C- Spine Flashcards
Forms the central axis of the skeleton
Vertebral Column
-Located in posterior trunk
Vertebral Column
Functions of the vertebral column
-Encloses and protects spinal cord
-Supports trunk and skull
-Provides muscle attachments
How many vertebrae are there in early life
33
The vertebral column is composed of small irregular bones called?
Vertebrae
how many vertebrae are true, movable vertebrae
24
which are false, fixed vertebrae
Sacral and coccygeal segments
Vertebral column is divided into five groups named according to region they occupy
Cervical vertebrae
Thoracic vertebrae
Lumbar vertebrae
Sacral vertebrae
Coccygeal vertebrae
Which regions have a lordotic curve
cervical and lumbar
which regions have a kyphotic curve
thoracic and pelvic
do lordotic curves convex or concave anteriorly
convex anteriorly
do kyphotic curves convex or concave anteriorly
concave anteriorly
has four curves that arch anteriorly and posteriorly from midcoronal plane
vertebral column
is a condition of abnormal lateral curvature of the spine
Scoliosis
is a condition of increased kyphotic curve of the thoracic spine (T-spine)
Kyphosis
How are the curves in scoliosis
curves right in the thorax and left in the lumbar
Comes out of normal space and pushed nerve ending
herniated nucleus pulposus (HNP)
“Slipped disk”
outer, fibrocartilaginous disk
Annulus fibrosus
where is the vertebral column centered ?
-Centered in the midsagittal plane
what fuses into the sacrum
-Sacral vertebrae fuse into the sacrum
what fuses to form the coccyx
-Coccygeal vertebrae fuse to form coccyx
How does the cervical curve anteriorly ?
Convex
how many groups is the vertebral column divided into
5
how does the thoraccic curve anteriorly
concave
how does the lumbar curve anteriorly ?
convex
How does the pelvic curve anteriorly ?
Concave
what helps separate the vertebrae and is composed of fibrocartilage
intervertebral disks
Disk is composed of
Annulus fibrosus
and
Nucleus pulposus
central, soft mass of the disk
Nucleus pulposus
allows movement of the bone
intervertebral disks
common area for slipped disks
L5 and S1
Two main parts of a typical vertebra
-body (anterior)
-Vertebral arch (posterior)
The two parts (body and vertebral arch) enclose a space called?
The vertebral foramen
What does the articulation of vertebral foramina form?
Vertebral canal
What is the vertebral arch formed by?
-two pedicle
-two laminae
-the above support four articular processes, two transverse processes and one spinous process
how do the laminae project from the pedicles
posteriorly and medially from the pedicles
What projects from the posterior part of the body of the typical vertebrae
pedicles
The bottom of the typical vertebrae is concave to form ?
Bottom is concave to form vertebral notches
Articulation of vertebral notches form ?
intervertebral foramina
what doe the lamina join together to create/form
posterior arch
what is the most posterior par of the vertebrae ?
spinous process
what projects laterally and a little posteriorly from junction of laminae and pedicles
Transverse process
what projects posteriorly and inferiorly from junction of both laminae ?
spinous process
what is a congenital condition in which the laminae fail to fuse
spina bifida
how many articular processes arise from junction of pedicles and laminae
4
-two superior
-two inferior
articulate with vertebrae above and below to form?
zygapophyseal joints
what is zygapoohyseal joints also called?
interarticular facet joints
what is the area in which the superior and inferior part of one vertebrae to the other articulate creating the joint space
zygapophyseal joints
how many cervical spine are there?
7
What occupies the neck region ?
Cervical Vertebrae
unique features in the Cervical Vertebrae
-Transverse foramina located on transverse processes
-Bifid spinous processes
what kind of spinous process does the Cervical Vertebrae have
Bifid spinous processes
what cervical vertebrae does not have a spinous process
C1
how is the body of the cervical vertebrae shaped compared to the others
more squared
what are the two atypical of the cervical vertebrae to join with the skull
C1 and C2
C1 is known as
atlas
what is C2 known as
axis
is also atypical bc it joins with Tspine
C7
is atlas on the top or bottom
top
articulates with the back of the skull and occipital bone
C1 atlas
turns around on the dens (odontoid)
C2
Where the head and neck attach and the only vertebrae that does not have a body
C1
makes it possible for our heads to spin/turn around
C2
only vertebrae that does not have a vertebral body
C1
What does C1 consist of
-Anterior arch
-Posterior arch
-Two lateral masses
-Two transverse processes
what does the superior articular. processes of C1 receive ?
Superior articular processes receive the condyles of the occipital bone
Has a conical process, called the dens or odontoid, on upper, anterior of body
C2 (axis)
Odontoid is received into anterior ring of what?
C1
most common fracture of C1?
Jefferson fracture
What two things make up where the odontoid comes through?
