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
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.
4/If the force is shearing, rather simply compress a vertebral body, you rip the connection between the vertebral bodies—this is the equivalent of pulling on a long bone & causing its dislocation from its joint or connection with another bone. This is worth 3 points
5/Similar to shear forces, distracting forces will rip the vertebral bodies apart. But rather than sliding forward or back, the vertebral bodies are pulled up or down, resulting in a vertical gap between the vertebral bodies. This is worth 4 points
6/This summarizes the TLICS scoring for fracture morphology. The higher the number, the greater the force and injury to the spine—ranging from simple compression fxs worth only 1 point to where the spine is literally ripped apart—a distraction injury, worth 4 points.
7/The next TLICS imaging finding is the integrity of the PLC. If it is intact, you get 0 pts. If you needed a tweetorial for that, well…I can’t help you much. If there is edema, but no true rupture on MRI, that is worth 2 pts. True disruption on MRI is worth 3 pts.
8/Here is an example of suspected injury—edema is seen in the posterior ligamentous complex, but the T2 dark lines that are the ligaments themselves appear intact. This is worth 2 pts.
9/If you can find a true disruption or gap in the T2 dark line of the ligament, that is considered truly disrupted and worth 3 points.
10/Here is the summary of the scoring for PLC injury in TLICS. Edema is suspicious, but only a true gap is considered injured.

So now you know how to score imaging findings in thoracolumbar fxs--I hope that takes a load off your back!

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More from @teachplaygrub

Jul 15
1/Is remembering cerebellar anatomy making you dizzy? Need help telling your flocculus from your nodule?
Here’s some help w/a #anatomy #tweetorial on the 9 lobules of the vermis!#medtwitter #FOAMed #FOAMrad #medstudent #neurorad #radres @medtweetorials #neurosurgery @StefanTigges
2/Coming from anterior, the first lobule is the lingula. It sticks out from the front of the vermis & is connected to the superior cerebellar peduncle. I remember this bc it has a very appropriate name—lingula—it looks like a tongue sticking out of the vermis to lick the SCP.
3/Moving clockwise, next is the central lobule. I remember this bc it is positioned exactly how a central lobule should be positioned, in the driver’s seat—where the front seat driver position would be if the vermis was a car—up front, looking out the windshield over the lingula
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Jul 12
1/”That’s a ninja turtle looking at me!” I exclaimed. My fellow rolled his eyes at me, “Why do I feel I’m going to see this on twitter soon…”He was right! A 🧵about 1 of my favorite imaging findings & pathology behind it #medtwitter #FOAMed #FOAMrad #medstudent #neurorad #radres Image
2/Now the ninja turtle isn’t an actual sign—yet! But I am hoping to make it go viral as one. To understand what this ninja turtle is, you have to know the anatomy. I have always thought the medulla looks like a 3 leaf clover in this region. Image
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Jul 6
1/ “Now listen carefully!” Does the word “tbone” make you think of a tough guy nickname before ear anatomy? Do you know the CT ice cream cone & then nada? Then you need this #tweetorial on tbone anatomy! #medtwitter #FOAMed #FOAMrad #medstudent #neurorad #radres @medtweetorials
2/For the middle ear, I have a rule of 3s. The middle ear is divided into 3 parts and it contains three ossicles. Today we will focus on the ossicles—each of which has 3 parts!
3/The first ossicle you meet when you enter the middle ear is the malleus. It is called the malleus because it acts like a mallet that hits a drum—literally—the ear drum! I think it looks like Dr. Evil’s mini me, with its short body and round bald head
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1/Do radiologists sound like they are speaking a different language when they talk about MRI? T1 shortening what?T2 prolongation who?
Here’s a translation w/a #tweetorial introduction to MRI
#medtwitter #FOAMed #FOAMrad #medstudent #neurorad #radres @MedTweetorials #neurosurgery Image
2/When it comes to bread and butter neuroimaging—MRI is definitely the butter. Butter makes everything taste better and packs a lot of calories. MRI can add so much information to a case Image
3/In fact, if CT is a looking glass into the brain—MRI is a microscope. It can tell us so much more about the brain and pathology that affects the brain. So let’s talk about the basic sequences that make up an MRI and what they can show us. Image
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Jun 22
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
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
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Jun 17
1/Radiologist not answering the phone?Just want a quick read on that stat head CT?

Here's a little help on how to do it yourself w/a #tweetorial on how to read a head CT!
#medtwitter #FOAMed #FOAMrad #medstudenttwitter #medstudent #neurorad #radres @MedTweetorials #neurosurgery Image
2/In bread & butter neuroimaging—CT is the bread—maybe a little bland, not super exciting—but necessary & you can get a lot of nutrition out of it. MRI is like the butter—everyone loves it, it makes everything better, & it packs a lot of calories. Today, we start w/the bread! Image
3/The most important thing to look for on a head CT is blood. Blood is Bright on a head CT—both start w/B. Blood is bright bc for all it’s Nobel prizes, all CT is is a density measurement—and blood is denser (thicker) than water and denser things are brighter on CT Image
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