Chapter 8: Cervical & Thoracic Spine Flashcards
1
Q
Intervertebral Disks- disks of fibrocartilage that act as a cushion. Outer fibrous layer is called
A
annulus fibrosis, inner layer is nucleus pulposus.
2
Q
True/ movable vertebrae:
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- Cervical: C1-C7
- Thoracic: T1-T12
- Lumbar: L1-L5
3
Q
False/ fixed vertebrae:
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- Sacral Vertebrae: 5 fused into 1- sacrum
- Coccygeal Vertebrae: 3-5 fused into 1- coccyx
4
Q
Concave:
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curves inward
5
Q
Convex:
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Curves outward
6
Q
cervical and lumbar curves
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convex anteriorly (lordotic curves)
7
Q
thoracic and pelvic curves-
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concave anteriorly (kyphotic curves)
8
Q
Primary curves: occur before birth
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Thoracic and pelvic curves
9
Q
Secondary (compensatory) curves: occur after birth
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Cervical and lumbar
10
Q
Cervical lordotic curve occurs when an infant
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begins to raise its head
11
Q
Lumbar lordotic curve occurs when a child
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begins to stand and walk
12
Q
Normal Kyphotic Curve
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20°-30º
13
Q
Normal Lordotic Curve
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30°-65°
14
Q
Kyphosis: any abnormal increase in the anterior
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concavity of the thoracic curve
15
Q
Lordosis: any abnormal increase in the anterior
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convexity of the lumbar or cervical curve
16
Q
Scoliosis: an abnormal
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Lateral curve of the spine
17
Q
Intervertebral joints: amphiarthroidal joints
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between the vertebral bodies
18
Q
Zygapophyseal joints: the 4 articular processes of the vertebral
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arch. 2 superior and 2 inferior on each vertebra
19
Q
Intervertebral Disks are not between
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1st & 2nd cervical vertebrae
20
Q
Slipped disk (HNP): when the nucleus pulposus protrudes through the
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annulus fibrosis and presses on the spinal cord
28
Q
A
C1
29
Q
A
C2
30
Q
Clay shoveler’s fracture- avulsion fracture of spinous
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processes of C6-T1, caused from hyperextension
33
Q
Hangman’s fracture- pedicles of C2 due to hyperextension causing
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odontoid to press into spinal canal posteriorly
34
Q
Odontoid fracture- involving the dens, can extend into
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lateral masses of C1
39
Q
Teardrop burst fracture- compression from hyperflexion causing comminuted with avulsed fragments of anterior inferior border and
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fragmented posterior vertebral body into spinal canal
41
Q
AP Open Mouth Projection- C1 & C2 Cervical Spine
A
- IR 8x10 IR portrait, 40 SID, 70-80 kVp
- Patient supine or erect, arms by sides. Align MSP to CR and midline of the table/bucky/IR. Adjust head with mouth open so occlusal plane is perpendicular with IR lower margin of upper incisors to base of skull (mastoid tips). Ensure no rotation, mandibular angles and mastoid tips equidistance from IR
Last step: have patient open mouth by dropping jaw and resting tongue in lower jaw. Suspend on exhalation - CR perpendicular to center of open mouth, Center IR with CR. Tight collimation to all 4 sides approx. 5”x5”
- Anatomy: Odontoid process (dens), vertebral body of C2, lateral masses and transverse processes of C1. Alantoaxial joints demonstrated through open mouth.
- Position: Optimal flex/ext. of neck by superimposition of the upper incisors on the base of skull. Neither teeth or occipital base superimposing dens (if teeth are slightly superimposed on upper dens, reposition by slight hyperextension). Can angle CR slightly cephalic (if occipital base is slightly superimposing dens, slightly hyperflex the neck or CR slight caudal angle). Incisors projected 1” for every 5º angle. No rotation: equidistance of lateral masses and/or transverse processes of C1 to mandibular condyles and center alignment of spinous process of C2.
