C Spine/thoracic Flashcards
List the four anteroposterior curves of the vertebral column and indicate if thy are kyphotic or lordotic
Cervical curvature ➡️ lordotic
Thoracic curvature➡️ kyphotic
Lumbar curvature ➡️ lordotic
Sacral curvature➡️ kyphotic
List the 5 regions of the vertebral column and list the number of vertebrae in each
Cervical (true) ➡️7 vertebrae Thoracic (true) ➡️ 12 vertebrae Lumbar (true) ➡️ 5 vertebrae Sacrum (false) ➡️ 5 that fuse to 1 Coccyx (false) ➡️ 3-5 that turn to 1
The _______ and ______ curves are primary curves present at birth
Thoracic and sacral
The _________ curve is a secondary curve that develops when a baby begins to lift his head
Cervical
________is an abnormal exaggerated thoracic curve or “humpback”. It is a (convex/concave) forward curve.
Kyphosis / convex
__________ is an abnormal exaggerated lumbar curve or “sway back”. It is a (convex/concave) forward curve.
Lordosis/ concave
_________ is an abnormal lateral curvature of the spine.
Scoliosis
The ______ process is the process extending posteriorly from the vertebral arch.
Spinous
The two ________ processes extend laterally from the vertebral arch
Transverse
The vertebral body is located on the (anterior/posterior) aspect of the verteba
Anterior
The _________ of the vertebra above articulates with the superior articular facet of the vertebra below to form the _______joint in the articulated vertebral column
Inferior articular/vertebral process
Zygapophyseal
The two _______ are the portions of the vertebral arch that extend posteriorly from the postero lateral margin of the vertebral body
Pedicles
The upper surface of the pedicle is the _______.
Superior vertebral notch
In the articulated vertebral column, the superior vertebral notch and the inferior vertebral notch of the vertebra above form an opening termed the _________.
Intervertebral foramen
What passes through the intervertebral foramen?
Spinal nerves and blood vessels
What are found between the vertebral bodies of the articulated vertebral column
Intervertebral disks
The inner portion of the intervertebral disk is the semi-gelatinous ________ and the outer is a tough fibrous ______.
Nucleus pulposus
Annulus fibrosis
When the inner portion escapes its confines and bulges out causing pressure on spinal nerves it is called ______or slipped disc
Herniated nucleus pulposus (HNP)
What is the structural classification, mobility, and movement type between the vertebral bodies
Mobility= amphiathrodial Structural= cartilaginous Movement = n/a
What is the structural classification, mobility, and movement type of the zygapophyseal joints
Mobility=diarthrodial
Structural=synovial
Movement=plane/gliding
What is the structural classification, mobility, and movement type of the atlantooccipital joint
Mobility = diarthrodial Structural = synovial Movement = ellipsis
What is the structural classification, mobility, and movement type of the atlantoaxial joint
Mobility = diarthrodial Structural = synovial Movement = trochoid/pivot
Which joint allows the movement of the head when you say “no”
Atlantoaxial / C1-C2
Which joint allows the movement of the head when you say “yes”
Atlantooccipital
Another name for C1
Atlas
Another name for C2
Axis
Which cervical vertebrae has many features of a thoracic vertebrae, including a long spinous process.
C7
Describe how the transverse foramina of cervical vertebrae are unique
Only the C spine has 3 foramen
Thoracic and lumbar only have 1
Describe how the spinous processes of the cervical vertebrae are unique
They are shorter and have bifid tips
The short column of bone located at the junction of a pedicle and a lamina of a cervical vertebrae is termed the _______ and is composed of _______and ______
Articular pillar
Inferior articular process and superior articular process
Which cervical vertebrae lacks both a vertebral body and a spinous process
Atlas /C1
The atlas is a ring made of the _______ anteriorly and _________posteriorly and two lateral masses
Anterior arch
Posterior arch
What is the distinctive feature of C2 that is a process of bone projecting superiorly from the body
Dens / odontoid
The spinous process of C7 is located at the level of the body of
T1
Which vertebrae is located at the level of the mastoid tip
C1
The palpable landmark that lies at the level of C3 is the
Gonion / angle of mandible
Which vertebrae is located at the level of the thyroid cartilage
C4-C5
What anatomy is demonstrated in a lateral c-spine (joints/foramina)
Zygapophyseal joints
What anatomy is demonstrated in RAO c-spine (joint/foramina)
Right intervertebral foramina
What anatomy is demonstrated in LAO c-spine (joint/foramina)
Left intervertebral foramina
What anatomy is demonstrated in RPO c-spine (joint/foramina)
Left intervertebral foramina
What anatomy is demonstrated in LPO c-spine (joint/ foramina)
Right intervertebral foramina
On a trauma patient with neck injury, which projection should be done first and why?
