Ch 8 Cervical + Thoracic Flashcards
exam review
Where do you inject for a Myelogram (cervical)?
What is this called?
C1-C2
Subarachnoid space
Cisternal puncture
What is Lordosis?
increased concavity (lumbar)
exaggerated lumbar curvature
(swayback)
What is Scoliosis?
exaggerated lateral curvature of the spine
What is Kyphosis?
increased (exaggerated) convexity in the thoracic area
(humpback)
What is Halatosis? **
what is concave?
rounded inward
or
depressed surface like a cave
what is convex?
rounded outward
or
elevated surface
Cervical is what type of curve?
first compensatory curve
concave
Thoracic is what type of curve?
first primary curve
convex
lumbar is what type of curve?
second compensatory curve
concave
sacrum (sacral) is what type of curve?
second primary curve
convex
What makes up the zygapophyseal joint?
superior and inferior articular processes**
compensatory curve=
concave (lordotic)
(1st cervical) (2nd lumbar)
Primary curve=
What are the 2 primary curves?
convex
(1st thoracic) (2nd sacrum)
What are primary curves?
convex curves
1st primary curve: thoracic
2nd primary curve: sacral
What are compensatory curves?
Concave curves
1st compensatory curve: cervical
2nd compensatory curve: lumbar
Where is the pedicle located? *****
What does it connect?
posterior to the body of the vertebrae
attaches body to vertebral arch
(terminate in the area of the transverse process)
Where are the laminae located? *****
What does it connect?
connects the transverse process to the spinous process
(posterior to transverse anterior to spinous)
In a cervical exam when would we see the zygapophyseal joints? (C2-C7)
true lateral
90 degrees to the midsagittal plane
When do we see the C1 & C2 Z joints?
In an AP open mouth
In a cervical exam when would we see the foramen?
45 degree oblique
When would we best see the intervertebral disk space best?
AP
When the positioning of the patient changes from AP to PA what happens to the angle?
AP to PA would change the angle from being cephalic to caudad and vice versa
How do we position for an open mouth?
upper incisors and base of skull lined up
When taking the Judd and Fuchs what are we looking for and what does it look like?
J: Dens sticking out in the hole of skull (foramen magna)
Book: Den’s and surrounding bony structures of the C1 ring
What is the name of the joint that articulates/connects the skull and the atlas?
Atlantooccipital joint
What is the purpose of the transverse foramen in the cervical spine?
For the nerve roots to connect to the brain **
How many zygapophyseal joints do we see in a lateral (cervical)?
5 Z joints
(C1 & C2 are seen in AP open mouth)
(t/f)
During trauma we are doing a cross table lateral for a cervical spine we don’t see the anatomy demonstrated we would use a sand bag.
false
Sandbags would cause more harm then good
how we position for a flexion cervical?
true lateral
depress chin until it touches chest
How would we position for extension cervical?
true lateral
raise chin and tilt head back as far as possible
What skull line would we use to position for Judd and Fuchs?
MML
(Mentomeatal line)
What is the space called that we inject myelograms?
What level of the spine is this?
Subarachnoid space
Cervical: C1-C2
Lumbar: L3-L4
Which foramen is seen in PA cervical oblique? (RAO/LAO)
downside (closest to IR)
(marker is on side down)
Which foramen is seen in AP cervical oblique?
foramen farthest from IR (upside)
(marker on side up)
(RPO/LPO)
Which foramen is seen on LAO cervical oblique?
how is the projection?
how are the markers?
left foramen (downside)
PA projection
Mark side down, left side (cause that foramen is best demonstrated)
Which foramen is seen on RPO cervical oblique?
how is the projection?
how are the markers?
left foramen (upside so opposite)
AP projection
Marker on side up, left-side (bc that foramen is best shown)
Which foramen is seen on LPO cervical oblique?
how is the projection?
how are the markers?
Right foramen (upside)
AP projection
Marker on side up, right-side (bc that foramen is best shown)
Which foramen is seen on RAO cervical oblique?
how is the projection?
how are the markers?
right side (downside)
PA projection
Marker is side down, right-side (bc that foramen is best demonstrated)
What level is the vertebral prominens at?
C7
What level is the jugular notch located at?
T2-T3
What level is the xiphoid tip located at?
T9-T10
What level is the thyroid cartilage located at?
C5
(varies between C4-C6)
What level is the sternal angle located at?
T4-T5
Where is mid thorax located?
How do we find this?
T7
by going 3-4 inches inferior to
jugular notch for AP
or 7-8 inches below vertebral promenins for PA
What is another way to find mid-thorax in an PA projection?
7-8 inches below vertebra prominens
(7 for women 8 for men)
What level is the EAM located at?
