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Radiographic Positioning > Chapter 9 Lumbar/Sacrum > Flashcards

Chapter 9 Lumbar/Sacrum Flashcards

1
Q

Spina Bifida

A

developmental anomaly characterized by incomplete closure of the vertebral canal

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2
Q

Spondylolysis

A

defect in the pars interarticularis that gives the scotty dog the appearance of a fracture through the neck in the oblique projection. It most commonly involves the fifth lumbar vertebra and predisposes it to the forward displacement of one vertebra on the other (see Spondylolisthesis)

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3
Q

Pagets Disease

A

metabolic disorder of unknown etiology- one of the most common chronic diseases of the skeleton. Destruction of bone followed by a reparative process results in weakened, deformed, and thickened bony structures that tend to fracture easily. Often involving multiple bones, it particularly affects the pelvis, femurs, skull, tibias, vertebrae, clavicles, and ribs.

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4
Q

Ankylosing Spondylitis

A

an inflammatory reaction in the sacroiliac joints which proceeds to complete bony fusion of these joints. If the spine is involved, the vertebral bodies are fused to each other. Advanced cases have a fixed gross kyphosis.

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5
Q

Herniated Nucleus Pulposus

A

soft inner part of the vertebral disk (nucleus pulposus) protrudes through fibrous outer layer of the disk. Occurs often between L4-L5, often causes sciatica (know what sciatica means). Myelograms used to be the way to see this (contrast injected in spinal canal and if nucleus pulposus was protruding the contrast would have an indent in it). Now CT and MRI are modalities of choice to see.

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6
Q

Lordosis (swaytback)

A

lumbar curvature is exaggerated- may be caused by pregnancy, extreme obesity, poor posture, rickets or tuberculosis of the spine- (increased concavity).

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7
Q

Metastases

A

Primary malignant neoplasms that spread to distant sites via blood and lymphatic.
Vertebrae may be a common site. Different types are as follows:
Osteolytic-destructive lesions with irregular margins.
Osteoblastic- proliferative bony lesions of increased density
Combination of both

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8
Q

Fractures:

Compression fx

A

fx of spine produced by compression- wedge shaped appearance of vertebral body.

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9
Q

Chance fx.

A

from hyperflexion force, often the result of usage of a seatbelt.

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10
Q

Spondylolisthesis

A

The forward displacement of one vertebra on the other

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11
Q

Osteolytic

A

Destructive lesions with irregular margins

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12
Q

Osteoblastic

A

Proliferative bony lesions of increased density

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13
Q

Sciatica

A

symptom not a disease

pain results from irritation of sciatic nerve caused by HNP of Lumbar region radiating to the buttocks.

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14
Q

Lumbar spine characteristics

A

Small transverse processes

Spinous process at the level of the inferior disk space

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15
Q

What position are the intervertebral foramina demonstrated for the L spine?

A

Best demonstrated on a lateral lumbar

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16
Q

Intervertebral Foramina

A

Superior and Inferior vertebral notches are lined up they make the intervertebral foramina.
Upper and lower portion of each pedicle is termed the superior and inferior vertebral notches.

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17
Q

Zygapophaseal Joints

A

30-50 degree angle form midsagital plane
upper vertebrae are nearer the 50 degree angle
lower vertebrae are nearer the 30 degree angle

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18
Q

Sacrum

A

Shovel shaped
Apex is pointed down
4 sets of pelvis sacral foramina similar to intervertebral foramina
Promontory of sacrum helps form the wall of the inlet of the true pelvis

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19
Q

Sacral Canal of Sacrum

A

continuation of the vertebral canal and contains certain sacral nerves

20
Q

Medial Sacral crest of Sacrum

A

formed by fused spinal processes of the sacral vertebrae

21
Q

What does the sacrum articulate with?

A

Articulates with the pelvis at the auricular surface (named because it resembles the auricle of the ear)

22
Q

Sacroiliac Joints (SI Joints)

A

Opens obliquely at about 30 degrees.

23
Q

“Scotty dogs”

A

Pedicle (eye of the scotty dog)
Pedicle should be close to middle of body of vertebrae.
If the “eye” is too far in front the patient is under-rotated.
If the “eye” is too far back the patient is over-rotated.

24
Q

Zygapophyseal Joint classification

A

Synovial
Diarthroidal
Plane/Gliding

25
Q

Intervertebral Joint classification

A

Cartilaginous

Syphysis/Amphiarthroidal

26
Q

How many sets of sacral foramina?

A

4 anterior sets

4 posterior sets

27
Q

Laminae of lumbar

A

Laminae of lumbar form bridge between transverse processes, lateral masses, & spinous process

28
Q

Pars Interarticularis

A

portion of laminae between superior & ingerior articular processes

29
Q

Promontory

A

best demonstrated on a lateral.

forms posterior wall of the inlet of the true pelvis

30
Q

Medial sacral crest

A

formed by fused spinous processes

31
Q

SI Joints

A

Sacrum articulates with the Ilium at the auricular surface to form SI joints

32
Q

Cornua

A

Sacral horns (cornua) inferior articular processes project inferior from each side of 5th sacral segment & posterior to articulate with horns (cornua) of coccyxf

33
Q

SI Joints

A

open oblique & posterior at 30 degrees

34
Q

Transverse processes of coccyx

A

Superior aspect of coccyx has two lateral projections termed transverse processes

35
Q

Men or women have more coccyx curvature?

A

Men have a more forward curvature of coccyx than women.

36
Q

Coccyx

A

Females are more likely to fracture their coccyx

37
Q

PA vs AP Lumbar

A

PA places lumbar in a more natural cuirvature
lower ovarian dose by about 30%
More OID on PA vs AP

38
Q

AP Lumbar

A

CR Iliac Crest
14 x 17 coned to 7 x 17
85@20

39
Q

Oblique Lumbar

A

RPO/LPO
CR L3 (1-2 inches above Iliac crest & 2 inches medial to ASIS)
10 x 12
85@25

40
Q

Lateral Lumbar

A

14 x 17 coned to 7 x 17
CR Iliac Crest
90@150
LEAD MAT

41
Q

L5-S1 (spot)

A

5 degree caudal angle from lateral lumbar should place in correct CR. (1 1/2 inches inferior to iliac crest & 2 inches posterior to ASIS)
4 x 6
90@60-80
LEAD MAT

42
Q

Lumbar Tail (coccyx & sacrum include L5 joint)

A 
5 degree caudal angle
bottom of light 1 inch below tailbone
10 x 12
90@60-80
LEAD MAT
43
Q

AP Sacrum/Coccyx (2 shots)

A

1st shot 15 degree cephalic angle
midway between ASIS & Pubic Symphysis
(top of light Iliac Crest)

2nd shot 10 degree caudal angle
midway between ASIS & Pubic Symphysis

10 x 12
85@25

44
Q

Lateral Sacrum

A 
No angle
10 x 12
CR 1 inch below tailbone
90@60-80
LEAD MAT
45
Q

SI Joints AP

A 
34 inch SID
30 degree cephalic angle
10 x 12
CR 2 inches below ASIS
85@25
46
Q

SI Joints Oblique

A 
RPO/LPO
10 x 12 coned to 4 x 6
patient in 25-30 degree oblique
No tube angle
CR 1 inch medial to ASIS
L marker RPO
R marker LPO
85@30

Radiographic Positioning (16 decks)

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