Module 9 Vertebral Column Flashcards
VERTEBRAL COLUMN FUNCTION
- Protect the spinal chord
- Provide attachments to back muscles and ribs
- Support the skull and trunk
SECONDARY VERTEBRAL CURVES
- Cervical curve
- Lumber curves
These develop because of weight bearing
PRIMARY VERTEBRAL CURVES
AKA kyphotic curves
- Thoracic curve
- Pelvic Curve
Present at birth
VERTEBRAL ARCH COMPOSITION
- 2 Laminae
- 2 pedicels
- 4 articular processes
- 2 transverse processes
- 1 spinous process
UNIQUE FEATURES OF THE CERVICAL SPINE
- Bifid tips on spinous processes
- Transverse foramina, which provide passage for the vertebral artery and veins
T SPINE VERTEBRAL IDENTIFICATION
Posterior slant of the transverse processes, as well as the longer spinous processes which have a more severe slant
VERTEBRAL COLUMN ARTICULATIONS
- Intervertebral joint= between vertebral bodies ( cartilaginous symphysis)
- Zygapophyseal joints= between facets( synovial gliding and ellipsodial)
- Atlantoaxial joint= C1-C2 ( synovial gliding and pivot )
- Costovertebral joint= ribs and thoracic vertebrae ( synovial gliding)
- Costotransverse Joints= transverse processes of thoracic vertebrae and rib tubercles. ( synovial gliding )
AP AXIAL C SPINE PROJECTION
- Patient erect n supine or erect with MSP centred to the midline of the table or Bucky
- Extend the head to throw off the mandible
- Respiration suspended
- CR 15-20 cephalade entering the thyroid cartilage exiting C4 ( to compensate for lordotic curvature)
AP AXIAL C SPINE PROJECTION STRUCTURES DEMONSTRATED
- C3 - T2
- Open intervertebral disc spaces
- Spinous processes to the pedicels
- Demonstrate the presence or absence of cervical ribs
LATERAL C SPNE PROJECTION
- Patient seated or standing at a vertical cassette holder
- Use 180 cm FFD
- Place patient in true lateral position
- Ensure chin elevation
- Centre coronal plane through the mastoid tips to the centre of IR
- Respiration suspended after expiration
- CR horizontally to C4
LATERAL C SPNE PROJECTION STRUCTURES DEMONSTRATED
- Base of skull to T 1
- Cervical bodies and intervertebral disc spaces
- Articular pillars, Spinous processes
- Lower 5 Apophyseal joints
- No rotation or tilt of the C spine
- If necessary, perform the Swimmers Method to demonstrate C7-T1
LATERAL C SPNE PROJECTION FLEXION / EXTENSION
To demonstrate motion or lack of motion of cervical vertebrae.
( to rule out whiplash injuries )
- Erect lateral seated or standing
- 180 cm SID
- Head and neck parallel to the plane of IR
- Respiration suspended at the end of expiration
- CR horizontal to C4
- Extension = patient elevates the chin as much as possible
- FLEXION = Patient drops head forward and draws chin as close as possible to the chest
LATERAL C SPNE PROJECTION FLEXION / STRUCTURES DEMONSTRATED
All 7 cervical spinous processes in profile, elevated and widely separated
LATERAL C SPNE PROJECTION / EXTENSION STRUCTURES DEMONSTRATED
All 7 cervical spinous processes in profile, depressed and closely spaced
AP OPEN MOUTH PROJECTION
- MSP centred to the midline of the IR, erect or supine
- Ensure No rotation of the head
- IOML is perpendicular to the IR
- Ask patient to open the mouth
- Patients tongue must be kept on the lower jaw to prevent shadowing
- CR Perpendicular to IR through the open mouth
AP OPEN MOUTH PROJECTION STRUCTURES DEMONSTRATED
- Odontoid , Atlas and axis
- Apophyseal joints between C1 and C2
- Superimposed base of skull with upper incisors above the odontoid
- Mandibular rami equidistant from odontoid
AP C SPINE OBLIQUE PROJECTION STRUCTURES DEMONSTRATED
- Intervertebral foramina and pedicels farthest from the IR
- Open inter vertebral disc spaces C2-C3 to C7- T1
-
PA C SPINE OBLIQUE PROJECTION STRUCTURES DEMONSTRATED
- The intervertebral foramina and pedicels closest to the IR
- C2-C3 to C7- T1 open intervertebral disc spaces
AP T SPINE PROJECTION
- Patient is supine with MSP centred with the centre of the table
- Place head on a thin pillow
- Flex knees and hips to lower back closer to IR
- Respiration on suspended expiration
- CR perpendicular to T7 midway between jugular notch and xiphoid
AP T SPINE PROJECTION STRUCTURES DEMONSTRATED
- Thoracic bodies and intervertebral disc spaces
- Transverse processes
- Spinous processes in the midline of the vertebral bodies
LATERAL T SPINE PROJECTION
- Patient in true lateral position
- Centre Midaxillary line to the midline of the table