1 inch above C1 (mastoid tip)
At what level is the mastiod tip located?
C1
(one inch inferior to EAM)
What is the jeffersons fx?
fx of C1 Ant & Post arches
from landing on feet/head abruptly
(AP open mouth best demonstrates this)
What is the clay shoveler’s fx?
avulsion fx of C6 to T1 from hyperextending neck
(best demonstrated in a lateral C spine)
What is a compression wedge fx?
collapse of T/L vertebral bodies from flexion
vertebral shapes like a wedge instead of a block
Scoliosis can be caused by:
Neuromuscular disorder
congenital (happens from birth)
idiopathic (just cause)
looking from the posterior aspect the cervical spine appears to be concave or convex?
concave
When do you see the zygapophyseal joints in a thoracic spine?
70-75 degree oblique from the midsagittal plane
When do you see the foramen in the thoracic spine?
90 degrees to the midsagittal plane
(true lateral)
Where is the facet located?
Where is the spinous process located?
Posterior to vertebral body
Where are the zygapophyseal located?
in between inferior/superior articular processes
Where is the thoracic process located?
Where is superior articular process located?
what helps form the intervertebral foramen?
inferior vertebral notch
&
superior vertebral notch
(t/f)
If the patient has a traumatic injury to their spine, its best to manipulate the tube rather than move the patient
true
Moving the patient in trauma situations can lead to more damage
What do you see in a PA cervical oblique?
AO or PO?
how is the positioning?
anterior oblique (AO)
15 degrees caudad
pedicles and foramina closest to IR
Mark side down
what do you see in an AP cervical oblique?
AO or PO?
how is the positioning?
posterior oblique (PO)
15 degrees cephalic
pedicles and foramina farthest from IR
Mark side up?
General:
Why is there a 15 degree cephalic angle for AP/oblique cervical spine?
shape and overlapping of the C-spine vertebrae
Exam:
What do you seen in the lateral cervical spine?
zygapophyseal joints
intervertebral disc space (joint spaces) (not best displayed but general idea)
What do you seen in a lateral thoracic spine?
intervertebral foramen
What do you see in a thoracic oblique spine?
zygapophyseal joints
(70-75 degree oblique)
What is demonstrated in an AP open mouth (cervical)?
C1 & C2 zygapophyseal joints
(AP open mouth)
What are the two main parts of the spine vertebrae?
body
vertebral arch
When do we see the Zygopophyseal joints in Cervical?
And Thoracic?
C spine: lateral L or R
T-spine: 70-75 degree oblique PO or AO
When do we see the intervertebral foramina in a cervical?
And thoracic?
C-spine: 45 degree oblique PO (upside) or AO (downside)
T-spine: lateral L or R
What is demonstrated in an oblique Cervical?
intervertebral foramina
(45 degrees)
What is best demonstrated in a lateral C spine?
Zygapophyseal joints
What is demonstrated in an AP thoracic spine?
intervertebral disc space
What would be some reasons to shoot a scoliosis x-ray PA instead of AP?
radiation safety to:
gonads
eyes
thyroid cartilage
breasts
(Mainly Thyroid)
What can lower the amount of radiation to the patient when shooting a scoliosis x-ray?
a filter (thick to thin)
shielding (brick shield**)
Exam:
What would we do for a functionality test of the spine?
flexion and extension
when would we do a cross table spine?
Trauma **
What is the nucleus pulposus?
(gusher)
inner layer of disk
(soft semi-gelatinous)
What is the annulus fibrosis?
(gusher)
outer layer of disk
Exam:
What projection would require the most amount of dose/penetration?
What is the kvp?
swimmers/ transthoracic cervical
80-90 kvp ***
General:
how many bones in the vertebral column for a child?
how many for an adult?
33 child
26 adult
General:
Where do the first 10 thoracic vertebrae articulate with the ribs?
costotransverse joints
&
costovertebral joints
General:
What is the anterior facet called?
What is the posterior?
Costovertebral joints (anterior facets)
Costotransverse joints (posterior facets)
General:
Where do the 11th and 12th thoracic vertebrae articulate with the ribs?
single costovertebral joints
(because 11/12 are false ribs)
General:
what part of the spine contains the spinal cord?
Vertebral foramen
General:
What does spine vertebrae consist of?
2 pedicles
2 lamina
2 transverse process (lateral)
1 spinous process (posteriorly)
1 large body (anteriorly)
4 articular processes (2 inferior 2 superior)
General:
what forms the zygapophyseal joints?
2 inferior articular processes
2 superior articular processes
(forms left and right Z joints)
General:
what is the space in between the vertebrae called?
intervertebral disc space
General:
what are the “anterior” facets called?
costovertebral joints
(for the head of the rib)
General:
what are the “posterior” facets called?
costotransverse joints
(for the tubercle rib)
General:
What are T1-T4 similar too?