- No motion, bony trabecular detail of cervical vertebrae, ST margins
42
Q
AP Axial Projection- Cervical Spine
A
- IR 8x10 portrait (can use 10x12), 40 SID, 70-80 kVp
- Pt supine or upright, arms by sides. Align MSP to CR and IR, TT or bucky. Adjust head so a line from lower margin of upper incisors to mastoid tips are perpendicular to IR. Ensure no rotation of head or thorax. Suspend on exhalation
- CR angle 15-20º cephalic to open up joint spaces due to superior vertebral body projecting inferiorly. CR enters level of upper margin of thyroid cartilage to pass through C4 (Adams Apple). Collimate to ST margins
- Anatomy shown: C3-T2 vertebral bodies, space between pedicles and intervertebral disk spaces
- Position: No rotation indicated by spinous processes & SC joints (if visible) equidistant from spinal column lateral borders. Mandible & base of skull superimposing C1 & C2
- ST margins, bony margins, and trabecular detail, no motion
43
Q
Anterior & Posterior Oblique Positions- Cervical Spine
A
- IR 10x12 portrait, 72 SID, 70-80 kVp
- Pt erect or recumbent (erect preferred) arms by side or adjusted to maintain position (if recumbent). Align MSP to CR, TT, IR, Bucky. Rotate patient 45º (may rotate head more to prevent superimposition of the mandible and upper vertebrae). Elevate chin to prevent mandible from superimposition of vertebrae, (AML) parallel with floor. Suspend respiration
- CR: RAO & LAO directed 15-20º caudal to C4 (thyroid cartilage).
- CR: RPO & LPO directed 15-20º cephalic to C4
Collimate to 4 sides of anatomy- soft tissue margins - Anatomy demonstrated:
RAO & LAO, intervertebral foramina & pedicles on the side of the patient closest to IR
RPO & LPO, intervertebral foramina & pedicles on the side of the patient farthest from IR. - Position: Intervertebral disk spaces and intervertebral foramina of interest- C2-C7 should be open & uniform in size & shape. Pedicles of interest should be demonstrated in full profile & the opposite, on-end pedicles should be aligned along the anterior body (on-end pedicles aligned with mid body & zygapophyseal joints indicate over-rotation). Obscured intervertebral foramina and pedicles indicates under rotation. Mandibular rami should not be superimposing upper vertebrae, base of skull should not superimpose C1. Collimate to area of interest (st margins)
- Clear st margins & bony margins, trabecular detail- no motion
44
Q
Lateral Positon- Cervical Spine (Erect)
A
- IR 10x12 portrait, 72 SID, 75-80 kVp. Upright bucky
- Position patient in lateral either sitting or standing with left shoulder against IR/bucky. Align MCP to CR and midline of IR- placing top of IR about 1-2” above EAM (top of ear attachment). Have patient relax and depress shoulders. Elevate chin so AML is parallel to floor to prevent superimposition of mandible on upper vertebrae. Suspend on full expiration (take a deep breath for maximum shoulder depression)
- CR perpendicular to center of IR, entering C4 (upper level of thyroid cartilage). Collimate to 4 sides of anatomy (ST margins)
- Anatomy: Cervical vertebral bodies, intervertebral joint spaces, articular pillars, spinous processes & zygapophyseal joints demonstrated.
- Position: C1-C7/T1 intervertebral joint spaces seen. Rami of mandible not superimposing C1-C2. R & L articular pillars & zygapophyseal joints should be superimposed for each vertebra. Vertebral bodies free of superimposition of articular pillars & spinous process seen in profile.
- Clear ST margins, including trachea & bony trabecular detail-no motion
45
Q
Lateral Cervical Spine Horizontal Beam (Trauma)
A
- IR 10x12 portrait to C-spine, 60-72 SID, 70-80 kVp
- Pt in supine position on table or stretcher. Do not move or manipulate spine or remove C-collar. Center CR to IR placing top of IR 1-2” above EAM (top of ear attachment). Depress shoulders- can use traction on arms to depress shoulders if pt consents. Suspend respiration on full expiration to depress shoulders
- CR perpendicular to IR directed horizontally (x-table) to C4 or upper margin of thyroid cartilage. Collimate on all sides of anatomy
- Anatomy seen: cervical vertebral bodies, intervertebral disk spaces, articular pillars, spinous processes, zygapophyseal joints
- Position: C1-C7/T1 intervertebral joint spaces are clearly seen (swimmers if C7-T1 is not demonstrated). R & L articular pillars and zygapophyseal joints superimposed. Bodies free of superimposition of the articular pillars. Spinous processes in profile posteriorly
- Clear ST margins, bony margiins and trabecular detail-no motion
46
Q
Lateral Position-Cervical Spine (Hyperflexion & Hyperextension)
Used to check for whiplash, and post spinal fusion
A
- IR 10x12 portrait , 60-72 SID, 70-80 kVp, upright bucky
- Pt in left lateral position, standing or sitting, arms by side. Align MCP to CR & IR (IR at top of ear attachment). Ensure a true lateral positon- no rotation of pelvis, shoulders and head. Relax and depress shoulders as much as possible.
- For Hyperflexion, depress chin towards chest-touching if possible
- For Hyperextension, raise chin and tilt head back as much as possible. Do not force patient movement!
