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Radiographic Procedures > Ch 9- Lumbar Spine > Flashcards

Ch 9- Lumbar Spine Flashcards

1
Q

What is the function of the lumbar spine?

A
  • Protects the spinal cord
  • Support for trunk
  • articulates with hip bone at S-I joints
  • Superior support for skull
  • Attachments for deep muscles of the back &
    lateral aspect of the ribs
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2
Q

What is the shape of the bodies of lumbar vertebrae?

A

Large, bean-shaped bodies that increase in size from the first to the fifth

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3
Q

How many lumbar vertebrae are there?

A

5

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4
Q

What are the unique features of the lumbar spine?

A
  • Transverse processes are smaller than T-spine
  • Pars interarticularis – part of lamina between articular processes
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5
Q

What is unique about the body of L5?

A

Has more of a wedge shape and articulates with the sacrum

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6
Q

What is the inclination angle of the Z joints in the lumbar region?

A

Inclined posteriorly and form an average angle of 30-60 degrees to the MSP

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7
Q

How are the intervertebral foramina of the lumbar vertebrae oriented?

A

At right angles to the MSP of the body, except for the fifth

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8
Q

What condition is known as spondylolisthesis?

A

Anterior displacement of one vertebra over the other, generally fifth over sacrum

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9
Q

How can spondylolisthesis be identified?

A

Seen in the oblique position by the ‘neck’ of the ‘scottie dog’

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10
Q

What is the sacrum formed by?

A

Fusion of 5 sacral vertebral segments into a curved, triangular bone

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11
Q

Where is the sacrum located in relation to the iliac bones?

A

Wedged between the iliac bones of the pelvis

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12
Q

How does the sacrum differ between males and females?

A

Males: longer, narrow, and more evenly curved; Females: more acutely curved with a sharper angle

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13
Q

What does the first portion of the sacrum resemble?

A

Resembles the vertebrae of the lumbar region

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14
Q

What is the sacral promontory?

A

A prominent ridge on the base of the sacrum

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15
Q

What is located behind the sacral bodies?

A

The sacral canal, a continuation of the vertebral canal

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16
Q

What do the pelvic sacral foramina allow for?

A

Passage of nerves and blood vessels

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17
Q

What articulates with the coccyx on the inferior surface of the sacrum?

A

An oval facet and two inferiorly projecting processes called the sacral cornua

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18
Q

What is the coccyx composed of?

A

3-5 rudimentary vertebrae which fuse into one bone in adulthood

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19
Q

How does the coccyx curve?

A

Inferiorly and anteriorly from articulation with the sacrum

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20
Q

What are the two types of joints in the spine?

A
  • Intervertebral joints
  • Zygapophyseal joints
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21
Q

What type of joint are intervertebral joints?

A

Cartilaginous symphysis that permits slight movement of the vertebrae

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22
Q

What type of joint are zygapophyseal joints?

A

Synovial gliding joints that permit free movement

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23
Q

What are the basic projections for the Lumbar Spine?

A
  • AP
  • AP Axial
  • AP Oblique - RPO & LPO
  • Lateral
  • L5-S1 Lateral Spot
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24
Q

What is the patient position for the AP Lumbar Spine?

A

Patient supine or upright with back touching IR, MSP centered to the midline of the grid and IR centered to the iliac crest