What are T5-T8 referred as?
What are T9-T12 similar to?
cervical vertebrae (small)
typical thoracic vertebrae (medium)
lumbar vertebrae (large)
General:
what is the joint between C1 and the skull?
What type of joint is this?
Atlantooccipital joint
synovial, diarthrodial, ellipsoid (condyloid)
General:
What is the name of the joints between C1 and C2?
What type of joints are these?
R and L lateral atlantoaxial joints
synovial, diarthrodial, plane or gliding
General:
what type of joints are the medial atlantooccipital joints?
synovial, diarthrodial, pivot (trochoid)
General:
What kind of joints are the intervertebral joints? (C2-T12)
amphiarthrodial (slightly moveable)
cartilaginous (symphysis)
General:
What kind of joints are the zygapophyseal joints?
plane or gliding
synovial
diarthrodial
General:
What type of joints are the costotransverse (T1-T10) and the costovertebral (T1-T12) joints?
plane or gliding
synovial
Diarthrodial
General:
How do we see the C-spine intervertebral foramina in an PA projection?
45 degree oblique LAO/RAO
15 degrees caudad
LAO shows left foramina
RAO shows right foramina
(AO shows the same side foramina)
(downside visualized)
General:
How do we see the C-spine intervertebral foramina in an AP projection?
45 degree oblique LPO/RPO
15 degrees cephalic
LPO shows right foramina
RPO shows left foramina
(PO shows the opposite side foramina)
(upside visualized)
General:
C spine AO key differences
15 degrees caudad
LAO/RAO
AO shows downside (same side) foramina
(ex: LAO shows left foramina)
General:
C spine PO key differences
15 degrees cephalic
LPO/RPO
PO shows upside (opposite side) foramina
(ex: LPO shows right foramina)
General:
when do you see the vertebral foramina in a T-spine x-ray?
R or L lateral
General:
When do you see the Zygapophyseal joints in a Thoracic spine?
70 degree oblique
LPO/RPO = upside (PO shows opposite side)
LAO/RAO =Downside (AO shows same side)
General:
what does wagging jaw best show?
General:
What are the cervical landmarks?
mastoid tip (C1)
gonion (C3)
thyroid cartilage (C5) (Adam’s apple)
vertebral Prominens (C7) last cervical spinous process
General:
what are the thoracic landmarks?
jugular notch (T2-T3)
sternal angle (T4-T5)
mid-thorax (T7) (3-4 inches below jugular notch or 7-8 inches below prominens)
xiphoid tip (T9-T10)
General:
What is the CR for AP open mouth?
What is best shown?
Upper incisors & base of skull lined up
CR is mid-mouth
Odontoid process (Dens) & C1 and C2
General:
What is the CR for a AP axial cervical?
What is best shown?
15 (supine) - 20 (erect) cephalic
CR is C4
disk space from C3-T2
General:
What is the CR for Oblique?
What is best shown?
RAO/LAO is 15 caudad
RPO/LPO is 15 cephalic
CR is C4
Foramen and pedicles best shown
General:
What is the CR for Lateral Cervical?
true lateral
CR is C4
expose on second expiration (to drop shoulders)
General:
What is the CR for Swimmers lateral cervical spine?
left arm raised, right arm dropped
3-5 caudad
CR is T1
(1 inch above jugular notch)
expose of second full expiration
General:
What is the CR for flexion cervical?
CR is C4
expose on 2nd expiration
head depressed to chin
General:
What is the CR for extension cervical?
CR is C4
expose of 2nd expiration
tilt head back as far as possible
General:
What is CR for Fuch’s method?
What does it best show?
AP projection
CR is parallel to MML
Dens and bony structures of C1
General:
What is the CR for Judd’s method?
What is best shown?
PA projection
CR is parallel to the MML
Dens/ Bony C1 is best shown
General:
What is the CR for AP Cervical wagging Jaw?
What is it also known as?
What is best shown?
CR is C4
mandible in continuous motion
OTTONELLO method
C1-C7 vertebral bodies w/ blurred mandible
General:
What is the CR for AP Axial projection vertebral arch (pillars)?
What is best shown?
20 to 30 caudad
CR is C5
Zygapophyseal joints in AP
General:
What is the CR for AP thoracic spine?
Best shown?
CR is T7
expose of expiration
intervertebral disk space
General:
What is the CR for lateral Thoracic spine?
CR is T7
intervertebral disk space and foramen
General:
What is the CR for Oblique thoracic spine?
what is best shown?
70 degree oblique
2nd full expiration
CR is T7