C-spine Flashcards
The transverse process arises from both _____ and _____
pedicle and body
The vertebral artery + veins pass through the _____
transverse foramina
T or F : there are 3 foramina that run vertically of the cervical vertebrae
True (R/L transverse foramina, vertebral foramen)
What range of cervical vertebrae have short bifid tips?
C2-C6
T or F : the anterior edge of cervical vertebral bodies are slightly more inferior, which causes overlapping of vertebral bodies
True
What part of C1 is described as:
- between the superior and inferior articular processes, is a short column/pillar, supports the weight of the head and assist in rotation of the head
lateral mass
These joints are located at right angles (90 degrees) to the MSP, thus visualized only in a true lateral position (C2-C7 only)
Zygapophyseal joints
What projection can the C1 zyga joint be seen only in?
AP Open mouth projection
What is the joint called in between C1 and C2?
Atlantoaxial joint
The intervertebral foramina can be identified by the _____? (they form the superior and inferior boundaries of the foramina)
pedicles
The intervertebral foramina are situated _____ to the MSP and are directed at a _____ degree inferior angle because of shape and overlapping of cervical vertebrae
45 degree oblique and a 15 degrees inferior
T or F: To open up and demo the c-spine’s intervertebral foramina, a 90 degree position with a 15 degree cephalad angle would be required
False, 45 degree oblique position w/15 degree cephalad angle
There is no _____ on the atlas (C1) but anteriorly has a anterior arch
body
Rather than two laminae and a spinous process, C1 has a _____
posterior arch
Articulations between C1 and the occipital condyles of the skulls are called _____
Atlantooccipital joints
T or F: embryologically, the odontoid process is actually the body of C1 then during development it fuses to C2
True (considered part of C2 in mature skeletons)
T of F: rotation of the head primarily occurs between C1-C3 with the odontoid process acting as a pivot
False, occurs between C1-C2
T or F: articulations between C1-C2 (atlantoaxial jt) are symmetric, therefore the relationship of the odontoid to C1 should be symmetric
True (if asymmetric, cause is injury or improper positioning)
What are the three joints/articulations involved between C1 and C2? Name their classification, mobility type, and movement type
R+L lateral atlantoaxial and medial atlantoaxial. All are Synovial and Diarthrodial, movement type is plane/gliding for R-L lateral and trochoid/pivot movement for medial
Where is the medial atlantoaxial joint articulation located?
Between the odontoid process of C2 and the anterior arch of C1
List the classification, mobility type, and movement type for the atlantooccipital joint
Synovial, Diarthrodial, and Ellipsoid/condyloid
T or F: because the last 4-5 cervical vertebrae have slightly lipped appearance and along w/ its general shape, a 20 degree cephalad angle is required to open up the lower intervertebral spaces in an AP projection
True
What two anatomical areas of the c-spine hold important info to physicians? (Bc of their relationship between consecutive vertebrae)
Intervertebral foramina and zyga joints
Where the zyga joints located?
Between the articular pillars of each vertebra
What cervical vertebrae and located at the level of the mastoid tip or 2.5 cm below EAM?
C1
What cervical vertebrae is located at the level of the gonion?
C3
What cervical vertebrae is located at the level of the Adam’s apple/thyroid cartilage?
C5
T or F: the spinous process of C7 is at the same level as the body of T1
True
If a patient is concerned about dose to their thyroid, what position can the tech do to reduce dose to the thyroid area? (Cspine projection)
C-spine oblique positioning in LAO/RAO instead of LPO/RPO position
Kv range for analog system and digital systems for a c-spine?
Analog: 70-85 kV
Digital: 75-85 kV
What are three ways scatter radiation can be reduced?
Close collimating, lead, and grid
When would a grid not be used? (2 reasons)
If the anatomy is less than 10cm or for a lateral c-spine the IR placement is far therefore creating an air gap technique (this reduces scatter reaching IR)
Name the pathology - results fr. hyperflexion of the neck that may include avulsion fractures (on spinous processes of C6-T1). best demo’d on a lateral c-spine
Clay Shoveler’s fracture
Name the pathology - frequently associated w/ osteoporosis, involves collapse of a vertebral body which results fr. Flexion or axial loading. Anterior edge collapses, changing vertebral body into a wedge shape. Best demo’d on a lateral projection.
Compression fracture
Name the pathology - fracture extends through pedicles of C2 with or w/out subluxation of C2 on C3. Happens when the neck is in extreme hyperextension
Hangman’s fracture
Name the pathology - nucleus pulposus protrudes through the annulus fibrosus (fibrous cartilage) into spinal cord causing pain, numbness radiating into extremities. Best demo’d in MRI, involves levels at L4-L5
Herniated Nucleus purposes (slipped disk)
When positioning the patient for an AP open mouth, what is an important part position to align in order to see the odontoid?
