Lumbar Spine Flashcards
Patient preperation
All jewelry and body piercings in the area to be exposed should be removed if possible
Remove all clothing; top and bottom, except underwear
AP/PA Lumbar Spine
patient supine or prone with knees and hips flexed
arms by their side of on their chest
CR - perpendicular
CP - MSP at L3 - Lower costal margin
Suspended expiration
AP/PA L-spine criteria
- T11 or T12 to mid sacrum visualized
- no rotation
- collimation width to SI joints to see psoas muscle
- SI joints equidistant from the vertebral column
- spinous processes in the midline
- open intervertebral joints
- optimal exposure factors
Lateral lumber spine
knees flexed, arms at right angles
CR - perpendicular to long axis of spine - along the coronal plane
- CR to L3 (LCM)
Lateral L-spine Criteria
Min. T12 to distal sacrum demonstrated
Intervertebral disk spaces open
Intervertebral foramina open
optimal exposure factors
Lateral L5-S1
CR - parallel to interilliac line - passing through both PSIS or sacral dimples
- often requires 5-8 caudad
- CR - 2” posterior ASIS and 1.5” inferior to iliac crest
- suspend on expiration
Lateral L5-S1 Criteria
L4, L5 and S1 demonstrated and centered
L5-S1 joint space open
Zygopophyseal Joints
- 25% of L1-2 and L2-3 zygopophyseal are shown on an AP projection
- A small percentage of L4-5 and L5S1 zygopophyseal joints are seen are seen on a lateral projection
- An oblique body position of 60 degrees may be needed to show L5S1 zygopophyseal joint
AP Oblique Lumbar Spine
- Rotate 45° to Rt. and Lt. (RPO/LPO)
- demonstrates the closest
zygopophyseal joint to the table - CR – Perpendicular
- CP – 2”medial to elevated ASIS, at
level of LCM - Suspended expiration
- Always bilateral views
PA Oblique Lumbar Spine
- Recovery position
- (RAO/LAO) Rotate 45°
from the prone position - demonstrates the farthest
zygopophyseal joint from the IR - CP –2” from spine on elevated
side at level of LCM - CR – perpendicular
- Suspended expiration
- Bilateral views
Scotty dog anatomy
eye - pedicle
nose - transverse process
ear- superior articular process
neck - pars interarticularis
leg - inferior articular process
Oblique L spine Criteria
- L1 to S1 demonstrated
- “Scottie dogs” and open
zygapophyseal joints - Pedicle near center of
vertebral body - Too anterior – patient is
under rotated - Too posterior patient is
over rotated
Hyperflexion and hyperextension L-spine
- may be done upright or recumbent
- lean forward as far as possible - the lean backwards as far as possible
- pelvis must remain stationary - acts as a ‘fulcrum’ or pivot point
Hyperflexion L-spine
- Left lateral position
- recumbent - ask patient to assume
fetal position - Erect - Bend forward, use pelvis as a
fulcrum - CP – L3 – LCM or at level of fusion
site if known - Place lead at back of spine
- Suspend breath on expiration
Hyperfelxion Criteria L-spine
- True lateral position of lumbar
spine in flexion - Assess stability and mobility of
the spinal fusion site - No motion
Hyperextension L-spine
- Left lateral position
- recumbent - ask patient to move torso and legs posteriorly – support their waist
- Erect - Bend backward as far as possible - use pelvis as a fulcrum
- CP – L3 – LCM or at level of fusion site if known
- Suspend breath on expiration
Hyperextension Criteria
- True lateral position of lumbar
spine in extreme extension - Assess stability and mobility
of the spinal fusion site - No motion
What is an AP/PA L-spine and see a winking owl what is that an indication of?
metastatic cancer usually from breast or chest
