Lecture 3 - Cervical and Thoracic Spine Flashcards
What are the reasons that we would image the thoracic and cervical spine?
- DDD
- Arthiritus
- Neck pain/stiffness
- Whiplash ligament damage
- Primary or metastatic tumour
- Non-specific shoulder and arm pain
What nerve root comes out of the C-spine?
Brachial plexus
What pathology is being shown here?
Hang man’s fracture
What is the hangmans fracture?
Bilateral pedicle fracture of C2
What pathology is being shown here?
Whiplash injury from forced flexion
What are the curves are being shown in this image?
Normal lordotic curves
Label each line
What is the prevertebral line showing?
The soft tissue of the neck
True or false?
The soft tissue should never be greater than the height of the vertebrae in front
True
What pathology is being shown here? What symptoms would this person present with?
Thoracic outlet syndrome; present with numbness, coldness and tingling on one limb
What is thoracic outlet syndome?
It is a term that refers to compression of the nerves, arteries, and veins in the lower neck and upper chest area.
True or false?
C1-C5 keeps the diaphragm alive
False; C3-C5 keeps the diaphram alive
With vetebral level
Label this image:
What articles need to be removed prior to imaging the C-spine?
- Dental appliances
- Jewelry in the area
- Hairpins or clips or elastics
- Thick hair braids
- Glasses
- Bra straps, buttons, zippers
What is the purpose of bringing the shoulders down in a lateral C spine?
To see C7-T1
Why do we raise the chin in a lateral c-spine?
To get the mandible off the spine
Label image:
What structures should be shown in a lateral c spine?
- Must see at least 1/3rd of T1
- Lateral cervical bodies
- Cervical Disc spaces
- Zygapophyseal joints
- No rotation
- Superimposed articular pillars
What position of the c spine is the best for imaging fractures?
The lateral c-spine
Critique this image:
Very good image:
1. Chin is raised
2. Articular pillars are superimposed
How do we ensure that the articular pillars are superimposed in the lateral c-spine?
Ensure that the inter pupurarily line is perpendicular to IR and that the MSP parallel to IR
Critique this image:
Bad image:
-Rotation (seeing double line of articular pillars; back of articular pillars)
-Articular pillars showing tilt (front part)
-Cannot see the top of the body of T1
How do you measure the angle on the lateral c spine to obtain the measurement for the angle of the AP?
- On lateral, draw a line across the top of vertebral body of C4/5
- A steeper angle of the vertebral bodies will have a steeper caudad or cephlad
When is the C-spine swimmers proceedure done?
Done only when C7/T1 disc space is not shown on the routine lateral
How do you position a c-spine swimmers projection?
(according to the textbook)
- Dependant arm raised above the head and forearm placed on head
- Humeral head can be rotated anteriorly
- Remote arm placed along patient’s side
- Push the shoulder down as much as possible
- Humeral head can be rotated posteriorly
- May require a 3° to 5° caudad angle if remote shoulder cannot be depressed enough
Erect - Left lateral
Critique this image:
- Good image for positioning
- Cannot see C2 and there is hand in the image
(this isnt a repeat)
Which shoulder is anterior in this image?
-The right shoulder is posterior and the left is anterior
If given an AP oblique C spine; what things should be facing UP?
- Pt facing UP,
- CR angled UP,
- foramina UP are demonstrated,
- marker is facing UP
What does the AP oblique axial projection of the C spine demonstrate?
Demonstrates intervertebral foramina of raised side (furthest from IR)
What positions are done for the AP oblique axial C-spine projections?
RPO and LPO positions
What does an RPO AP axial oblique c spine demonstrate?
RPO demonstrates the LEFT IV foramina
What does an LPO AP axial oblique c spine demonstrate?
LPO demonstrates the RIGHT
What projection/position is this image? What IV foramina is being demonstrated?
-RPO AP Axial oblique C spine
-Left IV foramina
What body position/projection is being demonstrated in this image? What IV foramina is being demonstrated?
-LPO AP axial oblique C spine
-Right IV foramina
What is circled in this image?
The left pedicles
What is being demonstrated in a PA axial oblique c spine projection?
Intervertebral Foramina CLOSEST demonstrated
What Axial oblique of the c spine is best; AP or PA? Why?
**PA oblique **
1. The side you are demonstrating is closer to the IR (better image quality),
2. most of radiation is absorbed by the back of the neck as opposed to the thyroid
3. It is best to shoot into the concave side of the lordotic curve
What errors are made in this image?