Aligning the lower margin of the upper incisors to the BOS (mastoid tips)
T o F: for an AP open mouth, the tongue does not obscure C1 and C2 so its position does not matter
False - keep the tongue in the lower jaw to prevent its shadow from superimposing the atlas and axis
What anatomy should be demonstrated in an AP open mouth?
Dens + body of C2, transverse process + lateral mass of C1, and the atlantoaxial joint
In an AP open mouth, how would you fix positioning if the teeth are superimposed on the upper dens
Reposition by slight hyperextension of the neck OR use a cephalic angle
In an AP open mouth, how would you fix positioning if the BOS is superimposed on the upper dens
Reposition by slight hyperflexion of the neck OR use a caudad angle (BOS/upper incisors projected 2.5 cm for every 5 degree caudad angle)
How can you detect if there is rotation in an AP open mouth? (3 things)
there should be equal distances from lateral masses/transverse processes of C1 to mandibular condyles, center alignment of spinous process of C2, and angle of mandible/mastoid tips equal distance fr. IR
In an AP axial projection, explain what you would do to start positioning the patient
Ensure lower margin of upper incisors + BOS are perpendicular to the able and the tip of the mandible to BOS should be parallel to the angle of the CR
what angle do you use for an AP axial projection? (supine vs. erect) and where is the centering located?
supine - 15 degrees cephalad + centered @ C4 (lower margin of thyroid cartilage)
erect - 20 degrees cephalad+ centered @ C4 (lower margin of thyroid cartilage)
Why is it necessary to use a 15-20 degree cephalad angle for an AP axial projection?
To demo the intervertebral disk spaces
For an AP axial, If a patient has severe kyphosis what angle would be used?
An angle more than 20 degrees (20 degrees is used for a more evident lordotic curvature)
T or F the mandible and BOS should superimpose the first two cervical vertebrae for an AP axial projection
True
Which vertebral bodies should be demonstrated on an AP Axial projection
C3-T2
Where do you look if there is rotation on an AP Axial projection?
spinous processes/SI jts (if visible) should be equidistant fr. the lateral borders of the spinal column
Why should both sides be examined when doing Oblique C-spines ?
for comparison purposes
How should the chin be positioned for an AP oblique?
protracted to prevent mandible fr. superimposing vertebrae & elevated to place AML // with the floor
T or F: in an AP oblique, elevating the chin too much will superimpose the BOS over C1
True
Anterior Oblique c-spine positions use what type of angle and where is the CR? is the side being demo’d side up or side down
15-20 degree CAUDAD to C4 (@ level of upper margin of thyroid cartilage) & demonstrates the anatomy that is side down
Do posterior Oblique c-spine positions demonstrate the side up or side down intervertebral foramina and pedicles?
Demos the side farthest from the IR
(LPO = right side)
(RPO = left side)
What type of angle is used if the patient was in an RPO position?
15-20 degree CEPHALAD angle to CR
To demonstrate the left side foramina/pedicles in an Oblique c-spine how can a patient be positioned?
LAO or RPO
if right side affected, RAO or LPO
In an Oblique c-spine, where would the opposite on-end pedicles be located?
the opposite on-end pedicles are aligned along the anterior cervical body
In an oblique c-spine, you are starting to see zyga joints, this indicates: over-rotation or under-rotation?
over-rotation
In an oblique c-spine, if the intervertebral foramina and pedicles are obscured this indicates: over-rotation or under-rotation?
under-rotation
A patient with spondylosis and osteoarthritis are clinical indications for what C-spine projection?
Lateral c-spine
The _____ is aligned to the CR for a Lateral c-spine
MCP
What are important instructions given to the patient in a Lateral c-spine to ensure visualization of C7-T1 ?
relax + drop shoulders down and forward as far as possible
T of F: the AML in a Lateral C-spine should be // to the floor
True (chin is elevated)
In a lateral c-spine, to prevent superimposition of the mandible on the upper vertebrae(C1-C2), the patient must _____
protract their chin
Why should the Lateral c-spine be done at 72” (180 cm) SID?
To compensate for the increased OID and provide better spatial resolution
If non-trauma, in a lateral c-spine what can be done to help depress the shoulders?
Give the patient 5-10 lb weights suspended fr. each wrist
T or F: in a Lateral c-spine the intervertebral foramina, zyga jts, intervertebral jts, articular pillars, and spinous processes are demonstrated
False, all except the intervertebral foramina are shown
