C T L Spine Sacrum Coccyx SI Joints Myelogram & Bone Densitometry

Question 1

What anatomy is best demonstrated on oblique views of the cervical spine?

Answer 1

Intervertebral foramina, located 45 degrees from MSP. Must use 15 degree cephalic or caudal angle depending on which oblique it is to open up the foramina

Question 2

What anatomy is best demonstrated on a lateral view of the cervical spine?

Answer 2

Cervical zygopophyseal joints (2nd-7th, the 1st and 2nd are visualized only on an AP) located 90 degrees from MSP

Question 3

What anatomy is best demonstrated on an LPO or RPO of the thoracic spine?

Answer 3

Thoracic zygapophyseal joints on side UP!!! Patient must be obliqued 70-75 degrees

Question 4

What anatomy is best demonstrated on a lateral view of the thoracic spine?

Answer 4

Intervertebral foramina

Question 5

What is best demonstrated on the open mouth Odontoid?

Answer 5

Atlas, axis, dens, and C1-C2 zygopophyseal joint space opened

Question 6

Why is the swimmers performed and what does it demonstrate?

Answer 6

Performed to demonstrate C7-T1 when they are not visible on the routine lateral.

Question 7

What are the names for a recumbent swimmers and an upright swimmers?

Answer 7

Recumbent- palow

Upright- twining

Question 8

Name and describe the primary curves?

Answer 8

• thoracic and sacral
• formed shortly after birth
• convex (posterior) or kyphotic

Question 9

Describe the first compensatory curve:

Answer 9

• develops in cervical region as baby lifts head and sits up

- concave (posteriorly) or lordotic

Question 10

Describe the second compensatory curve:

Answer 10

• develops in the lumbar region when children learn to walk

- concave (posteriorly) or lordotic

Question 11

What is lordosis?

Answer 11

describes the normal posterior concavity of the lumbar and cervical spine, but also describes abnormally increased sway back curvature of lumbar spine. “bent backwards”

Question 12

What is kyphosis?

Answer 12

describes an abnormal or exaggerated humpback curvature of the thoracic spine with increased convexity posteriorly.

Question 13

What is scoliosis?

Answer 13

abnormal exaggerated lateral curvature S shaped spine. often seen in ages 10-14, may cause deformity of the entire thorax

Question 14

What is the protocol for a patient with cervical spine trauma?

Answer 14

patient should not be moved until a cross table lateral C-spine film has been obtained and cleared by a physician. do not move head or neck, or remove c-collar!!

Question 15

Describe the clay shovelers fracture:

Answer 15

• caused by hyper flexion of the neck
• results in avulsion fracture on the spinous processes of C6 thru T1
• best demonstrated on lateral c-spine

Question 16

Describe hangman’s fracture:

Answer 16

• occurs with severe hyperextension
• extends thru the pedicles of C2 with or without subluxation of C2 or C3
• dens is pressed against brain stem

Question 17

What is a jeffersons fracture?

Answer 17

anterior and posterior arches of C1 splinter due to impact of the skull.

Question 18

Describe the teardrop burst fracture:

Answer 18

vertebral body is comminuted with triangular fragments displaced into the spinal canal. high probability that it will result in quadriplegia

Question 19

Define osteoporosis:

Answer 19

When normal bone tissue atrophies causing holes in the bone causing it to weaken. It develops over time and is asymptomatic

Question 20

What does BMD and ROI stand for?

Answer 20

bone mineral density

region of interest

Question 21

What are the risk factors for osteoporosis?

Answer 21

• women (white or asian, thin framed, older)
• previous fx, or family history of hip fx
• smoking
• hormone level
• premature menopause, amenorrhea
• neuromuscular disorders
• chronic steroid use
• Poor vision, disability
• vitamin D defficiency

Question 22

what are the routine bone densitometry projections?

Answer 22

L Spine and both hips

Question 23

What is the alternate projection for BD and when would it be used?

Answer 23

-If the pt has had surgery to the spine/has scolliosis/has compression fx, a PA forearm can be used instead of the L spine
-can be done normally if one hip is good but if neither hips can be scanned then do a PA forearm in place of the hip
.-

Question 24

What is a T score and what is it for normal bone versus osteoporosis?

Answer 24

• Compares the pt w/ an average, young healthy individual with peak bone mass
• normal=above -1
• osteoporosis=below -2.5

Question 25

describe the procedure for the L spine scan:

Answer 25

Pt supine legs flexed

• ROI is L1-L4
• Scan L5S1 -T12
• if abnormality is found then it should be deleted

Question 26

describe the procedure for the hip scan:

Answer 26

• Pt supine legs extended, legs internally rotated w/ feet wrapped around support
• scan should include femoral head and neck, greater trochanter, and 1.5” of femur
• if only 1 hip is being done it should be on the pt non dominant side

Question 27

What is myelography?

Answer 27

Radiologic exam of the CNS structures situated within the vertebral canal. may be performed of C T or L spine

Question 28

Why is myelography performed?

Answer 28

• To demonstrate spinal cord compression

- to asses disk diseases in patients who can’t have an MRI

Question 29

Where does the spinal cord begin and end?

Answer 29

Begins at the medulla oblongata of the brain and ends at the L1 L2 disk space.

Question 30

What is the myelographic significance of where it ends?

Answer 30

It is important bc the puncture is made below the spinal cord proper.

Question 31

What is the importance os the subarachnoid space?

Answer 31

It contains the cerebrospinal fluid and it is the area that the spinal needle is introduced to inject contrast into the spinal canal.

Question 32

At what level is the spinal puncture made?

Answer 32

L2L3 or L3L4

Question 33

What supplies are necessary for a myelogram?

Answer 33

myelogram tray, spinal needles, contrast media

Question 34

Why is the pt asked to hyperextend neck during a myelogram?

Answer 34

to prevent contrast from entering the brain

Question 35

What films are usually performed following a lumbar myelogram? Cervical?

Answer 35

XTL and PA for both

Question 36

What type of contrast is used for myelography?

Answer 36

Non ionic, water soluble, intrathecal approved.

Question 37

What anatomy is demonstrated on the lateral L spine?

Answer 37

intervertebral foramina

Question 38

What anatomy is demonstrated on a 30-60 degree LPO or RPO L spine?

Answer 38

Zygapophyseal joint on side DOWN!

Question 39

Define all the anatomical parts of the scotty dog on an oblique L-spine: 
Nose
Eye
Neck
Ear
Leg

Answer 39

Nose-transverse process
Eye-pedicle
Neck-pars interarticularis
Ear-superior articular process
Leg-inferior articular process
***Dog is facing down on RPO/LPO

Question 40

What is the routine for a scoliosis series?

Answer 40

PA/AP
Lateral
AP right and left bending

Question 41

What is ankylosing spondylitis?

Answer 41

• inflammatory arthritis
• begins with the SI joints and progresses up the vertebral column.
• Spine becomes rigid as intervertebral and costovertebral joints fuse
• Most common in men ages 17 and 35.
• Chronic condition causing pain and stiffness

Question 42

What is a chance fracture?

Answer 42

hyper flexion of the L spine. Often from a lap seat belt

Question 43

What is herniated nucleus pulposus?

Answer 43

herniated slipped disk

Question 44

What is spina bifida?

Answer 44

congenital, posterior aspects of the vertebra do not develop exposing part of the spinal cord. Occurs most often at L-5. Varies in severity.

Question 45

What anatomy is demonstrated on posterior oblique views of the SI joints?

Answer 45

LPO/RPO SI Joints demonstrate the SI joint on the UPSIDE. CR is perpendicular, 1 inch medial to upside ASIS