Ch 9 - Cervical Spine Flashcards
What is another name for the vertebral column?
Spine
What is the primary function of the vertebral column?
Encloses and protect the spinal cord
Acts as a support for the trunk
Supports the skull superiorly
Provides for attachment to the deep muscles of the back and ribs laterally
How many cervical vertebrae are there?
7
How many thoracic vertebrae are there?
12
How many lumbar vertebrae are there?
5
How many sacral vertebrae are there?
5 fused to 1
How many coccygeal vertebrae are there?
3-5 fused to 1
How many vertebrae are present in early life?
33
What are the true vertebrae?
The 24 vertebral segments in the upper three regions
What are the false vertebrae?
The pelvic and two lower regions
What are the four curves of the vertebral column called?
Cervical, Thoracic, Lumbar, and Pelvic curves
What is lordosis?
Any abnormal increase in the anterior convexity
Which parts of the spine demonstrate a lordotic curve?
Cervical and lumbar
What is kyphosis?
Any abnormal increase in the anterior concavity
Which parts of the spine demonstrate a kyphotic curve?
Thoracic and pelvic spines
What is scoliosis?
Any abnormal lateral curvature of the spine
What angle do the lumbar and pelvic curves join at?
Lumbosacral angle
Which curves are considered primary curves?
Thoracic and Pelvic curves
When does the cervical curve develop?
When infants start holding up their head at 3-4 months
When does the lumbar curve develop?
When children begin to walk at 1-1.5 years
What are disc composed of?
- Annulus fibrous - outer, fibrocartilaginous disk
- Nucleus pulosus - central, soft mass
What is an HNP?
Herniated nucleus pulosus or “slipped disk”
What is the typical shape of a vertebral body?
Cylindrical
What are the two main parts of a typical vertebra?
Anterior mass (body) and posterior ringlike portion (vertebral arch)
What forms the vertebral arch?
Two pedicles and two laminae
What do the pedicles and laminae support?
Two transverse processes and one spinous process
What direction do the pedicles project from the body of the vertebreae?
Posteriorly and their surfaces are concave and are called vertebral notches
How and where do the transverse processes project from?
Laterally and poseteriorly from the junction of the pedicles and laminae
How and where do the spinous process project from?
Posteriorly and inferiorly from the junction of the laminae and posterior midline
What arise from the junction of the laminae to articulate with the vertebrae above and below?
Four articular processes - 2 superior and 2 inferior processes
What is the first cervical vertebra called?
Atlas
What unique feature does the Atlas have?
Ringlike structure with no body
What does the anterior portion of the Atlas ring receive?
Dens (odontoid process) from C2
What is the second cervical vertebra called?
Axis
What process arises from the upper surface of the body of the Axis?
Dens
What is the seventh cervical vertebra known as?
Vertebra prominens
What is a typical cervical vertebra’s body shape?
Small, oblong with slightly elongated anteroinferior borders
How many foramina does a typical cervical vertebra have?
Three: right and left transverse foramina, and vertebral foramen
What is the function of the transverse foramina in cervical vertebrae?
Transmit the vertebral artery and vein
What are the characteristics of spinous processes in cervical vertebrae?
Short with double pointed tips (bifid)
Where are the superior and inferior articular processes located on a cervical vertebra?
Posterior to the transverse processes
What angle do the Z joints of the 2nd-7th cervical vertebrae lie at?
Right angle to the MSP
What are the projections for cervical spine?
- AP Open Mouth (Odontoid)
- AP Axial
- AP Fuchs (optional)
- AP “Wagging Jaw”
- Lateral
- Flexion & Extension (optional)
- RPO / LPO
or
RAO / LAO
What is the patient position for AP Axial Cervical Spine?
Supine or upright facing the tube with the MSP centered to the grid and chin slightly extended so that the occlusial plan is perp to the tabletop
What is the tube angle for AP Axial Cervical Spine?
15-20 degrees cephalic
Where is the central ray positioned in AP Axial Cervical Spine?
Angled at C4, entering slightly inferior to the thyroid cartilage
What are the structures demonstrated in AP Axial C-Spine?
Lower 5 cervical bodies and upper 2 or 3 thoracic bodies and intervertebral disk spaces
What is the evaluation criteria for AP Axial C Spine?
- Area from superior portion of C3 to T2 and surrounding soft tissue
- Shadows of the mandible and occipital bone superimposed over the atlas and the axis
- Open intervertebral disk spaces
- Spinous processes in the center of the vertebral bodies
- Mandibular angles and mastoid process equidistant to vertebrae
What is the position for the AP “Open Mouth” Projection?
Patient placed in the supine or upright position facing the tube with the MSP centered to the midline of the grid and patient’s mouth opened as wide as possible with head adjusted so that a line from the lower edge of the upper incisors is perpendicular to the IR.
What is the Central Ray position for the AP “Open Mouth” Projection?
- Perpendicular to the center of the IR and entering the midpoint of the open mouth (C1-C2 space)
What are the structures demonstrated in AP “Open Mouth” projection?
An AP projection of the atlas and axis through the open mouth
What are the evaluation criteria for the AP “Open Mouth” Projection?
- Dens, atlas, axis and between articulations
of 1st and 2nd cervical vertebrae - Entire joint space between atlas and axis
- Wide open mouth
- Mandibular rami equidistant from dens
When should the Fuch’s method be used?
When the dens was not able to be clearly demonstrated in the open mouth position
What is the patient position for the Fuch’s method?
