C T L Spine Sacrum Coccyx SI Joints Myelogram & Bone Densitometry Flashcards
What anatomy is best demonstrated on oblique views of the cervical spine?
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
What anatomy is best demonstrated on a lateral view of the cervical spine?
Cervical zygopophyseal joints (2nd-7th, the 1st and 2nd are visualized only on an AP) located 90 degrees from MSP
What anatomy is best demonstrated on an LPO or RPO of the thoracic spine?
Thoracic zygapophyseal joints on side UP!!! Patient must be obliqued 70-75 degrees
What anatomy is best demonstrated on a lateral view of the thoracic spine?
Intervertebral foramina
What is best demonstrated on the open mouth Odontoid?
Atlas, axis, dens, and C1-C2 zygopophyseal joint space opened
Why is the swimmers performed and what does it demonstrate?
Performed to demonstrate C7-T1 when they are not visible on the routine lateral.
What are the names for a recumbent swimmers and an upright swimmers?
Recumbent- palow
Upright- twining
Name and describe the primary curves?
- thoracic and sacral
- formed shortly after birth
- convex (posterior) or kyphotic
Describe the first compensatory curve:
- develops in cervical region as baby lifts head and sits up
- concave (posteriorly) or lordotic
Describe the second compensatory curve:
- develops in the lumbar region when children learn to walk
- concave (posteriorly) or lordotic
What is lordosis?
describes the normal posterior concavity of the lumbar and cervical spine, but also describes abnormally increased sway back curvature of lumbar spine. “bent backwards”
What is kyphosis?
describes an abnormal or exaggerated humpback curvature of the thoracic spine with increased convexity posteriorly.
What is scoliosis?
abnormal exaggerated lateral curvature S shaped spine. often seen in ages 10-14, may cause deformity of the entire thorax
What is the protocol for a patient with cervical spine trauma?
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!!
Describe the clay shovelers fracture:
- 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
Describe hangman’s fracture:
- occurs with severe hyperextension
- extends thru the pedicles of C2 with or without subluxation of C2 or C3
- dens is pressed against brain stem
What is a jeffersons fracture?
anterior and posterior arches of C1 splinter due to impact of the skull.
Describe the teardrop burst fracture:
vertebral body is comminuted with triangular fragments displaced into the spinal canal. high probability that it will result in quadriplegia
Define osteoporosis:
When normal bone tissue atrophies causing holes in the bone causing it to weaken. It develops over time and is asymptomatic
What does BMD and ROI stand for?
bone mineral density
region of interest
What are the risk factors for osteoporosis?
- 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
what are the routine bone densitometry projections?
L Spine and both hips
What is the alternate projection for BD and when would it be used?
-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
.-
What is a T score and what is it for normal bone versus osteoporosis?
- Compares the pt w/ an average, young healthy individual with peak bone mass
- normal=above -1
- osteoporosis=below -2.5
describe the procedure for the L spine scan:
Pt supine legs flexed
- ROI is L1-L4
- Scan L5S1 -T12
- if abnormality is found then it should be deleted
describe the procedure for the hip scan:
- 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
What is myelography?
Radiologic exam of the CNS structures situated within the vertebral canal. may be performed of C T or L spine
Why is myelography performed?
- To demonstrate spinal cord compression
- to asses disk diseases in patients who can’t have an MRI
Where does the spinal cord begin and end?
Begins at the medulla oblongata of the brain and ends at the L1 L2 disk space.
What is the myelographic significance of where it ends?
It is important bc the puncture is made below the spinal cord proper.
What is the importance os the subarachnoid space?
It contains the cerebrospinal fluid and it is the area that the spinal needle is introduced to inject contrast into the spinal canal.
At what level is the spinal puncture made?
L2L3 or L3L4
What supplies are necessary for a myelogram?
myelogram tray, spinal needles, contrast media
Why is the pt asked to hyperextend neck during a myelogram?
to prevent contrast from entering the brain
What films are usually performed following a lumbar myelogram? Cervical?
XTL and PA for both
What type of contrast is used for myelography?
Non ionic, water soluble, intrathecal approved.
What anatomy is demonstrated on the lateral L spine?
intervertebral foramina
What anatomy is demonstrated on a 30-60 degree LPO or RPO L spine?
Zygapophyseal joint on side DOWN!
Define all the anatomical parts of the scotty dog on an oblique L-spine: Nose Eye Neck Ear Leg
Nose-transverse process Eye-pedicle Neck-pars interarticularis Ear-superior articular process Leg-inferior articular process ***Dog is facing down on RPO/LPO
What is the routine for a scoliosis series?
PA/AP
Lateral
AP right and left bending
What is ankylosing spondylitis?
- 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
What is a chance fracture?
hyper flexion of the L spine. Often from a lap seat belt
What is herniated nucleus pulposus?
herniated slipped disk
What is spina bifida?
congenital, posterior aspects of the vertebra do not develop exposing part of the spinal cord. Occurs most often at L-5. Varies in severity.
What anatomy is demonstrated on posterior oblique views of the SI joints?
LPO/RPO SI Joints demonstrate the SI joint on the UPSIDE. CR is perpendicular, 1 inch medial to upside ASIS