Radiographs Spine

Bone mineral density can be measured at various sites throughout the skeletal system and by various methods. The site of measurement can be either central (hip and/or spine) or peripheral (heel, forearm, or hand). Dual-energy x-ray absorptiometry (DXA) can be used to measure central and peripheral sites of bone mineral density. Quantitative ultrasound, peripheral quantitative computed tomography, radiographic absorptiometry, and single-energy x-ray absorptiometry are used to measure peripheral sites. 

Boden SD (1996) The use of radiographic imaging studies in the evaluation of patients who have degenerative disorders of the lumbar spine. J Bone Joint Surg Am 78(1 ) 114-124... 

Putzier M et al (2006) Charite total disc replacement-clinical and radiographical results after an average follow-up of 17 years. Eur Spine J 15(2) 183-195... 

In the Breast Cancer Prevention Trial (Fisher et al. 1998) a clinical survey aimed at determining the potential of tamoxifen for breast cancer prevention in women at increased risk, 13,338 pre- or postmenopausal women were monitored over 5 years. After randomization, women in the treatment group (n = 6681) were given a 20-mg daily dose of tamoxifen, while the remaining (n = 6707) received a placebo. Although the overall rate of fractures was about the same in both groups, tamoxifen-treated women sustained fewer hip, spine, and Colles fractures. Nevertheless, relevant data may have been biased, since in this trial there was an indiscriminate inclusion of pre- and postmenopausal women and no spinal radiographs were carried out. 

All women included in MORE met criteria for osteoporosis defined as a lumbar spine or femoral neck bone mineral density (BMD) T score equal to or less than 2.5 or as the presence of a radiographic vertebral fracture. These women are considered to be at lower risk for breast cancer than women with normal BMD since this parameter could partially reflect a woman s lifetime exposure to estrogens (Zhang et al. 1997). After the start of MORE, NHANES III criteria standardizing total hip BMD measurements became available allowing part of... 

Repeated exposure to excessive concentrations of hydrogen fluoride over a period of years may result in an increased radiographic density of bone and eventually may cause crippling fluorosis (osteosclerosis due to deposition of fluoride in bone)/ The early signs of increased bone density from fluoride deposition are most apparent in the lumbar spine and pelvis and can be detected by X ray. 

FIGURE 45.1 Radiographs of (a) tibial fracture fixed with four pins and an external bar (b) a total hip joint replacement in a patient who sustained a femoral fracture and was treated with double bone plates, screws, and surgical wire (arrows) (c) application of wires, screws, and plates in the spine. 

For the cervical spine C7/T1 is often visualised on the initial film however, if not, traction to the arms will improve visualisation. This needs to be applied by an experienced medical practitioner who holds the child above their elbows and gently pulls the arms towards the child s feet. Older children can be asked to stretch down to their toes to allow the cervical/thoracic junction to be demonstrated. The AP cervical spine positioning and resultant radiographs are shown in figures 2.30 and 2.31. 

Fig. 7.52. Lateral cervical spine radiograph in a 2-week-old baby. The anterior arch of Cl is ossified (arrow)...

Lustrin ES, Karakas SP, Ortiz AO et al (2003) Pediatric cervical spine normal anatomy, variants and trauma. Radiographics 23 539-560... 

Fig. 14.11a-d. AP and lateral radiograph (a,b) showing an avulsed fragment from the tihial spine. The sagittal CT reconstructions (c) confirm the injury. The coronal T2 fat saturated MR image (d) shows oedema around the tihial spine as well as associated oedema in the femoral condyle... 

The pre-vertebral soft tissue thickness is increased in children. A pre-vertebral space of less than 6 mm at C3 level is normal. Widening of the pre-vertebral space can be seen in expiration and in crying. A repeat radiograph in extension and inspiration would help to exclude this. The pre-vertebral space is unreliable in isolated posterior injuries to the spine. 

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