Patient in the supine or upright position facing the tube with the MSP centered to the midline of the grid and IR centered at the top of the Mastoid process
How is the central ray positioned in Fuchs method?
Perpendicular and enters the neck on the MSP level just distal to the tip of the chin
What are the structures demonstrated in the Fuchs method?
AP projection of the dens lying with the circular foramen magnum
What is the Evaluation Criteria for the Fuch’s method?
- Entire dens within the foramen magnum
- Symmetry of mandible, cranium and
vertebrae indicating no rotation of head
and neck
What is the AP “Wagging Jaw” Projection (Ottonello method)?
An AP projection of the C-spine where the mandibular shadow is blurred by having the patient perform an even chewing motion of the mandible during the exposure.
What is the patient position for AP “Wagging Jaw”?
Patient placed in the supine or upright position facing the tube with MSP centered to the midline of the grid and IR centered at the level of C4.
- Patient mandible open/closed repeatedly
Where is the central ray positioned for AP”Wagging Jaw” Projection?
Perpendicular to C4
What are the structures demonstrated in AP “wagging jaw”?
The entire cervical spine, with the mandible blurred
What are the evaluation criteria for the AP
wagging jaw”?
- All seven cervical vertebrae
▪ Blurred mandible with resultant visualization of the underlying atlas and axis
What is the patient positioned for Lateral C-spine?
Patient standing or seated in a true lateral with left shoulder touching the grid and IR centered to the coronal plane that passes through the Mastoid tips
What is the SID used for Lateral C-spine?
72” SID
What is the central ray position for Lateral C-Spine?
Perpendicular to C4
What are the structures demonstrated for Lateral C-spine
The cervical bodies and their intervertebral disk spaces, the articular pillars, the lower five zygapophyseal joints, and the spinous processes
What must a good lateral C-spine projection include?
C7
What are the evaluation criteria for lateral C-spine?
- All seven cervical vertebrae and T1
- Neck extended so that the rami of the
mandible are NOT overlapping C1 or C2 - Nearly superimposed rami
- No rotation / tilt of the cervical spine
How is no rotation demonstrated in a Lateral T spine?
Good visualization of the Z joints and intervertebral disk spaces
What is the patient position for Lateral C-spine Hyperflexion?
- Patient standing or seated in a true lateral with left shoulder touching the grid
- Head down so that the chin is as close to the chest as possible
What is the patient position for Lateral C-spine Hyperextension?
- Patient standing or seated in a true lateral with left shoulder touching the grid
- Head up so that the chin is elevated as much as possible
What is the purpose of the Hyperflexion and Hyperextension of the lateral c-spine?
To show normal intersegmental movement or changes in intersegmental alignment resulting from trauma or disease
Where is the central ray posisitioned for Hyperflexion and Hyperextension of the Lateral C-spine?
Perpendicular to C4
What are the structures demonstrated for Hyperflexion and Hyperextension Lateral C-spine?
Mobility of the cervical spine. Zygopopyseal joints and disk spaces are also shown
What are the evaluation criteria for Hyperflexion?
- Body of mandible almost vertical
- All seven spinous processes in profile
- All seven vertebrae in a true lateral
What are the evaluation criteria for Hyperextension?
- Body of mandible almost horizontal
- All seven cervical vertebra in true lateral
What is the patient position for the AP Axial Oblique Projection of the C-Spine?
- Supine or upright facing the tube with the MSP centered to the midline of the grid
- Patient rotated at a 45 degree angle from the grid (L/R side depending on the position requested)
What is the tube angle for the AP Axial Oblique projection of the C-Spine? (RPO/LPO)
Angled 15-20 degrees cephalic
Where is the central ray positioned for the AP Axial Oblique projection of the C-spine? (RPO/LPO)
Angled at the level of C4 so the CR coincides with the angle of the foramina
What are the structures demonstrated in the AP Axial Oblique - RPO/LPO C-Spine?
- Intervertebral foramina and pedicles FURTHEST from the IR.
- A general oblique projection of the bodies and the cervical spine
What is the evaluation criteria for the AP Axial Oblique RPO/LPO C-spine?
- Open intervertebral formania furthest from the IR
- Open disk spaces
- Uniform size and shape of foramina
- No overlap of the mandible with C1 or C2
(Chin elevated) - Occipital bone not overlapping the C1
- C1 to T1
How is the patient positioned for the PA Axial Oblique RAO/LAO C-spine?
Prone or upright facing the grid with the MSP centered to the midline of the grid
- Patient rotated at a 45 degree angle from the grid (L/R side depending on the position requested)
What is the tube angle for PA Axial Oblique LAO/RAO C-Spine?
15-20 degrees caudad
What is the central ray position for PA Axial Oblique LAO/RAO C-spine?
Angled to C4 so that the central ray matches the angle of the foramina
What are the structures demonstrated in a PA Axial Oblique LAO/RAO C-spine?
- Intervertebral foramina and pedicles CLOSEST
to the IR. - Also demonstrates an oblique
projection of the bodies and cervical spine, in
general
What is the evaluation criteria for PA Axial Oblique LAO/RAO C-spine?
▪ All seven cervical and thefirst thoracic vertebrae
▪ Appropriate 45-degree rotation of body and neck
□ Open intervertebral foramina closest to the IR, from C2–C3 to C7–T1
□ Uniform size and contour of the foramina
▪ Appropriately elevated chin
□ Mandible not overlapping the atlas and axis
□ Occipital bone not overlapping the atlas and axis
▪ Open intervertebral disk spaces