-The marker is face up
-Mandible is not parallel to bucky
-Collimator is not tilted so it is clipping C7
What vertebral bodies does the AP axial C-spine projection demonstrate?
Demonstrates C3-T2
What should we see on an AP Axial C spine?
- Visualization of C3 to T2
- Open intervertebral spaces due to the angle that we have used
- Spinous processes equidistant to pedicles-no rotation
What is wrong with this image?
The chin is not lifted up
What is another name for the Wagging Jaw projection?
Ottonello Method
How do you position an Ottonello Method – Wagging Jaw projection?
- SID – min 40” or 102 cm
- CR perpendicular to IR
- CP – C4
- Ask patient to open and close mouth continuously during exposure – ensure they are not moving their head
- Need small mA and long time
What vertebral bodies does the Ottonello Method – Wagging Jaw projection demonstrate?
Demonstrates C1 to C7
What vertebral bodies does the AP open mouth Odontoid projection demonstrate?
Demonstrates the Atlas and Axis
What should be seen on an AP open mouth Odontoid?
- Atlas & Axis and their articulations
- Must see the lateral edges of both the atlas and axis
- Entire dens through open mouth
- Superimposed upper occlusal plane/base of skull
What is missing in this image?
The teeth :)
What is the one issue with this image?
The back of the head is shown in the middle of the mouth showing that the chin is lifted too high
What is an axial load fracture known as?
A Jeffersons fracture
What is the one issue with this image?
Only half of the dens is demonstrated
What is the purpose of doing an AP FUCHS Method?
Done following a properly positioned open-mouth odontoid image that still has the dens obscurred
What is the MML?
MML: Mental meatal line
What should be seen on the AP FUCHS Method?
- Dens within the foramen magnum
- Symmetric image
- No rotation
What is the purpose of hyperflexion and extension projections?
Functional study – assess flexibility or instability
What projection is this and what are the 2 issues with this image?
Hyperflexion
1. Cannot see C7
2. All spinous processes should come apart equally, and C1/C2 have a significant space
What is the one issue with this image?
- Spinous processes should come together in hyperextension; Spinous processes have not come together in this image
What patient preparation should be made prior to poisitioning the thoracic spine?
- All jewelry and body piercings in the area to be exposed should be removed if possible
- Remove everything from the waist up and tie the gown at the back
- Bra off
What side of the tube should be facing the patients head in an AP Thoracic Spine?
The anode side
What should be seen on an AP Thoracic Spine?
- No rotation
- Spinous processes and trachea in midline of spine
- SC joints are symmetrical
- Vertebral bodies well penetrated
- Tight collimation to thoracic spine
What vertebral bodies are demonstrated on an AP throacic spine?
C7 to L1 demonstrated
What pathology is shown here?
- Kyphosis
- Compression fracture due to osteoperosis
How much should the tube be tilted for female patients in a lateral thoracic spine?
10° cephalad on average for females
Textbook answer
How much should the tube be tilted for male patients in a lateral thoracic spine?
15° cephalad on average for males
Textbook answer
Why do males need more of an angle for the lateral thoracic spine?
Wider shoulders
If you are going to use a spounge for the lateral thoracic spine; where should it be placed?
Just above the illiac crest
What vertebral bodies should be demonstrated on a lateral T-spine?
T1 to L1 demonstrated
What should be seen on the lateral T-spine?
- Intervertebral disc spaces open
- No rotation
- Optimal exposure factors
- Shows us compression fractures!
What is circled in this image?
The left main stem bronchus
Why is the lateral cervico-Thoracic “Swimmers” projection done?
Needed because you will not see the upper thoracic vertebrae on a normal lateral t-spine
True or false?
Do not remove collar or neck supports without physician’s permission
True
Can you move the paitents head if they are on a fracture board and have a collar on?
No
What is the cross table – horizontal ray lateral also known as?
Dorsal decubitus position
When is the Trauma Swimmers view done?
Swimmers view if C7-T1 are not visible on XTL trauma
Is the curve of the spine in this image normal?
Yes; these are trauma views, so the normal lordotic curve will be shown more in this image
What pathology is being shown here?
Z joint-dislocation of the spine-paralyzed
What does it mean by the dependant side?
The side that is against the bucky
What projection is this?
Critique both the positives and negatives of this image:
Cross-table lateral Swimmer’s Method
Positives
-C2 shown
-Right arm was placed in line with spine to act as a filter
Negatives
-Didnt need to include base of skull
-The left marker should have been rotated and an arrow used.
