Discover and read the best of Twitter Threads about #spine
Most recents (21)
1/Remembering spinal fracture classifications is back breaking work!
A #tweetorial to help your remember the scoring system for thoracic & lumbar fractures—“TLICS” to the cool kids!
#medtwitter #radres #FOAMed #FOAMrad #neurorad #Meded #backpain #spine #Neurosurgery
A #tweetorial to help your remember the scoring system for thoracic & lumbar fractures—“TLICS” to the cool kids!
#medtwitter #radres #FOAMed #FOAMrad #neurorad #Meded #backpain #spine #Neurosurgery
2/TLICS scores a fx on (1) morphology & (2) posterior ligamentous complex injury. Let's start w/morphology. TLICS scores severity like the steps to make & eat a pizza:
Mild compression (kneading), strong compression (rolling), rotation (tossing), & distraction (tearing in)
Mild compression (kneading), strong compression (rolling), rotation (tossing), & distraction (tearing in)
3/At the most mild, w/only mild axial loading, you get the simplest fx, a compression fx—like a simple long bone fx--worth 1 pt.
This is like when you just start to kneading the dough. There's pressure, but not as much as with a rolling pin!
This is like when you just start to kneading the dough. There's pressure, but not as much as with a rolling pin!
1/Understanding cervical radiculopathy is a pain in the neck! But knowing the distributions can help your search
A #tweetorial to help you remember cervical radicular pain distributions
#medtwitter #radres #FOAMed #FOAMrad #neurorad #Meded #meded #spine #Neurosurgery
A #tweetorial to help you remember cervical radicular pain distributions
#medtwitter #radres #FOAMed #FOAMrad #neurorad #Meded #meded #spine #Neurosurgery
2/First, a rule of thumb—or rather a rule of elbow! You have 10 fingers. If you divide that in half, you get 5.
If you divide your arm in half, that's at the elbow, you'll also get 5--C5 that is! C5 radiates to the elbow. So if it radiates below this, it's > C5 & above is < C5
If you divide your arm in half, that's at the elbow, you'll also get 5--C5 that is! C5 radiates to the elbow. So if it radiates below this, it's > C5 & above is < C5
3/So let’s start with C2. C2 predominantly radiates along the dorsal aspect of the scalp, as it supplies the greater occipital nerve. I remember this bc the number 2 has a swan like neck that mimics the contour of the back of the head and its distribution
1/Feeling unarmed when it comes to evaluating cervical radiculopathy & foraminal narrowing on MR?
Here’s a #tweetorial that’ll take that weight off your shoulder & show you how to rate cervical foraminal stenosis!
#medtwitter #meded #FOAMed #radtwitter #neurorad #spine #radres
Here’s a #tweetorial that’ll take that weight off your shoulder & show you how to rate cervical foraminal stenosis!
#medtwitter #meded #FOAMed #radtwitter #neurorad #spine #radres
2/First, the anatomy. Nerve rootlets arise from the anterior & posterior horns, merging to form anterior (motor) & dorsal (sensory) nerves roots in the thecal sac.
These come together & the dorsal root has its dorsal root ganglion before the spinal nerve extends extravertebral
These come together & the dorsal root has its dorsal root ganglion before the spinal nerve extends extravertebral
3/Think of it like a road system but carrying information/impulses instead of cars. Small roads (rootlets) merging to make larger roads (roots), before these finally merge together onto the big highway, which is the dorsal root ganglion and spinal nerve
1/I always say you can tell a bad read on a spine MR if it doesn’t talk about the lateral recess
What will I think when I see your read? What do you say about lateral recesses?
Here’s a #tweetorial on lateral recess #anatomy & grading stenosis
#medtwitter #neurorad #spine
What will I think when I see your read? What do you say about lateral recesses?
Here’s a #tweetorial on lateral recess #anatomy & grading stenosis
#medtwitter #neurorad #spine
2/First anatomy.
Thecal sac is like a highway, carrying the nerve roots down the lumbar spine.
Lateral recess is part of the lateral lumbar canal, which is essentially the exit for spinal nerve roots to get off the thecal sac highway & head out into the rest of the body
Thecal sac is like a highway, carrying the nerve roots down the lumbar spine.
Lateral recess is part of the lateral lumbar canal, which is essentially the exit for spinal nerve roots to get off the thecal sac highway & head out into the rest of the body
3/Exits have 3 main parts.
First is the deceleration lane, where the car slows down as it starts the process of exiting.
Then there is the off ramp itself.
The off ramp leads into the service road, which takes the car to the roads that it needs to get to its destination
First is the deceleration lane, where the car slows down as it starts the process of exiting.
Then there is the off ramp itself.
The off ramp leads into the service road, which takes the car to the roads that it needs to get to its destination
1/Talk about twisting your back! Do spine vascular lesions make your brain feel tangled like the dilated vessels you see?
