L-Spine Flashcards
what occupies the posterior abdominal region
lumbar vertabrae
How many vertebrae are in the lumbar
5
what are the unique features of the lumbar
Transverse processes are smaller than T-spine
Pars interarticularis – part of lamina between articular processes
what is the part of lamina between articular processes
pars interarticularis
what is seen on the obliques in the lumbar spine
Zygapophyseal joint
Seen on obliques
45degrees
what is seen on the laterals for the lumbar spine
Intervertevbral Foramen
Seen on Lateral
90degrees
Formed by fusion of five sacral segments into curved, triangular bone
sacrum
wedged between iliac bones of pelvis
articulation=sacroilliac (SI) joints
Curves inferiorly and anteriorly from articulation with sacrum
Coccyx
Formed by fusion of three to five rudimentary vertebrae
Coccyx
Anatomic features for coccyx.
Cornu
Anatomic features
of sacrum
Promontory
Canal
Foramina
Cornu
how is the body different in the lumbar
broader
how is the lamina in the lumbar spine
shorter
how is the spinous processes in the lumbar
shorter and broader
where is the apex and base on the coccyx
apex at the bottom and base at the top
essential projections for L spine
AP
Lateral
Lateral L5-S1
AP oblique
RPO
LPO
AP axial lumbosacral (LS) junction and SI joints (Ferguson)
patient position for AP L spine
Supine or upright
part position for AP L Spine
MSP centered to midline
Shoulders and hips in same horizontal plane
Arms crossed on chest
Reduce lordosis by flexing hips and knees to place lower back closer to table
CR for AP L spine
perp to IR
CR For lumbosacral exams
enters patient at iliac crests (L4)
CR For lumbar only
enters patient at 1½ inches (3.8 cm) above iliac crests (L3)
what does the lateral L spine demonstrate
Lateral L-spine demonstrates
intervertebral foramina
part position for lateral L spine
True lateral with MCP vertical
Knees flexed and superimposed
Arms, with elbows flexed, at right angle to body
Place radiolucent support under lower spine to place horizontal, if needed
patient position for lateral L spine
Recumbent or upright
Use same as for AP
CR for Lateral L spine
Perpendicular to IR
Enters patient on MCP at iliac crests (L4)
if spine is not horizontal for the lateral L spine , what should the degree of angulation be?
horizontal, angle caudad 5 to 8 degrees
More for females
Part position for L5-S1
MCP perpendicular to IR
Hips extended
Superimposed knees, may be slightly flexed
With elbows flexed, place arms at right angle to body
Support lower spine in horizontal position in same manner as for lateral projection
CR for Lateral L5-S1
When spine is horizontal, perpendicular to a coronal plane 2 inches (5 cm) posterior to anterior superior iliac spine (ASIS) and 1½ inches (3.8 cm) inferior to iliac crest
If not, angle 5 degrees caudad for males, 8 degrees caudad for females
if the spine is not horizontal for L5-S1 what degree of angulation should be used?
If not, angle 5 degrees caudad for males, 8 degrees caudad for females
what does the oblique projection of the lumbar vertebrae demonstrate?
Oblique projections demonstrate
zygapophyseal joints
of most lumbar vertebrae.
Patient position
for AP Oblique L-Spine
Patient position
Recumbent or upright
Use same position as AP
Part position
for AP Oblique L-Spine
45-degree posterior oblique position
CR for AP oblique L spine
CR
Perpendicular to IR
Enters patient 2 inches (5 cm) medial to elevated ASIS at L3 (1½ inches or 3.8 cm above iliac crests
KNOW SCOTTIE DOG
ear= superior articular process
body=lamina
leg=inferior articular process
eye=pedicle
nose= transverse process
neck= pars interarticularis
what does it mean if the pedicle is anterior on the vertebral body in the obliques for L spine
which means that the patient is not rotated enough.
what does it mean if the pedicle is posterior on the vertebral body in the obliques for L spine
which means that the patient is rotated too much.
patient position for AP Axial (ferguson)
Supine
part position for AP Axial (Ferguson )
MSP centered to IR
Extend lower limbs, or abduct thighs and place vertical
what is the degree of angulation for AP axial (ferguson)
Angled cephalad 30 to 35 degrees
Use less angle on males, more on females
CR for AP Axial Ferguson
Angled cephalad 30 to 35 degrees
Enters patient on MSP at 1½ inches (3.8 cm) above pubic symphysis
are you able to do the L spine PA Axial as well ?
Note: May also be performed with patient in prone position (PA axial) with CR angle 35 degrees caudad. Only AP axial is referred to as Ferguson method.
