lakes, NJ, USA). An integrated computer-guided navigation system was used in all cases. In the technique modification, a handheld drill with a navigated guide was used to create the path for inserting guidewires through the pedicles and into the vertebral bodies. After drill removal, placement of the guidewires through the pedicles took place. The PS were

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2017 Journal of Spine Surgery

9. Evaluation of bone mineral density of the lumbar spine using a novel phantomless dual-energy CT post-processing algorithm in comparison with dual-energy X-ray absorptiometry (PubMed)

Evaluation of bone mineral density of the lumbar spine using a novel phantomless dual-energy CT post-processing algorithm in comparison with dual-energy X-ray absorptiometry Current techniques for evaluation of bone mineral density (BMD) commonly require phantom calibration. The purpose of this study was to evaluate a novel algorithm for phantomless in vivo dual-energy computed tomography (DECT)-based assessment of BMD of the lumbar spine in comparison with dual-energy X-ray absorptiometry (...) (DEXA).Data from clinically indicated DECT and DEXA examinations within two months comprising the lumbar spine of 47 patients were retrospectively evaluated. By using a novel automated dedicated post-processing algorithm for DECT, the trabecular bone of lumbar vertebrae L1-L4 was selected and analysed. Linear correlation was analysed using Pearson's product-moment correlation coefficient for the comparison of the results from DECT and DEXA.A total of 186 lumbar vertebrae in 47 patients (mean age, 58

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2017 European Radiology Experimental

10. Lumbar spine evaluation: accuracy on abdominal CT (PubMed)

Lumbar spine evaluation: accuracy on abdominal CT To determine if the lumbar spine can be accurately evaluated on an abdominal CT.The electronic medical records at our institution were searched to find all consecutive patients who had an abdominal CT within 12 months of a lumbar spine MRI obtained between 01 November 2010 and 31 October 2015. The abdominal CT studies were retrospectively reviewed in a blinded fashion for the presence of any significant lumbar spine abnormalities (...) . The prospective lumbar spine MRI reports were used as the standard of reference.5,031 patients had lumbar spine MRI studies at our institution during the study period of 01 November 2010 to 31 October 2015. 144 patients met the inclusion criteria of our study. No patients were excluded. 107 patients had 256 abnormal findings on the lumbar spine MRI studies. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of abdominal CT in lumbar spine evaluation on a per

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2017 The British journal of radiology

11. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 15: Electrophysiological monitoring and lumbar fusion

. Based on this study there is no evidence to suggest that intraoperative neuromonitoring can be used to prevent neurological deficits during surgery. Parker et al. 10 performed a retrospective study ex- amining the records of 418 patients in whom 2450 con- secutive pedicle screws were placed (Table 1). Multimo- dality neuromonitoring was performed (MEPs, SSEPs, and evoked EMG response) for all surgeries that were performed on the lumbar spine (L1–S1). This study was unique in that CT scans were (...) Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 15: Electrophysiological monitoring and lumbar fusion J Neurosurg Spine 21:102–105, 2014 102 ©AANS, 2014 J Neurosurg: Spine / Volume 21 / July 2014 Recommendations There is no evidence that conflicts with the previous recommendations regarding electrophysiological moni- toring published in the original version of the “Guidelines for the performance of fusion procedures for degenerative

2014 Congress of Neurological Surgeons

12. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 17: Bone growth stimulators as an adjunct for lumbar fusion

Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 17: Bone growth stimulators as an adjunct for lumbar fusion J Neurosurg Spine 21:133–139, 2014 133 ©AANS, 2014 J Neurosurg: Spine / Volume 21 / July 2014 Recommendations There is no evidence that conflicts with the previ - ous recommendations regarding bone growth stimulation published in the original version of the “Guidelines for the performance of fusion procedures for degenerative (...) disease of the lumbar spine.” 18 Grade C The routine use of DCS in patients over the age of 60 years is not recommended, as the evidence demonstrates no impact on fusion rates (single Level II study). For patients younger than 60 years of age, undergoing a lumbar fusion, the use of DCS is an option as studies have demonstrated a positive impact on fusion rate; how- ever, there is insufficient evidence regarding its impact on clinical outcome (single Level III study/multiple Level IV studies). Grade I