Cross table lateral, so the radiologist/dr can determine if the spinal chord is compromised
List the routine for a trauma c-spine
Lateral
Both obliques
AP
Odontoid
What SID is a lateral c-spine and why?
72”
To reduce magnification caused by OID
Gould the lateral c-spine be taken on inspiration or expiration and why?
Expiration
To relax the shoulders down
The most inferior interspace that should be visualized on the x-table lateral c-spine is
C7-T1
If the interspace between c7-T1 cannot be visualized with a lateral c-spine, which position should you do?
Swimmers
To position the patient for the open mouth odontoid, the flexion of the head should be such that the____________ line is perpendicular o the IR
Lower margin of the base of the incisors to the mastoid tips
List the routine projections for the routine c-spine
Lateral
Both obliques
AP
+/- odontoid
On the AP axial c-spine, the CR is angled ________ degrees to enter the MSP just below the thyroid cartilage and to exit at the level of _________
< 15-20
C4
How do you determine the patient was in a true AP with no rotation on the AP axial C-spine image?
Spinous process and SC joints equidistant
Mandible and base of skull superimposed over C1-C2
The patient is rotated ______ degrees for the RAO or LAO c-spine and the CR is directed _________degrees (cephalad/caudad) to exit at the level of the thyroid cartilage
45
15-20
Caudad
How do you determine that the patient properly extended their chin on the RAO c-spine image?
The jaw line does not superimpose on the vertebrae
When performing the erect lateral c-spine, the top of the IR should be placed at the level of the
Ear attachment
When positioning the patient for the erect lateral c-spine, the coronal plane passing through the _________ should be centered to the middle of the IR
C4 thyroid cartilage
How do you determine the patient was in the true lateral position with no rotation or tilt on the erect lateral c-spine image
Intervertebral joint spaces are clearly seen.
Bodies should be free of superimposition of articular pillars
Posterior boarders of bodies are superimposed
Superimposition of right and left zygapophyseal joints
Why do you have to angle c-spine AP an oblique
Because the vertebral bodies overlap
Avulsion (pulling or tearing away) fracture of the spinous process of any vertebra C6-T1; may see double spinous process sign on AP radiograph bc of displacement of avulsed fractured segment
Clay shovelers fx
Wedge shaped vertebral body from lateral perspective; irregular spacing from AP perspective
Compression fx
Fx of the anterior C2 arch, usually also with anterior subluxation (partial dislocation) of C2 on C3
Hangmans fx
Bilateral offset or spreading of the lateral masses of C1 relative to dens
Jeffersons fx
Possible narrowing in disk spacing between vertebrae and protrusion of disk into spinal canal on CT or MRI
Herniated nucleus pulposus (HNP)
Abnormal or exaggerated convex thoracic curvature
Kyphosis
Abnormal or exaggerated lateral curvature of spine
Scoliosis
Degeneration of cartilage and formation of osteophytes (bony outgrowths)
Osteoarthritis
Most common radiographic examination for clay shoveler’s fx
Lateral and AP c-spine
CT
Most common radiographic examination for compression fx
Lateral and AP of affected spine
CT
Most common radiographic examination for hangman’s fx
Lateral c-spine
CT
Most common radiographic examination for jefferson’s fx
AP open mouth (odontoid) of C1-C2
Lateral x table
CT
Most common radiographic examination for herniated nucleus pulposus (HNP)
AP and lateral of affected spine
MRI
Most common radiographic examination for kyphosis
Lateral t-spine
Scoliosis series, including lateral bending
Most common radiographic examination for osteoarthritis
AP and lateral C and/or T spine
Most common radiographic examination for osteoporosis
DXA bone density exam of AP L-spine and lateral hip
The two main parts of a typical vertebra are the
Body and vertebral arch
The ________ are two bony aspects of the vertebral arch that extend posteriorly from each pedicle to join at the midline
Lamina
The ______ foramina are created by two small notches on the superior and inferior aspects of the Pedicles.