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25
What is the position of the central ray in AP Lumbar spine?
Perpendicular and centered to the MSP and level of the iliac crests
26
What are the structures demonstrated in AP Lumbar spine?
The lumbar bodies, intervertebral disk spaces, interpediculate spaces, laminae, and spinous and transverse processes
27
What are the evaluation criteria for the AP Lumbar spine?
▪ Area from the lower thoracic vertebrae to the sacrum ▪ X-ray beam collimated to the lateral margin of the psoas muscles ▪ No artifact across the midabdomen from any elastic in the patient’s underclothing ▪ No rotation □ Symmetric vertebrae, with spinous processes centered to the bodies □ Sacroiliac joints equidistant
28
What is the patient position for the AP Axial Lumbar projection?
Patient supine or upright with back touching IR, MSP centered to the midline of the grid
29
What is the tube angle for the AP Axial Lumbar?
30-35 degrees cephalic
30
What is the position of the central ray in AP Axial Lumbar?
Angled and directed to 1.5" superior to the pubic symphysis
31
What are the structures demonstrated in AP Axial Lumbar?
The lumbosacral joint and a symmetric image of both sacroiliac joints free of superimposition
32
What are the evaluation criteria for the AP Axial Lumbar?
- Lumbosacral junction and sacrum ▪ Open intervertebral disk space between L5 and S1 ▪ Both sacroiliac joints
33
What is the patient position for the AP Oblique Lumbar - RPO/LPO position?
Patient is supine or upright with back touching the IR and obliqued 45 degrees with affected side down. Grid centered to the spine which is 2" medial to the elevated ASIS
34
What is the position of the central ray for AP Oblique RPO/LPO?
CR 2" medial to the elevated ASIS and 1/5" above the iliac crest
35
What are the structures demonstrated in the AP Oblique RPO/LPO position?
The lumbar or lumbosacral spine or both, showing the articular processes of the side closest to the IR. Both sides are examined for comparison
36
What is the evaluation criteria for the AP Oblique RPO/LPO?
▪ Area from the lower thoracic vertebrae to the sacrum ▪ Zygapophyseal joints closest to the IR—open and uniformly visible through the vertebral bodies (Scotty dog appearance) ▪ Vertebral column parallel with the tabletop so that T12–L1 and L1–L2 intervertebral joint spaces remain open
37
If the Z joint is not well seen and the pedicle is anterior on the vertebral body what does that demonstrate?
Under rotation
38
If the Z joint is not well seen, and the pedicle is posterior on the vertebral body what does that demonstrate?
Over rotation
39
What part of the lumbar vertebrae does the ear of the scotty dog represent?
Superior articular process
40
What part of the lumbar vertebrae does the eye of the scotty dog represent?
Pedicle
41
What part of the lumbar vertebrae does the nose of the scotty dog represent?
Transverse process
42
What part of the lumbar vertebrae does the body of the scotty dog represent?
Lamina
43
What part of the lumbar vertebrae does the front foot of the scotty dog represent?
Inferior articular process
44
What is the patient position for the Lateral Lumbar spine?
Patient in the left lateral recumbent or upright with MCP centered a little posterior to the grid
45
What is the position of the Central Ray for the Lateral Lumbar?
Perpendicular and at the level of the iliac crests
46
If the spine is not able to be placed horizontal to the IR, what should the tube angle be?
5 degrees caudad for males 8 degrees caudad for females
47
What are the structures demonstrated in the Lateral Lumbar?
The lumbar bodies and their intervertebral disk spaces, the spinous processes, and the lumbosacral junction - profile image of intervertebral foramina of L1–L4
48
What is the evaluation criteria for the lateral lumbar spine?
▪ Area from the lower thoracic vertebrae to the coccyx for lumbosacral spine procedure ▪ Vertebrae aligned down the middle of the image ▪ No rotation □ Superimposed posterior margins of each vertebral body □ Nearly superimposed crests of the ilia when the x-ray beam is not angled □ Spinous processes in pro􀐸le ▪ Open intervertebral disk spaces and intervertebral foramina (L1–L4)
49
What is the patient position for the Lateral L5-SI Lumbosacral Junction "Spot"?
Patient in the left lateral recumbent or upright with MCP centered a little posterior to the grid