The anterior arch and the transverse atlantal ligament
what is C7 also called?
Vertebra prominens
why is C7 also called the vertebra prominens?
Bc of its long, prominent spinous process
what joint is seen on the lateral cervical spine
Zygapophyseal joint
what angle does the Zygapophyseal joint sit at on a lateral
90degrees
what view is the Zygapophyseal joint seen on the cervical spine
lateral
90degrees
for the cervical spine what is seen on the obliques ?
Intervertebral Foramen
what view is the Intervertebral Foramen
seen on the cervical spine
obliques
@ 45 degrees
The dens is located on
C2
What unique anatomic feature is found in the typical cervical vertebra
Presence of the transverse foramina in transverse processes.
what is the distance for cervical spine projections except for open mouth and ap axial
60-72
What is the SID for open mouth and ap axial
40 degrees
recommended breathing for lateral c spine
suspension after full expiration
why do we do suspension after full expiration for lateral c spine
to depress shoulders
breathing for open mouth cspine
phonates “ah”
why does the patient phonate “ah” during open mouth
to depress tongue to floor of mouth
What is the breathing for swimmers cervical spine
breathing technique to blur lung anatomy
what are the essential projections of the Cspine
AP (Fuchs) for dens
AP open-mouth position for C1 and C2
AP axial
Lateral (Grandy)
Lateral
-Hyperflexion
-Hyperextension
Lateral (swimmer’s technique)
-Cervicothoracic Region
AP axial oblique
Right posterior oblique (RPO)
Left posterior oblique (LPO)
PA axial oblique
Right anterior oblique (RAO)
Left anterior oblique (LAO)
which side do we mark down for cervical oblique projections
mark side down
SID for open mouth
40 inches
CR for open mouth
Directed perpendicular to the IR
Enters patient at midpoint of open mouth
part position for open mouth
-Align edge of upper incisors and mastoid tip perpendicular to IR
-occlusal plane
-Mouth open as wide as possible
What view should you not do if there is a cervical fracture
Fuchs
what is sometimes called a tip shot
Fuchs
only upper part of dens is demonstrated
Fuchs
why is the open mouth done ?
for C1 and C2
why is fuchs usually done
if you are unable to get the tip on the open mouth
patient position for fuchs
supine
patient position for open mouth
supine or standing up
SID for fuchs
40 inches
when doing the fuchs what happens to the dens
dens with in the foramen magnum
Part position for AP dens (Fuchs)
Extend chin until tip is vertical
Midsagittal plane (MSP) of head perpendicular to IR
Central Ray for AP dens (Fuchs)
Perpendicular
Enters patient on MSP, just distal to chin tip
What is not seen in the fuchs that is seen on the open mouth
the lateral masses are not seen bc it is mainly done for the tip shot
what spaces should be equal in the open mouth and if the space is not open what does that indicate
equal spaces between the lateral masses and dens and if there is not equal spaces that most likely indicates there is a fracture so stop what you are doing
patient position for AP Axial C Spine
upright or supine
SID for AP Axial C spine
40 inches
where are you centering for AP axial C spine
C4
Degree of angulation for AP axial C spine
15 to 20 degrees
CR for AP axial Cp spine
Directed through C4 at 15 to 20 degrees cephalad
part position for AP axial C spine
Shoulders in same horizontal plane
MSP aligned with long axis of IR
MSP of head perpendicular
Extend chin to place occlusal plane perpendicular to tabletop
what does the 15 to 20 degrees do for the AP Axial C spine
opens up disc space
what vertebrae is seen on the ap cervical spine ?
seeing 3 to 7, not 1 and 2
what is the breathing for the ap axial cspine
suspended breathing (hold your breath)
demonstrates
zygapophyseal joints
of cervical spine.
Lateral projection
patient position for the lateral c spine (Grandy)
Upright, seated or standing
part position for lateral c spine (GRANDY)
MCP perpendicular to IR
MSP parallel to IR
Shoulders in same horizontal plane, relaxed down
Chin elevated and mandible protruded
CR for Lateral c spine (Grandy)
Horizontal and perpendicular to C4
what is recquired if T1 is not demonstrated on the lateral c spine
lateral of cervicothoracic (swimmers)
is required.
what is the SID for lateral cspine
72
what is the breathing for the lateral c spine
expiration to depress shoulders
where do we center for lateral c spine
C4
lateral c spine is done to see which two joint spaces
C7 and T1
-Used to demonstrate
absence of normal movement
from trauma or disease
(mobility)
-ex. whiplash
Lateral c-spine (hyperflexion and hyperextension)
patient position for Lateral C-Spine Hyperflexion and Hyperextension
Upright, seated or standing
part position for hyperextension
Same as for lateral (Grandy)
Hyperextension: Have patient relax head as far back as possible
part position for hyperflexion
Same as for lateral (Grandy)
Hyperflexion: Have patient put chin as close to chest as possible
What is the CR for Lateral C-Spine Hyperflexion and Hyperextension
Horizontal and perpendicular to C4
what is the distance for Lateral C-Spine Hyperflexion and Hyperextension
72 inches
what is being demonstrated on the ap axial oblique cspine
Intervertebral foramina
on side farther from IR are demonstrated.