Essential projections for the SI joints
AP oblique
RPO
LPO
25-35 degrees
what side is being best demonstrated in the AP oblique SI joints
SI joint farther from IR
is demonstrated (elevated side).
patient position for AP oblique SI joints
supine
part position for AP oblique si joints
25- to 30-degree posterior oblique position
Support body in position
Long axis parallel with table
IR centered at level of ASIS
how much should the patients body be rotated for the ap oblique SI joints
25 to 30 degrees posterior oblique position
CR for AP oblique SI joints
Perpendicular to IR
Enters patient 1 inch (2.5 cm) medial to elevated ASIS
if you are doing a pa oblique si joint what side is being shown
LAO shows left joint
Essential Projections: Sacrum and Coccyx
Sacrum
-AP axial
-Lateral
Coccyx
-AP axial
-Lateral
patient position for Ap axial sacrum
Supine
May also be performed with patient prone (PA axial projection), if needed for comfort
Part position for ap axial sacrum
MSP in midline of table
ASIS equidistant from table
Arms in comfortable, symmetric position out of field
Support knees, if supine
how much of an angle is needed for ap axial coccyx
10degrees caudal (AP)
10 degrees cephalic if PA
how many degrees is needed for ap axial sacrum
15degrees cephalic(supine)
CR for ap axial sacrum
Enters MSP at 2 inches (5 cm) superior to pubic symphysis
For prone – enters MSP at level of sacral curve
patient position for AP/PA axial coccyx
Supine or prone
Choose position that maximizes patient comfort
Part position for
AP/PA Axial Coccyx
Same as used for sacrum
CR for AP/PA Axial Coccyx
Enters MSP at 2 inches (5 cm) superior to pubic symphysis
For PA, enters MSP at coccyx
patient position for lateral sacrum
Patient position
Recumbent lateral
Hips and knees flexed for comfort
Arms at right angle to body
Knees superimposed
Support spine to horizontal position
Interiliac plane perpendicular to IR
Shoulders and pelvis in true lateral
MCP vertical
Sacrum centered to IR
CR for lateral sacrum
CR
Perpendicular to level of ASIS and to a point 3½ inches (9 cm) posterior
patient position for lateral coccyx
Patient position
Recumbent lateral
Hips and knees flexed for comfort
Arms at right angle to body
Knees superimposed
Support spine to horizontal position
Interiliac plane perpendicular to IR
Shoulders and pelvis in true lateral
MCP vertical
CR for lateral coccyx
Perpendicular to 3½ inches (9 cm) posterior and 2 inches (5 cm) inferior to ASIS
Close collimation improves visibility
Typical scoliosis examination may include
PA (or AP) upright
PA (or AP) upright with lateral bending
Lateral upright (with or without bending)
PA (or AP) recumbent
Demonstrates amount/degree of curvature that occurs with force of gravity acting on body
Scoliosis Radiography
Also used to evaluate fixation devices, such as Harrington rods
Scoliosis Radiography
Bending studies used to differentiate between primary and compensatory curves
Scoliosis Radiography
Patient position
Scoliosis: PA Thoracolumbar
Upright, facing vertical Bucky
Part position
Scoliosis: PA Thoracolumbar
Ensure MCP parallel to Bucky
Arms abducted and not in field
CR for Scoliosis: PA Thoracolumbar
Perpendicular to Bucky
Patient position
Scoliosis: Lateral Thoracolumbar
Upright, lateral
Part position
Scoliosis: Lateral Thoracolumbar
MCP perpendicular to Bucky
Arms at right angle to body
CR
Scoliosis: Lateral Thoracolumbar
Perpendicular to Bucky
Scoliosis: PA Thoracolumbar (Ferguson)
First radiograph taken in same manner as previously described PA
Second PA radiograph taken with patient’s convex side elevated 3 to 4 inches (7.6 to 10.2 cm)
what view is compensating so both sides are level?
Scoliosis: PA Thoracolumbar (Ferguson)
where on the sacrum does a lot of injuries occur
base at top L5 joint S1
SID for AP L spine
40 inches
recomended breathing for AP L spine
Respiration suspended at end of expiration
what needs to be included in a lateral L spine
-L5, S1 junction
-open disc space
-intervertebral foramen
what lateral is standard for lumbar spine and why would you possibly change it
standard is left lateral but for scoliosis it is better to do a Right lateral
in the lateral L5-S1 how is the IR and CR to the interilliac line
IR is perp to interilliac line
and the CR is parallel to interilliac line
what is AP Axial (ferguson) done for
Its done for L5-S1
*to open up the joint spaces
what is SI joints typically done for
arthiritis
what is the recommended breathing for the AP and PA oblique L spine
Respiration suspended at end of expiration
what is the SID for AP and PA oblique L spine
40 inches
what is the recomended breathing for the lateral lumbar
Respiration suspended at end of expiration
what is the SID for lateral lumbar
40 inches
what is a lateral curvature of the spine
scoliosis
why do we do ap or pa
ap- definition
pa- radiation protection
what do you do to your technique for peristalsis or any movement of the bowels
increase mA decrease time
how is the spine in the thoracic and lumbar for scoliosis
right in thoracic, left in lumbar
what can you do for motion
decrease time, communicate better with patient
what is the breathing technique and SID for L5-S1 LUMBO-
SACRAL JUNCTION
respiration suspended and 40 inches
recomended breathing for SI joints and SID
Respiration suspended
40” SID
what is the recomended breathing and SID for sacrum and coccyx
Respiration suspended
40” SID
what is the breathing and SID for lumbar spine
respiration suspended and 40 inches