Here’s a #tweetorial on #spine vascular #anatomy & dural arteriovenous fistulas (dAVF)
#medtwitter #meded #FOAMed #neurotwitter #neurosurgery #neurorad
Here’s a #tweetorial on #spine vascular #anatomy & dural arteriovenous fistulas (dAVF)
#medtwitter #meded #FOAMed #neurotwitter #neurosurgery #neurorad
2/To understand spinal dural AVFs, you need to understand basic spinal vascular anatomy.
The spine is LONG—to get blood from the top of the cord to the bottom is like going through the length of a marathon course
The spine is LONG—to get blood from the top of the cord to the bottom is like going through the length of a marathon course
3/So we will need to tackle it like you tackle running a marathon.
When you run a marathon, you replenish yourself at aid/water stations along the way so you can make it all the way through.
Same w/spinal arterial vasculature—it needs to be replenished on the way down.
When you run a marathon, you replenish yourself at aid/water stations along the way so you can make it all the way through.
Same w/spinal arterial vasculature—it needs to be replenished on the way down.
1/”I LOVE spinal cord syndromes!” is a phrase that has NEVER, EVER been said by anyone.
Never fear—here is a #tweetorial on all the incomplete #spinalcord syndromes!
#medtwitter #neurotwitter #neurology #neurosurgery #neurorad #radres #meded #FOAMed #FOAMrad #radtwitter #spine
Never fear—here is a #tweetorial on all the incomplete #spinalcord syndromes!
#medtwitter #neurotwitter #neurology #neurosurgery #neurorad #radres #meded #FOAMed #FOAMrad #radtwitter #spine
2/Spinal cord anatomy can be complex. On imaging, we can see the ant & post nerve roots. We can also see the gray & white matter. Hidden w/in the white matter, however, are numerous efferent & afferent tracts—enough to make your head spin.
3/Lucky for you, for the incomplete cord syndromes, all you need to know is gray matter & 3 main tracts. Anterolaterally, spinothalamic tract (pain & temp). Posteriorly, dorsal columns (vibration, proprioception, & light touch), & next to it, corticospinal tracts—providing motor
1/Have disagreements between radiologists on the degree of cervical canal stenosis become a pain in the neck?!
Here’s a #tweetorial on cervical stenosis grading that’s easy, reproducible & evidence based
#medtwitter #spine #neurosurgery #radres #neurorad #meded #FOAMed #FOAMrad
Here’s a #tweetorial on cervical stenosis grading that’s easy, reproducible & evidence based
#medtwitter #spine #neurosurgery #radres #neurorad #meded #FOAMed #FOAMrad
2/In the lumbar spine, it is all about the degree of canal narrowing & room for nerve roots. In the cervical spine, we have another factor to think about—the cord. Cord integrity is key. No matter the degree of stenosis, if the cord isn’t happy, the patient won’t be either
3/Cord flattening, even w/o canal stenosis, can cause myelopathy. No one is quite sure why. Some say it’s b/c mass effect on static imaging may be much worse in dynamic positions, some say it’s repetitive microtrauma, & some say micro-ischemia from compression of perforators
1/Hate it when one radiologist called the stenosis mild, the next one said moderate--but it was unchanged?!
Here’s a #tweetorial of a lumbar grading system that’s easy, reproducible & evidence-based
#medtwitter #spine #neurosurgery #radres #neurorad #meded #FOAMed #FOAMrad
Here’s a #tweetorial of a lumbar grading system that’s easy, reproducible & evidence-based
#medtwitter #spine #neurosurgery #radres #neurorad #meded #FOAMed #FOAMrad
2/Lumbar stenosis has always been controversial. In 2012, they tried to survey spine experts to come to a consensus as to what are the most important criteria for canal & foraminal stenosis. And the consensus was…that there was no consensus. So what should you use to call it?
3/Well, you don’t want just gestalt it—that is a recipe for inconsistency & disagreement. But you don’t want to measure everything either—measurements are not only cumbersome, they introduce reader variability & absolute measurements don’t mean the same thing in every patient.
1/When it comes to brachial plexus pathology, you shouldn’t have to wing it! A #tweetorial to help you figure out #brachialplexus injuries
#medtwitter #meded #neurosurgery #orthotwitter #orthopedics #neurorad #radres #medstudent #FOAMed #FOAMrad #spine #radiology #neurotwitter
#medtwitter #meded #neurosurgery #orthotwitter #orthopedics #neurorad #radres #medstudent #FOAMed #FOAMrad #spine #radiology #neurotwitter
2/When it comes to brachial plexus injuries, the most important distinction to make is whether it is a pre or post ganglionic injury. Pre ganglionic injuries are nerve root avulsions from the spinal cord and cannot be repaired, while most post ganglionic injuries can be repaired
3/It’s like repairing a house. If there’s a structural flaw at the beginning, before you’ve even built it, you won’t even try to build it, you’ll just scrap the design (preganglionic). But if there’s damage after the house is built, you can salvage it w/repair (postganglionic)
1/Ready for some heavy lifting? My second #tweetorial on the BRACHIAL PLEXUS! This time we cover how the #brachialplexus looks on #MRI.