2014 Congress of Neurological Surgeons

13. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 9: Lumbar fusion for stenosis with spondylolisthesis

separately. 25Part 9: Lumbar fusion for stenosis with spondylolisthesis 59 J Neurosurg: Spine / Volume 21 / July 2014 Kanayama and colleagues 17 performed a small ran - domized controlled trial comparing osteogenic protein-1 (OP-1) to autograft plus ceramic as fusion materials in a group of 19 patients undergoing instrumented PLF fol- lowing decompression for stenosis associated with spon- dylolisthesis. The OP-1 group was found to have a slightly lower fusion rate as judged by CT scans, dynamic radio (...) Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 9: Lumbar fusion for stenosis with spondylolisthesis J Neurosurg Spine 21:54–61, 2014 54 ©AANS, 2014 J Neurosurg: Spine / Volume 21 / July 2014 Recommendations There is no evidence that conflicts with the previous recommendations formulated from the first iteration of the Lumbar Fusion Guidelines. Grade B Surgical decompression and fusion is recommended as an effective treatment

2014 Congress of Neurological Surgeons

14. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 11: Interbody techniques for lumbar fusion

Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 11: Interbody techniques for lumbar fusion J Neurosurg Spine 21:67–74, 2014 67 ©AANS, 2014 J Neurosurg: Spine / Volume 21 / July 2014 Recommendations There is no evidence that conflicts with the previous recommendations formulated from the first generation of Lumbar Fusion Guidelines published in the original version of the “Guidelines for the performance of fusion procedures (...) for degenerative disease of the lumbar spine.” Grade B The addition of an interbody fusion is recommended as an option to enhance the fusion rate (which lowers the reoperation rate) in patients undergoing lumbar fusion. However, the improvement in fusion rates with the addition of interbody fusion has not consistently translated to an im- provement in clinical outcomes (multiple Level II reports). The addition of posterolateral lumbar fusion (PLF) to interbody fusion is not recommended in patients under- going

2014 Congress of Neurological Surgeons

15. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 13: Injection therapies, low-back pain, and lumbar fusion

Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 13: Injection therapies, low-back pain, and lumbar fusion J Neurosurg Spine 21:79–90, 2014 79 ©AANS, 2014 J Neurosurg: Spine / Volume 21 / July 2014 Therapeutic Recommendations There is no new evidence that conflicts with the pre - vious recommendations regarding injection therapies pub- lished in the original version of the “Guidelines for the per - formance of fusion procedures (...) for degenerative disease of the lumbar spine.” 27 Lumbar Epidural Steroid Injections Grade C Lumbar epidural steroid injections (ESIs) are an op- tion for the short-term relief of chronic low-back pain without radiculopathy in patients with degenerative dis- ease of the lumbar spine (Level III evidence). Caudal ESIs are an option for decreasing low-back pain of greater than 6 weeks’ duration, without radiculop - athy, in patients with degenerative disease of the lumbar spine (Level III evidence). Lumbar Facet

2014 Congress of Neurological Surgeons

16. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 7: Lumbar fusion for intractable low-back pain without stenosis or spondylolisthesis

Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 7: Lumbar fusion for intractable low-back pain without stenosis or spondylolisthesis J Neurosurg Spine 21:42–47, 2014 42 ©AANS, 2014 J Neurosurg: Spine / Volume 21 / July 2014 Recommendations There is no evidence that conflicts with the previous recommendations published in the original version of the Lumbar Fusion Guidelines (“Guidelines for the perfor- mance of fusion procedures (...) for degenerative disease of the lumbar spine”). Grade B Lumbar fusion or a comprehensive rehabilitation pro- gram incorporating cognitive therapy are recommended as treatment alternatives for patients with chronic low- back pain that is refractory to traditional conservative treatment, such as physical therapy, and is due to 1- or 2-level degenerative disc disease without stenosis or spon- dylolisthesis (multiple Level II studies). It is recommended that lumbar fusion be performed for patients whose low-back