Intervertebral
The opening or passageway for the spinal cord is the
Vertebral spinal canal
The spinal cord begins with the ______ of the brain and extends down to the ______ vertebra, where it tapers and ends. This tapered ending is called the ________
Medula oblongata
Lower boarder of L1
Conus medullaris
What is found between the superior and inferior articular processes
Zygapophyseal joints
T/F the zygapophyseal joints of all vertebrae are visualized only in a true lateral position
False
C1-C2 is visible with AP or frontal projection
A short column of bone found between the superior and articular processes in a typical cervical vertebra is called
Articular pillar
What I the term for the articular pillar for the C1 vertebra
Lateral masses
The zygapophyseal joints for the second through the seventh cervical vertebrae are at ________ degree angle to the midsagittal plane
90
The thoracic vertebrae are at a _______ degree angle to the midsagittal plane
70-75
What is the name of the joint found between the superior articular processes of c1 and the occipital condyles of the skull
Occipitoatlantal articulation
The modified body of C2 is called the
Dens or odontoid process
A lack of symmetry of the zygapophyseal joints between C1 and C2 may be caused by injury or may be associated with
Rotation of the skull
Which specific thoracic vertebrae are classified as typical thoracic vertebrae (I.e. They least resemble cervical or lumbar vertebrae)
T5-T8
For the central Ray to pass through and “open” the intervertebral spaces on a 45 degree angle posterior oblique projection of the cervical vertebrae, what central Ray angle is required
15 degree cephalad
The upper portion of the sternum
The mandibrum
The superior margin of the mandibrum
Jugular notch / suprasternal notch
The center portion of the sternum
The body
The joint between top and center portion of the sternum
Sternal angle
The most inferior aspect of the sternum
Xiphoid process (tip)
The gonion is at what vertebral level
C3
The xiphoid process is at what vertebral level
T9-T10
The thyroid cartilage is at what vertebral level
C4-C5
The jugular notch is at what vertebral level
T2-T3
The sternal angle is at what vertebral level
T4-T5
The mastoid tip is at what vertebral level
C1
The vertebral prominence is at what vertebral level
C7-T1
3-4inches below the jugular notch is at what vertebral level
T7
What organs are radiosensitive and of greatest concern during cervical and thoracic spine radiography
Gonads, thyroid, parathyroid, and breast
Two advantages of using higher KVP exposure factors for spine radiography, especially on AP thoracic spine
Increased density
Decrease in pt dose
T/F When using digital imaging for spine radiography, it is important to use close collimation, grid, and lead masking
True
To ensure that the intervertebral joint spaces are open for lateral thoracic spine projections it is important to
Keep the vertebral column parallel to the IR
For lateral and oblique projections of the cervical spine, it is important to minimize magnification and maximize detail by
Using small focal spot and increasing SID
Differences between spondylitis an spondylosis
Spondylitis is an inflammatory process of the vertebrae
Spondylosis is a condition of the spine characterized by rigidity of a vertebral joint
Most geriatric pts have a fee of falling of the table
True
What is the name of the radiographic procedure that requires the injection of contrast media into the subarachnoid space
Myelography
Which imaging modality is ideal for detecting early signs of osteomyelitis
Nuclear medicine
Which two landmarks must be aligned for an AP “open mouth” projection
Lower margin of upper incisors and base of skull
What is the purpose of the 15-20 degree angle for the AP axial projection of the cervical spine
To open up intervertebral disk spaces
For an AP axial of the cervical spine, a plane through the tip of the mandible and __________ should be parallel to the angled central Ray
Base of the skull
T/F less CR angle is required for the AP axial projection of the cervical spine of the examination is performed supine rather than erect
True
What are the two important benefits of a SID longer than 40 inches for the lateral cervical spine projection
Compensates for increased OID; reduces magnification
Less divergence of xray beam to reduce shoulder superimposition of C7
Which foramina are demonstrated with a LPO position of the cervical spine
The right intervertebral foramen (upside)
Which foramina are demonstrated with a LAO position of the cervical spine
Left intervertebral foramen (downside)
In addition to extending the chin, which additional position technique can be performed to ensure that the mandible is not superimposed over the upper cervical vertebrae for the oblique projections
Rotate the skull to a near lateral position
What is the recommended SID for a lateral projection o the cervical spine
60-72 inches
The lateral projection I the cervical spine should be taken on inspiration or expirariton and why
Expiration to bring the shoulders all the way down
The proper name for the swimmers position is
Twining method
Where should the CR be for swimmers
T1 1 in above the jugular notch or level of vertebral promines
Which region of the spine must be demonstrated with the swimmers position
C5-T3
Which projection is considered a “functional study” of the cervical spine
Hyperextention and hyper flexion lateral positions
When should the Judd or Fuchs method be performed
If unable to demonstrate the upper part of the debs with the open mouth AP
Which AP projection of the cervical spine demonstrates the entire upper cervical spine with one single projection
Wagging jaw
Which two things can be done to produce equal density along the entire thoracic spine for the AP projection (especially for a pt with a thick chest)
Correct use of anode-heel effect; use of compensating wedge filter
Which zygapophyseal joints are demonstrated in a RAO projection of the thoracic spine
Right (downside)
Which projections delivers the greatest skin dose to the Pt
Cervicothoracic lateral positions
T/F The thyroid dose used during a posterior oblique cervical spine projection is more than 10 times greater than the dose used for an anterior oblique projection of the cervical spine
True
Which structures are best demonstrated with an AP axial vertebral arch projection
Articular pillars (lateral masses)
What CR angle must be used with the AP axial vertebral arch projection
20-30 degrees Caudad
Which zygapophyseal joints are best demonstrated with a LPO position of the thoracic spine
Right
How much rotation of the body is required for an oblique position of the thoracic spine from a true lateral position
20 degrees from a lateral position