#medtwitter #meded #neurosurgery #orthotwitter #orthopedics #neurorad #radres #medstudent #FOAMed #FOAMrad #spine #radiology #neurotwitter
#medtwitter #meded #neurosurgery #orthotwitter #orthopedics #neurorad #radres #medstudent #FOAMed #FOAMrad #spine #radiology #neurotwitter
2/Brachial plexus is how the cervical nerves reach the arm. In the coronal plane, it looks like a slide, guiding nerves downward. Bc nerves are traveling laterally, sagittal MRI plane is our plane of choice to cut the nerves in cross section & see down the barrel of the nerves
3/But it’s more than a slide, it’s a complex highway, w/nerves joining & dividing—like highway off ramps & on ramps. If you want to know more about this intrinsic anatomy, see my first brachial plexus tweetorial here:
1/Need help reading spine imaging? I’ve got your back!
A #tweetorial about the ABCs of reading spine MRs & CTs.
#medtwitter #FOAMed #FOAMrad #medstudenttwitter #medstudent #neurorad #radres #neurosurgery #spine #orthopedics @medtweetorials @stefantigges
A #tweetorial about the ABCs of reading spine MRs & CTs.
#medtwitter #FOAMed #FOAMrad #medstudenttwitter #medstudent #neurorad #radres #neurosurgery #spine #orthopedics @medtweetorials @stefantigges
2/A is for alignment. Normal spinal alignment is perfectly in balance, resulting in the minimal energy needed for erect posture. Even subtle changes in alignment need compensatory changes to maintain posture, resulting in more work/energy expenditure & pain.
3/The goals for alignment on imaging: (1) look for unstable injuries & (2) look for malalignment that causes early degenerative change. Abnormal motion causes spinal elements to abnormally move against each other, like grinding teeth wears down teeth—this wears down the spine
1/Remembering spinal fracture classifications is back breaking work!
A #tweetorial to review the scoring system for thoracic & lumbar fractures—“TLICS” to the cool kids! #medstudenttwitter #medtwitter #radres #FOAMed #FOAMrad #neurorad #Meded #backpain #spine #Neurosurgery
A #tweetorial to review the scoring system for thoracic & lumbar fractures—“TLICS” to the cool kids! #medstudenttwitter #medtwitter #radres #FOAMed #FOAMrad #neurorad #Meded #backpain #spine #Neurosurgery
2/We’ll talk about the imaging part of TLICS. TLICS scores a fx on (1) morphology & (2) posterior ligamentous complex (PLC) injury. Let’s start w/morphology. W/only mild axial loading, you get the simplest fx, a compression fx—like a simple long bone fx--worth 1 pt.
3/As the axial force grows, this becomes a burst fx with retropulsion of the posterior vertebral body—just as greater force causes more comminution in long bone fxs. A burst is worth 2 points.
1/Understanding cervical radiculopathy is a pain in the neck! But knowing the distributions can help your search
A 🧵to help you remember cervical radicular pain distributions #medstudenttwitter #medtwitter #radres #FOAMed #FOAMrad #neurorad #Meded #backpain #spine #Neurosurgery
A 🧵to help you remember cervical radicular pain distributions #medstudenttwitter #medtwitter #radres #FOAMed #FOAMrad #neurorad #Meded #backpain #spine #Neurosurgery
2/First, a rule of thumb—or rather a rule of elbow! You have 10 fingers. If you divide that in half, you get 5. Similarly, if you divide your arm in half at the elbow, you get 5--C5 that is! C5 radiates towards the elbow. So if it radiates below this, it is > C5 & above is < C5
3/So let’s start with C2. C2 predominantly radiates along the dorsal aspect of the scalp, as it supplies the greater occipital nerve. I remember this bc the number 2 has a swan like neck that mimics the contour of the back of the head and its distribution
1/Even attendings have to use google sometimes! Never be afraid to do whatever it takes to get the right diagnosis
A🧵about an interesting spine case that I gasped, “What the…” when I opened it #medtwitter #radres #FOAMed #FOAMrad #neurorad #Meded #backpain #spine #Neurosurgery
A🧵about an interesting spine case that I gasped, “What the…” when I opened it #medtwitter #radres #FOAMed #FOAMrad #neurorad #Meded #backpain #spine #Neurosurgery
2/Older pt w/lower extremity numbness. MRI showed intradural, extra-axial rounded lesions in the lower thoracic region that avidly enhanced on post-contrast imaging—like gang busters enhancement
3/On the T2 weighted images, the lesions showed a very distinct donut-like appearance, with a very dark, almost black rim and a bright center.