2014 Congress of Neurological Surgeons

17. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 16: Bone graft extenders and substitutes as an adjunct for lumbar fusion

was measured with CT and considered significantly greater on the investigational intertransverse space. The authors concluded that HA is a safe and ef - fective graft extender for posterolateral lumbar fusion. A Part 16: Bone graft extenders and substitutes 111 J Neurosurg: Spine / Volume 21 / July 2014 TABLE 2: Calcium phosphate salts: summary of evidence* Authors & Year Level of Evidence Description of Study Comments Dai & Jiang, 2008 II T h e o b j e c t i v e o f t h i s s i n g l e - c e n t e r p r o (...) Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 16: Bone graft extenders and substitutes as an adjunct for lumbar fusion J Neurosurg Spine 21:106–132, 2014 106 ©AANS, 2014 J Neurosurg: Spine / Volume 21 / July 2014 Recommendations There is no evidence that conflicts with the previous recommendations published in the original version of the “Guidelines for the performance of fusion procedures for degenerative disease of the lumbar

2014 Congress of Neurological Surgeons

18. Lumbar Spine CT

Lumbar Spine CT Lumbar Spine CT Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Lumbar Spine CT Lumbar Spine CT Aka: Lumbar Spine CT (...) , L-Spine CT II. Indications l l dislocation III. Disadvantages Radiation exposure (reduced with spiral CT) Poor sensitivity for soft tissue changes Poor accuracy in non-displaced l s IV. Advantages Less sensitive to patient movement compared with MRI Less expensive than MRI No contraindication for patient with implantable device Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Lumbar Spine CT." Click on the image (or right

2018 FP Notebook

19. Primary phosphaturic mesenchymal tumour of the lumbar spine: utility of 68Ga-DOTATOC PET/CT findings (PubMed)

Primary phosphaturic mesenchymal tumour of the lumbar spine: utility of 68Ga-DOTATOC PET/CT findings Primary phosphaturic mesenchymal tumours (PMTs) frequently occur in the soft tissue or bone, but rarely in the spine. The majority of patients experience long-term ostalgia and recurrent fractures. Detection of PMT can be challenging, but the clinical symptoms dramatically improve after removal of the tumour.Wepresent a case of primary PMT in the lumbar spine. CT scan showed a low-density tumour (...) with a well-defined sclerotic margin in the L5 vertebra. MRI revealed a hypointense tumour on T2 weighted imaging and heterogeneous enhancement. 68Ga-labelled 1,4,7,10-tetraazacyclododecane-N,N',N″, N‴-tetraacetic acid-D-Phe1-Tyr3-octreotide (68Ga-DOTATOC) positron emission tomography/CT scan demonstrated intense focal uptake within the tumour. Histologically, proliferation of oval to short spindle-shaped cells with fibrocollagenous stroma, abundant various-sized vessels, microcysts and thickened

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2016 BJR | case reports

20. Lumbar spine MRI versus non-lumbar imaging modalities in the diagnosis of sacral insufficiency fracture: a retrospective observational study. (PubMed)

of this study is to show the proportions of modalities used in diagnosing SIF in practice and to compare the clinical and imaging features of SIF diagnosed by lumbar spine MRI (L-spine MRI) with those diagnosed by non-lumbar imaging modalities (bone scan, pelvic bone CT, pelvis MRI).Forty-two patients with SIF were enrolled in this study. SIFs diagnosed by L-spine were assigned to group 1 and SIFs diagnosed by non-lumbar imaging modalities (bone scan, pelvic bone CT, pelvis MRI) were assigned to group 2 (...) . The clinical and imaging features of SIFs were assessed and compared between two groups.SIF were more commonly diagnosed by L-spine MRI (group 1: n = 27, 64.3%) than non-lumbar imaging modalities (group 2: n = 15, 35.7%), which was comprised of pelvic bone CT (n = 6, 14.3%), bone scan (n = 5, 11.9%), and pelvis MRI (n = 4, 9.5%). Lower back pain, radiating pain and comorbid other causes of pain were more frequently identified in group 1. Fracture involving bilateral sacral ala with horizontal component

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2018 BMC Musculoskeletal Disorders

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