patient position for AP Axial Oblique C-Spine
Upright, seated or standing, in 45-degree posterior oblique position (preferred)
Recumbent 45-degree posterior oblique position
what is shown on the lateral cspine hyperextension/ hyperflexion
all seven sinous processes C1-C7
where do we center for AP Axial Oblique C-Spine
C4
where do we center for lateral c spine (grandy) and Lateral C-Spine Hyperflexion and Hyperextension
C4
CR for AP Axial Oblique C-Spine
Directed to C4 at 15 to 20 degrees cephalad
Part position
AP Axial Oblique C-Spine
Head and body at 45-degree angle from IR
C-spine centered to IR
IR centered to C4
Chin elevated and protruded
What is demonstrated on PA Axial Oblique C-Spine
Intervertebral foramina
on side closer to IR are demonstrated.
Distance for AP Axial Oblique C-Spine
72inches
SID for PA Axial Oblique C-Spine
72 inches
what does the angle do on the AP Axial oblique cspine
opens up the foramen
patient positon for PA Axial Oblique C-Spine
Upright, seated or standing, in 45-degree anterior oblique position (preferred)
Recumbent 45-degree anterior oblique position
what is the breathing for the ap axial oblique cspine
suspended breathing
what is the degree of angulation for the AP axial oblique cspine
15-20
what is the position for AP axial oblique c spine projections
rpo and lpo
how many degrees of oblique is the ap axial oblique cspine
45 degrees
for ap axial oblique cpsine what side do we mark
the side that is down
part position for PA Axial Oblique C-Spine
Head and body at 45-degree angle to IR
C-spine in center of IR
IR at level of C4
Chin elevated and protruded
CR for
PA Axial Oblique C-Spine
Directed to C4 at 15 to 20 degrees caudad
what is the pa axial oblique cspine positions
rao and lao
where do we center for PA Axial Oblique C-Spine
c4
what is the benefit of doing the pa axial oblique cspine instead of ap
less oid
degree of angulation for pa axial oblique cspine
15-20 degrees caudad
This projection is needed
when C7 is not well demonstrated
on lateral C-spine projection.
Lateral (swimmer’s technique)
the swimmers technique shows what junction
C7 and T1
SID for Lateral Cervicothoracic (Swimmer’s)
40inches
patient position for Lateral Cervicothoracic (Swimmer’s)
Upright, seated or standing, in true lateral position
Recumbent true lateral position with head resting on arm or other firm support
what is it called when the patient is standing up for Lateral Cervicothoracic (Swimmer’s)
Twinning
Method
what is it called when patient is lying down for Lateral Cervicothoracic (Swimmer’s)
Pawlow
Method
what is the part position for Lateral Cervicothoracic (Swimmer’s)
MCP centered to midline of grid
Extend arm closer to IR above head, and rotate humeral head anteriorly
If upright, flex elbow, and rest forearm on head
Depress shoulder farther from IR, if possible
Head and body in true lateral position
C7-T1 interspace in center
CR for Lateral Cervicothoracic (Swimmer’s)
Perpendicular to C7-T1 interspace if shoulder away from IR is depressed
if shoulder cannot be depressed for Lateral Cervicothoracic (Swimmer’s) how much should you angle
If shoulder cannot be depressed, angle 3 to 5 degrees caudad
Which essential projection of the cervical vertebrae demonstrates the left zygapophyseal joints?
Lateral, left lateral position
What is the CR angle and direction for the AP axial oblique projection of the cervical vertebrae?
15 to 20 degrees cephalad
Recomended breathing for AP Axial Cspine
Respiration suspended
recomended breathing for AP Axial Obliques (LPO/RPO) cspine
Respiration suspended
SID for AP Axial Obliques (LPO/RPO) Cspine
60-72inches
recomended breathing and SID for PA Axial Obliques
(RAO/LAO)
Respiration suspended
60”-72” SID is recommended
breathing and SID for lateral grandy method
Respiration suspended at end of full expiration
60”-72” SID is recommended
breathing and SID for lateral flexion and extension
Respiration suspended
60-72” SID is recommended
breathing and SID for AP fuchs method
Respiration suspended
40” SID
breathing and SID for CERVICO-
THORACIC REGION
Lateral
Twining Method
Respiration suspended or use shallow breathing
40” SID
Breathing and SID for Lateral
Pawlow Method CERVICO-
THORACIC REGION
Respiration suspended
40” SID