1/”Tell me where it hurts.” How back pain radiates can tell you where the lesion is—if you know where to look!
A 🧵about how to remember lumbar radicular pain distributions. #medstudenttwitter #medtwitter #radres #FOAMed #FOAMrad #neurorad #Meded #backpain #spine #Neurosurgery
A 🧵about how to remember lumbar radicular pain distributions. #medstudenttwitter #medtwitter #radres #FOAMed #FOAMrad #neurorad #Meded #backpain #spine #Neurosurgery
2/Let’s start with L1. L1 radiates to the groin. I remember that b/c the number 1 is, well, um…phallic. So the phallic number 1 radiates to the groin.
3/Let’s skip to L3 for a second. I remember L3 is to the knee—easy, it rhymes!
Kicking off “Spine: Disc & Vertebra” at #SNRXXII/#ASNR22
Diana Gomez-Hassan, John Carrino, & @lubdha_shah.
@TheASNR @WorldFNRS
Diana Gomez-Hassan, John Carrino, & @lubdha_shah.
@TheASNR @WorldFNRS
Dr. Walter Bartinski on “Discography: To Be or Not To Be” at #SNRXXII/#ASNR22. Poetic #spine #radiology from experienced #NeuroRad faculty!
Dr. Alessandra Splendiani discusses “Non-anatomic: Functional Dynamic Evaluation of Degenerative Spine Disease” at #SNRXXII/#ASNR22. This hybrid meeting has some great #spine #radiology virtual talks, also available on-demand!
#NeuroRad
#NeuroRad
Everyone’s trying to sell you something, or take something off you, or get you to do something.
Everyone’s out for themselves.
No one can be trusted.
People are greedy.
People are lazy.
It’s a dog-eat-dog world.
That’s how I sometimes feel.
1/31
#shieldofvalues
#trust
Everyone’s out for themselves.
No one can be trusted.
People are greedy.
People are lazy.
It’s a dog-eat-dog world.
That’s how I sometimes feel.
1/31
#shieldofvalues
#trust
But it’s far from the truth, isn’t it?
These are just the lies we’re being told – or it’s people behaving that way because of the lies they’ve been told.
2/31
#shieldofvalues
#greed
These are just the lies we’re being told – or it’s people behaving that way because of the lies they’ve been told.
2/31
#shieldofvalues
#greed
Our media is our enemy – and much of our schooling too.
We’re victims of cognitive imperialism – and the invading empire has established its outposts in the hinterlands of our minds.
3/31
#media #Enemy #shieldofvalues
We’re victims of cognitive imperialism – and the invading empire has established its outposts in the hinterlands of our minds.
3/31
#media #Enemy #shieldofvalues
Major Gen P. V Sardesai (Rtd) passes away at #Pune, recently. He was 80. @adgpi @AK7CAV @IaSouthern @bharatrakshak
@LestWeForgetIN @FlagsOfHonour @aparanjape @nitingokhale @ShivAroor @Girbane @MandarDiwakar @pune_pro
@LestWeForgetIN @FlagsOfHonour @aparanjape @nitingokhale @ShivAroor @Girbane @MandarDiwakar @pune_pro
He showed extraordinary valour in the 1965 Indo-Pak battle. His unit had almost reached #Lahore, When he got an important msg, which was to be conveyed to the commanding officer. #CO #Tanks #War
As thr was no wireless communication working, the then Captain Sardesai, stepped out of his tank, amongst constant bombshelling he made sure that his CO gets the message from top Officers.
#Oregon’s #HERC will be #reviewing its formally passed (2016) #back #spine #note60medicaid #prohibition-policy in #August. Where they intructed doctors/ providers to #force #taper back #pain patients. It will be virtual and allow public comment if you register.
If you need a rehash of what note 60 is, please lmk. content.govdelivery.com/accounts/ORDHS…
This is a very important meeting for us all to stand behind. For a myriad of reasons.
Esp concerning not only for the Nation but Oregon. The back review for medicaid specifically. Using the same influencers for a review is of concern.
painnewsnetwork.org/stories/2020/4…
painnewsnetwork.org/stories/2020/4…
Chou, to be blunt. Chou’s work was referenced numerous times for the development of #Oregon’s #medicaid back #spine #prohibition #forced #taper #GL60 policy (that predates the chronic pain task force).
Using Chou’s work again for the review? Is a major concern.
Using Chou’s work again for the review? Is a major concern.
AHRQ title or not, Chou is principle researcher on both the previous back spine Guideline note 60, AND the upcoming review - of said back/ spine guidelines.
“Definition of insanity comes to mind”. What results should be expected?
“Definition of insanity comes to mind”. What results should be expected?