50
What is the position of the central ray for the L5-S1 Lumbosacral Junction "Spot"?
CR centered 2 inches posterior to the upright ASIS and 1.5 inches inferior to the iliac crest.
51
What are the structures demonstrated in the L5-S1 Lumbosacral Junction "Spot"?
The lumbosacral junction, the lower one or two lumbar vertebrae, and the upper sacrum
52
What is the Evaluation Criteria for the L5-S1 Lumbosacral Junction "Spot"?
▪ Lumbosacral joint in the center of the image ▪ Open lumbosacral intervertebral disk space ▪ Crests of the ilia closely superimposing each other when the x-ray beam is not angled
53
What are the essential projections for the Sacrum?
AP Axial and Lateral
54
What are the essential projections for the Coccyx?
AP Axial and Lateral
55
What is the patient position for AP Axial Sacrum?
Supine or prone and MSP centered to the midline of the grid
56
What is the tube angle for the AP Axial Sacrum?
15 degrees cephalic for supine 15 degrees caudad for prone
57
What is the central ray position for the AP Axial Sacrum?
Angled and entering the MSP 2" superior to the pubic symphysis for supine Angled and entering MSP at level of sacral curve for prone
58
What are the structures demonstrated in the AP Axial Sacrum?
Sacrum demonstrated without foreshortening and with curve straightened
59
What is the evaluation criteria for the AP Axial Sacrum?
▪ Sacrum centered and seen in its entirety ▪ Sacrum free of foreshortening, with the sacral curvature straightened ▪ Pubic bones not overlapping the sacrum ▪ No rotation of the sacrum, as demonstrated by symmetric alae
60
What is the patient position for AP Axial Coccyx?
Supine or prone and MSP centered to the midline of the grid
61
What is the tube angle for AP/PA Coccyx?
Angled 10 degrees caudad if supine Angled 10 degrees cephalic is prone
62
What is the central ray position for AP/PA Coccyx?
Entering MSP at 2" above the pubci symphysis for supine Entered MSP at coccyx for prone
63
What are the structures demonstrated in the AP/PA Coccyx?
Coccyx free from superimposition
64
What is the evaluation criteria for the AP/PA Coccyx?
- Coccyx centered and seen in its entirety for more ebook/ testbank/ solution manuals requests: email 960126734@qq.com ▪ Coccygeal segments not superimposed by pubic bones ▪ No rotation of coccyx, as demonstrated by distal segment in line with pubic symphysis
65
What is the patient position for the lateral sacrum and coccyx?
Patient in left lateral recumbent with knees flexed, arms at a right angle to the body and sacrum centered to the IR
66
What is the position of the central ray in Lateral Sacrum and Coccyx?
Perpendicular and directed to the level of the ASIS and to a point 3.5 inches posterior
67
What are the structures demonstrated in the Lateral Sacrum and Coccyx?
The sacrum and coccyx seen with short-scale contrast
68
What is the evaluation criteria for the Lateral Sacrum?
- Sacrum and coccyx ▪ Closely superimposed posterior margins of the ischia and ilia, demonstrating no rotation
69
What are the typical exams for scoliosis?
 PA (or AP) upright  PA (or AP) upright with lateral bending  Lateral upright (with or without bending)  PA (or AP) recumbent
70
What do the typical scoliosis exams demonstrate?
 Demonstrates amount/degree of curvature that occurs with force of gravity acting on body  Also used to evaluate fixation devices, such as Harrington rods  Bending studies used to differentiate between primary and compensatory curves
71
What is the patient position for Scoliosis: PA Thoracolumbar?
Upright, facing the vertical bucky with MCP parallel and arms abducted and not in field of view
72
What is the patient position for Scoliosis: Lateral Thoracolumbar?
Upright, lateral with MCP perpendicular to the bucky and arms at a right angle to the body
73
What is the process for PA Thoracolumbar (Ferguson)
 First radiograph taken in same manner as previously described PA  Second PA radiograph taken with patient’s convex side elevated 3-4"  Ferguson specified that elevation must be sufficient to require patient to expend effort to maintain position
74
What does a scoliosis series frequently include?
Two AP or PA images taken for comparison, one erect and one recumbent

Radiographic Procedures (7 decks)

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