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Basic Procedures Class > Lumbar Spine > Flashcards

Lumbar Spine Flashcards

1
Q

How many Lumbar vertebrae are there?

A

5

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2
Q

Lamina lie ________ to the pedicles & transverse processes

A

Posterior

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3
Q

Intervertebral foramen are at __ degree angle to the MSP, they are demonstrated in the _________ projection

A

90, Lateral

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4
Q

Zygapophyseal joints may range from ____ to ____ degrees to the MSP

A

30 to 60

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5
Q

___ degree oblique demonstrates the majority of the z-joints

A

45

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6
Q

The area between the superior & inferior articulating process is the

A

pars interarticularis

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7
Q

The lumbar spine has a natural ___________ curvature

A

-Lordotic

*Concave posteriorly
*Convex anteriorly

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8
Q

Lumbar Spine Considerations

A

-Patient should empty bowels and bladder before exam if possible
-PA Projection
-PA projection can be used instead of the AP in order to reduce exposure to the gonads
-PA projection also aids in visualization of the disc spaces, as the angle of beam divergence mimics the angle of the spine from that direction

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9
Q

Why do we flex our knees for the AP Lordotic projection

A

because the natural lordotic curvature tends to distort the joint spaces in the AP projection

*You could also do a PA projection to help with this

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10
Q

AP Lumbar Spine Positioning

A

-14 X 17 Cassette LW in bucky
-Pt supine or upright
-SID of 48” may be used to reduce distortion of disc spaces
-If pt is supine, flex the knees and hips to place lower back in contact with the table
-CR perpendicular to MSP at the level of the iliac crests
-Collimate to the spine
-Shield if possible
-Suspend respiration at the end of full expiration

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11
Q

AP Lumbar Spine Evaluation Criteria

A

-Symmetric vertebrae, with spinous processes centered to the bodies
-Sacroiliac joints equidistance from the vertebral column
-Open intervertebral disc spaces

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12
Q

AP Lumbar Spine Closer Up

A
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13
Q

Lateral Lumbar Spine Positioning

A

-14 X 17 Cassette LW in bucky
-SID: 48 inches to reduce magnification
-Pt recumbent, lying on affected side
-May be performed upright
-If recumbent, have patient flex hips, knees, and elbows
-Pt in true lateral position with knees and hips superimposed
-May place a sponge or radiolucent pad under waist to alleviate lateral curvature on
patient’s with larger hips
-CR perpendicular to the MCP at the level of the iliac crests
-May need to angle the CR caudally 5 to 7 degrees if the spine is not completely horizontal
-Collimate
-Shield
-Suspend respiration at the end of full expiration

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14
Q

How is quality of Lateral projections enhanced?

A

Laying a strip of lead rubber on table posteriorly

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15
Q

Lateral Lumbar Spine Evaluation Criteria

A

-Profile image of the intervertebral foramina of L1-L4
-Open intervertebral disc spaces
-Superimposed iliac crests and posterior margins of the vertebral bodies

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16
Q

L5-S1 “Spot” Lumbar Spine Positioning

A

-SID: 40 inches
-10 X 12 Cassette LW in bucky
-Pt in lateral recumbent position laying ON AFFECTED SIDE
-Flex hips, knees, and elbows and place arms at right angles to the body
-Superimpose knees and hips, placing a support between knees if necessary for pt comfort
-If needed, place a radiolucent sponge under the waist to straighten the lumbar spine
-CR angled 5 to 8 degrees caudal to a point 2 inches posterior to the elevated ASIS and 1.5 inches inferior to the crest (may be perpendicular)
-Collimate
-Suspend respiration

17
Q

What else can you do for the L5-S1 spot if you don’t use an angle

A

put sponge under the waist

18
Q

L5-S1 “Spot” Lumbar Spine Evaluation Criteria

A

-Lateral projection of the lumbosacral junction, the lower one or two lumbar vertebrae, and upper sacrum
-Disc space between lumbar and sacral vertebra is open
-Crests of the ilia should be closely superimposed if beam is not angled

19
Q

AP Oblique Lumbar Spine Positioning

A

-14 X 17 Cassette LW in bucky
-SID: 40 inches
-Pt either upright or supine
-Rotate the patient to a 45 degree oblique position
-CR perpendicular to 2 inches medial to the elevated ASIS and 1 to 1.5 inches above the iliac crests
-Collimate
-Shield
-Suspend respiration at end of full expiration

20
Q

AP Oblique Lumbar Spine Evaluation Criteria

A

-Articular processes of the side closest to the IR
-Both sides are done for comparison
-When the patient is properly positioned, the
-vertebrae form the appearance of “Scottie Dogs”
-T12-L1 and L1-L2 intervertebral joint spaces open

21
Q

T or F: Flexion and extension laterals are often added to a series when a patient has a history of surgical lumbar fusion or prior trauma

A

True

22
Q

T or F: Lateral Flexion and Extension views should be performed in acute trauma settings

A

False, just trauma

23
Q

Lateral: Flexion & Extension Lumbar Spine positioning

A

-14 X 17 Cassette LW in bucky
-SID: 48
-Pt upright or in lateral recumbent position using positioning criteria for lateral lumbar spine
-For the first radiograph, have the pt bend forward to flex the spine as much as possible
-For the second radiograph, have the patient bend backward to extend the spine as much as possible
-CR perpendicular to the spinal fusion area or L3

24
Q

Lateral: Flexion & Extension Lumbar Spine Evaluation Criteria

A

-Hyperflexion and hyperextension to determine whether motion is present in the area of a spinal fusion, indicating a non-union, or to localize a herniated disk as shown by limitation of motion
-No rotation of vertebral column
-Hyperflexion or hyperextension identification markers placed on the film

25
Q

AP: Right & Left Bending Lumbar Spine Positioning

A

-14 X 17 LW in bucky
-SID: 48
-Pt supine or upright, using positioning criteria for AP lumbar spine
-Make the first radiograph with the pt in maximum right bending position
-Make second radiograph with pt in maximum left bending position
-Cross the patient’s leg over the opposite side….right bending requires left leg crossed over the right and left bending requires right leg crossed over the left
-CR perpendicular to 1 to 1 ½ inches above the crest at the MSP
-Shield
-Suspend respiration

26
Q

AP: Right & Left Bending Lumbar Spine Evaluation Criteria

A

-These studies are used in patients with early scoliosis, herniated disk, or postoperative spinal fusion
-Bending directions should be identified with appropriate lead markers

27
Q

Lumbar Spine Pathology

A
28
Q

Lumbar Spine Pathology X-ray Images

A
29
Q

The forward displacement at the L5-S1 vertebra is referred to as

A

Spondylolithesis

30
Q

“Scottie Dogs” Labeling

A
31
Q

Spondylolysis

A

Fracture of vertebrae, defects of the pars

32
Q

Spondylolisthesis

A

Forward displacement

33
Q

Which projection shows the “Scottie Dogs”

A

AP Oblique Lumbar

Basic Procedures Class (11 decks)

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