C Spine And T Spine Flashcards
Total bones in vertebral column
Children 33
Adult 26
What are the 5 divisions of the vertebral column
Cervical vertebrae Thoracic vertebrae Lumbar vertebrae Sacrum Coccyx
When stacked what forms the spinal canal
The vertebral foramina
Spinal canal
Begins at the base of the skull and extends to the sacrum
What does the spinal canal contain
Contains spinal cord and is filled with cerebrospinal fluid
Spinal chord
Enclosed and protected by the spinal canal
Begins with medulla oblongata
The spinal chord passes through what
The foramen magnum of the 1st cervical vertebra and ends at the lower level of L-1
Where does the spinal chord terminate
The conus medullaris
In some people the conus medullaris may extend to as low as
The body of L-2
To avoid striking the spinal chord what is a common site for lumbar puncture
L-3 L-4
Intervertebral disks
Fibrocartilage disks that separate adult vertebrae
Where are there no intervertebral disks?
C1 and C 2
Function of intervertebral disks
Act as a cushion
Allow for flexibility and movement of vertebral column
The intervertebral disks account for how much length of the vertebral column
One quarter the length
what is the inner portion of the intervertebral disks
nucleus pulposus
what is the outer portion of the intervertebral disks
annulus fibrosus
nucleus pulposus
central core of disk
pulpy and gelatinous
annulus fibrosis
fibrocartilage disk
surrounds nucleus pulposus
keeps nucleus material in the center
herniated nucleus pulposus (HNP)
when the nucleus pulposus ruptures and protrudes into the vertebral canal and impinges on a spinal nerve
AKA slipped disk
where does an HNP most commonly occur?
the lumbar region
cervical vertebrae
the most superior 7 vertebrae
occupy the region of the neck
thoracic vertebrae (dorsal)
next 12 bones after the cervical spine
forms the midback region
articulates with the ribs
lumbar vertebrae
next 5 vertebrae after the thoracic
form the lower back
largest and strongest vertebrae
the load of the body weight increases toward the inferior end of the column which are common sites of injury
sacrum
the 5th lumbar vertebrae articulates with the sacrum
articulates with the coccyx inferiorly
coccyx
the sacrum and coccyx develop as multiple separate bones and fuse into two distinct bones
vertebral curvatures
when viewed from the side the vertebral column has 4 curves
they are either concave or convex
concave curve
a rounded inward or depressed surface
like a cave
convex curve
rounded outward or elevated surface
cervical and lumbar regions have what curvatures
concave curvatures
thoracic and sacral regions have what curvatures
convex curvatures
primary curves
soon after birth the thoracic and sacral curves begin to develop
they’re called primary curves
secondary/compensatory curves
cervical and lumbar curves because they develop after birth
when does the cervical curve develop
when the child begins to hold the head up at about 3-4 months
when does the lumbar curve develop
when the child begins to walk
what is the purpose of the vertebral curvatures
increase strength of vertebral column
maintain balance in upright position
which curves are usually more pronounced in women
lumbar and sacral curves
3 abnormal distortions of the normal spinal curvature
- lordosis
- kyphosis
- scoliosis
lordosis
bent backward “swayback”
any abnormal increase in the posterior concavity of the lumbar or cervical region
also can be a normal concavity
what can lordosis be caused by
pregnancy, obesity, poor posture, rickets, or tuberculosis of the spine
kyphosis
humpback
any abnormal increase in the posterior convexity of the thoracic curve
results in stooped posture/ reduced height
what can kyphosis be caused by
compression fractures, poor posture, rickets, or other spinal diseases
in the frontal view the vertebral column is
near straight with a little lateral curvature
True or false:
a slight lateral curvature is sometimes present in the upper thoracic region
TRUE
True or False:
the slight lateral curve is to the right in right handed pts. and to the left in left handed pts.
TRUE
scoliosis
any abnormal curvature of the spine
occurs when a pronounced S-shaped lateral curve exists
true or false:
the vertebral column develops a second or compensatory curve in the opposite direction to keep the head centered over the feet
TRUE
a typical vertebrae is composed of what 2 main parts
- body
2. vertebral arch
- body
thick, weight bearing anterior portion of the vertebra
cylindrical in shape
- vertebral arch (neural arch)
consists of a ring or arch of bone extending posteriorly from the vertebral body
vertebral foramen
where the body and the arch enclose a space
true or false:
when the vertebrae are stacked on one another, the vertebral foramina form the vertebral canal that encloses the spinal cord
TRUE
pedicle
extends posteriorly from the vertebral body
little feet
form the sides of the vertebral arch
true or false:
the superior and inferior borders of the pedicles are concave
True
the concave border of the upper surface of the pedicle is called?
superior vertebral notch
the concave border of the lower surface of the pedicle is called?
inferior vertebral notch
when the vertebrae are stacked, the inferior and superior vertebral notch line up and form the?