- CR perpendicular to IR directed horizontally to C4. CR & IR centered. Collimate to area of interest
- Anatomy: C1-C7 included
- Position: No rotation demonstrated by superimposition of mandibular rami. Hyperflexion, spinous processes should be separated. Hyperextension, spinous processes close in proximity
- Clear ST, bony margins, trabecular detail, including trachea, no motion
47
Q
AP Projection-C1&C2 (Fuchs Method)
(Used to demonstrate the superior portion of the dens/odontoid)
A
- IR 8x10 landscape, 40 SID, 70-80 kVp
- PT supine (can be done upright). Pt MSP to CR and midline of IR or TT. Elevate chin as needed to bring MML near perpendicular to TT or bucky, adjust CR angle as needed to be parallel with MML. No rotation- angles of mandible equidistance to TT or Bucky/IR.
- CR enters parallel to MML directed inferior to tip of mandible. Collimate to all 4 sides
- Anatomy: Odontoid process & other structures of C1 & C2.
- Position: Dens should be centered within the foramen magnum, no rotation indicated by the symmetric appearance of mandible arched over the foramen magnum. Correct extension of neck by tip of mandible clearing the superior portion of the odontoid and foramen magnum.
- Clear bony margins trabecular markings of dens and other structures of C1 & C2
48
Q
Cervicothoracic (Swimmers) Lateral Position (C5-T3 Region)
(Used when C7-T1 intervertebral joint space isn’t visualized for lateral c-spine, or when upper T-spine isn’t visualized for lateral T-spine)
A
- IR 10x12 IR portrait- use grid, 60-72 SID, 80- 90 kVp
- Pt erect or supine (for trauma). Place patient in preferred erect position. Align MCP to CR and midline of bucky/IR. Place patients arm and shoulder closest to IR up, flexing elbow and resting forearm on head- left side. Position arm furthest from IR down and rotate slightly posterior to place humeral head post to vertebrae. Ensure no rotation of head and thorax. Suspend respiration on full expiration.
- CR perpendicular to IR (slight caudal angle of 3-5º if shoulders can’t be separated). CR directed to T1- approx. 1” above jugular notch ant. and C-7 prominens posteriorly. Collimate on all 4 sides of anatomy.
- Anatomy: Vertebral bodies & intervertebral disk spaces of C5-T3 are shown. Humeral head & arm farthest from IR are magnified and inferior to T4-T5 (if visible)
- Position: Minimal vertebral rotation indicated by superimposition of cervical of zygapophyseal joints, articular pillars, and posterior ribs. Humeral heads separated vertically
- Clear demonstration of bony margins & trabecular detail of lower C & upper T spine, no motion of anatomy of interest.
49
Q
AP Projection- Thoracic Spine
A
- IR 14x17 lengthwise, 40 SID, 80-90 kVp
- Pt supine, arms by side, head towards anode side of table. Flex knees and hips to reduce thoracic curvature. Upright: arms by side, feet hip width apart, pt AP. Align MSP to TT, bucky, or IR
CR perpendicular to IR. Suspend respiration on expiration to reduce lung volume and create more uniform density - CR directed to T7- 3-4” below jugular notch or 1-2” below sternal angle. Collimate to 2 sides of anatomy minimum.
- Anatomy demonstrates: thoracic vertebral bodies, intervertebral joint spaces, spinous and transverse processes, posterior ribs, costovertebral articulations.
- Position: Spinal column from C7-L1 centered to midline of IR. No rotation demonstrated by SC joints equidistant from spine.
- Clear bony margins and trabecular detail of T-spine, no motion
50
Q
Lateral Position of Thoracic Spine
A
- IR 14x17 portrait, 40 SID, 80-90 kVp (lower kVp for osteoporotic patients)
- Lateral recumbent or Erect: Lay patient on left side recumbent with knees and hips flexed, with support between knees. Place sponge under lumbar region for patients with broad shoulders
(or use 10-15º angle of CR) - Upright: have patient place feet hip width apart with left shoulder against bucky. Have patient hold on to devise or bend elbows and rest hands on head. Ensure no rotation of thorax by aligning scapulae and hips (or spinous processes)
- CR perpendicular to long axis of thoracic spine directed to T7 (3-4” below jugular notch) (7-8” below C7 prominens), can also use inferior angle of scapula. **Use orthostatic breathing of minimum 2-3 seconds **
- Anatomy: thoracic vertebral bodies, intervertebral joint spaces & intervertebral foramina. T1-T3 may not be well visualized and a swimmers may need to be done in addition.
- Position: Intervertebral disk spaces should be open. No rotation demonstrated by superimposed posterior vertebral bodies. Due to OID of ribs farthest from IR, ½” maximum of posterior rib separation (will not be completely superimposed due to OID). Collimation to area of interest. Use lead blocker when patient is supine
- Clear bony margins and trabecular detail, no motion of anatomy of interest