intervertebral foramina
what runs through the intervertebral foramina
spinal nerves and blood vessels
lamina
posterior part of vertebral arch
extend posteriorly from the pedicle to form the spinous process
transverse process
project laterally from the pedicles
between lamina and pedicles
spinous process
extends posteriorly from the midline
serve as points of attachment for muscles
spina bifida
a congenital defect of the vertebral column when the lamina fail to unite posteriorly at the mid line
superior and inferior articular processes
4 processes that arise from the junction of the pedicles and lamina to articulate with the vertebra above and below
the articular surfaces are covered with fibrocartilage and are called
facets
each superior articular process has a facet on its
posterior surface
each inferior articular process has a facet on its
anterior surface
zygopophyseal joints
the articulation of the superior articular process of one vertebra to the inferior articular process of the vertebra above
3 joints of the vertebral column
- intervertebral joints
- zygopophyseal joints
- costal joints
True or False
without the costal joints respiration could NOT occur
TRUE
- intervertebral joints
slightly movable
between the vertebral bodies
intervertebral disks are located in these joints
- costal joints
located in the thoracic region
articulate with the rib and the vertebra
costovertebral joints
head of the rib articulates with the body of the vertebra
costotransverse joints
tubercle of the rib articulates with the transverse process of the vertebra
Atypical cervical vertebrae
first 2 vertebrae and the seventh vertebrae
C1 and C2 are modified to join the skull
C7 long spinous process to join the thoracic vertebrae
typical cervical vertebrae
C3-C6
contain:
transverse foramina, bifid spionous process tips, overlapping vertebral bodies, 3 foramina
transverse foramen in cervical vertebrae
the hole in each transverse process
vertebral artery veins and certain nerves pass through here
pillar
between the superior and inferior articular process is a short column of bone
in C1 what is the pillar called
lateral mass
the superior articular process of C1 contains a facet that articulates with what
the occipital condyles of the skull
atlantoocipital articulation
the articulation between the atlas and the occipital bone
Jefferson fracture
comminuted fracture that occurs as a result of axial loading AKA landing on ones head or abruptly on ones feet
the skull slams into the ring and the anterior and posterior arches of C1 are fractured
true or false
thoracic vertebra have facets and demifacets on them for the ribs
TRUE
what is the level of the mastoid tip
C1
what is the level of the gonion
C3
what is the level of the thyroid cartilage
C4-C6
what is the level of the vertebra prominens
C7 or the body of T1
whats the level of the jugular notch
T2 T3
what is the level of the sternal angle
T4 T5
cervical spine routine projections
AP open mouth
AP axial
Obliques
Lateral
cervical spine special projections
cervicothoracic lateral, twining method, swimmers lateral hyperflexion hyperextension AP fuchs PA judd AP wagging jaw (ottonello method) AP axial (pillar)
Thoracic spine routine projections
AP
Lateral
Thoracic spine special projection
obliques
CERVICAL SPINE
AP open mouth shows
fractures involving C1 and C2
demonstrates jefferson fractures
CERVICAL SPINE
AP open mouth SID/Central ray
SID = 40
8x10 IR
CR is perpendicular to the IR directed through the center of the open mouth
line from lower margin of upper incisors to mastoid tip is perpendicular to IR
taken on expiration
If the dens cannot be seen on the AP open mouth then what do you do
do the fuchs or the judd method
CERVICAL SPINE
AP axial shows
pathology involving C3-C7
shows clay shoveler’s fracture, compression fracture and HNP
Clay shoveler’s fracture
results from hyperextension of neck and causes avulsion fracture of spinous process of C6-T1
compression fracture
associated with osteoporosis
collapse of a vertebral body
CERVICAL SPINE
AP axial SID/central ray
SID = 40 8x10 ir same alignment as AP open mouth CR centered at level of thyroid (C4-C5) angle 15 degrees cephalad when supine angle 20 degrees caudad when upright suspend breathing
CERVICAL SPINE
obliques show
intervertebral foramina
CERVICAL SPINE
obliques SID/central ray
SID = 40-72 72 preferred 8x10 or 10x12 45 degree obliquity elevate chin CR 15 degrees caudad at C4 for RAO/LAO CR 15 degrees cephalad at C4 for RPO/LPO suspend breathing
CERVICAL SPINE
obliques
Anterior oblique positions/PA oblique projections show
downside RAO (right), LAO (left) intervertebral foramina
CERVICAL SPINE
obliques
posterior oblique positions/AP oblique projections show
upside
RPO (left) LPO (right)
intervertebral foramina
CERVICAL SPINE
lateral shows
spondylosis and osteoarthritis C1-C7/T1 SID = 60-72 8x10 or 10x12 CR perpendicular directed to C4 suspend on full expiration shows the zygopophyseal joints
if C7/T1 is NOT shown on a lateral C-spine you must perform what
a swimmer’s lateral
hangman’s fracture
occurs when neck is subjected to extreme hyperextension
very unstable fracture due to the dens pressing against the brain stem
odontoid fracture
involves the dens and can extend into the lateral masses or arches of C1
teardrop burst fracture
due to compression with hyperflexion
vertebral body comminuted with triangular fragments posterior body displaced into spinal canal
quadriplegia is a high probability
subluxation
vertebral body appears to have jumped over the vertebral body immediately inferior to it
CERVICAL SPINE
swimmer’s lateral cervicothoracic shows
(twining method)
SID 60-72
10x12
arm and shoulder closes to IR is elevated and rotated anteriorly
CR perpendicular to IR centered 1 inch above jugular notch
a slight caudad angle (3-5 degrees) may be necessary to help separate shoulders
suspend on expiration or use breathing technique
CERVICAL SPINE
hyperflexion/hyperextension
demonstrates vertebral mobility
frequently performed to rule out whiplash injury or to follow up after spinal fusion
same positioning as lateral c spine but one pic with chin depressed one with chin pushed back
CERVICAL SPINE
fuchs (AP) or Judd (PA)
Done only if you did NOT get the dens on the AP open mouth
MML needs to be perpendicular to table
adjust CR angle so it is parallel to MML
suspend breathing
CERVICAL SPINE
ottonello method
mandibular shadow is blurred so you can see the C spine in its entirety
CERVICAL SPINE
AP axial Pillars
shows pillars of C4-C7 SID = 40 supine hyperextend pts. neck CR angled 20-30 degrees CAUDAD to enter through C5 suspend breathing