- Patients at right angles to the long axis, elevating the ribs clearing them from the intervertebral foramina
- Respiration shallow
- Long time exposure used to obliterate the vascular markings
- CR T 7
- Angle 10 deg cephalad for females
- Angle. 15 deg cephalad for males ( larger shoulders)
LATERAL T SPINE PROJECTION STRUCTURES DEMONSTRATED
- Thoracic bodies and interspaces,
- Intervertebral foramina and pedicles
- Lower spinous processes
- Upper 4 thoracic vertebrae are not seen due to patients shoulders
LATERAL CERVICOTHORACICEGION PROJECTION
Swimmers Technique
- Patient in true lateral position
- Centre. I’d axillary line with centre of the table or Bucky
- Elevate the arm closest to IR and rest forearm on head
- Without rotating the patient rotate the shoulder closest to the IR forward and shoulder furthest to IR Backwards
- Dipress shoulder distal to IR
- Restauration on expiration to blur out lung markings
- CR 5cm above the jugular notch
LATERAL CERVICOTHORACICEGION PROJECTION
( Swimmers Technique )
STRUCTURES DEMONSTRATED
- Lateral C 5- T5 projected between the two shoulders
L SPINE AP PROJECTION
- Patient supine with MSP centred to midline of table
- Patients head on firm pillow
- Flex both knees
- Respiration at suspended expiration
- CR perpendicular to L3
- CR L/S perpendicular L4
L SPINE AP PROJECTION
STRUCTURES DEMONSTRATED
- Lumber bodies
- Open intervertebral disc spaces
- Lamina, Spinous processes in the midline of the body, transverse processes
L SPINE LATERAL PROJECTION
- Patient in true later position
- Mid axillary line centred with midline of table
- Arms placed at right angles to the long axis of the table
- Hips and knees flexed and superimposed
- Respiration at suspended end of expiration
- CR perpendicular to L3
- CR perpendicular to L4 L/S
- CR angled 8deg caudad for females and 5deg for males
L SPINE LATERAL PROJECTION
STRUCTURES DEMONSTRATED
- Lumber bodies and intervertebral joint spaces
- Superimposed posterior margin of each vertebral body
- Spinous processes, Lumpsacral junction
- Superior 4 intervertebral foramina
L5/ S1 LATERAL PROJECTION
LUMBOSACRAL JUNCTION
- Patient at true lateral position
- Arms at right angles to the long axis of the body
- Extend hips and knees with superimposition
- Respiration Suspended
- CR 4cm inferior to the iliac crest and 5 cm posterior to the to the elevated ASIS
AP OBLIQUE LSPINE PROJECTION
- Can be done erect or supine
- Patient in an oblique position
- MCPt 45 deg with the table
- Respiration must be suspended end expiration
- CR perpendicular to L3 3,8 cm above the iliac crest
AP OBLIQUE LSPINE PROJECTION
STRUCTURES DEMONSTRATED
Scotty dogs- Apophyseal joints closest to the IR
PA OBLIQUE LSPINE PROJECTION
- Patient in a semi prone position supporting the. Selves with their forearm and flexed knee fo the elevated side
- Patient in a 45 deg prone oblique position
- Respiration suspended at end of expiration
- CR L3 entering the elevated side 5 cm lateral to the MSP
PA OBLIQUE LSPINE PROJECTION
STRUCTURES DEMONSTRATED
Scotty dogs, Apophyseal joints farthest from the IR
SPINAL FUSION STUDIES
FLEXION
LATERAL PROJECTION
Done to determine motion in the area of spinal fusion or to locate a herniated disc
- Patient standing in true lateral position with left side closest to IR
- Respiration suspended at end of expiration
- CR perpendicular to L3
- Either leaning backwards for one and forwards for the other image
AP AXIAL SI joint PROJECTION
- Patient supine with MSP centred to the centre of the table
- Lower limbs extended
- CR angled 30-35 deg cephalad 3,8 cm superior to the symphysis pubis
Structures demonstrated = SI joints
AP OBLIQUE SI JOINTS PROJECTION
- Done supine
- Elevate affected side 25-30 deg
- CR perpendicular entering 2,5 cm medial to the elevated ASIS at the level of the ASIS
- RPO demonstrates left SI joint
- LPO demonstrates right SI joint
APAXIAL SACRUM PROJECTION
- Patient MSP in-line with midline of table
- Patients legs extended to avoid symph superimposition
- Respiration suspended
- 15deg cephalad 5 cm superior to the symphysis pubis
-
APAXIAL SACRUM PROJECTION
STRUCTURES DEMONSTRATED
Sacrum free of superimposition
LATERAL SACRUM PROJECTION
- Patient in true lateral position
- Centre the MCP 9cm from the MCP and centred to the IR
- Place arms at right angles to the long axis of the body
- Flex the hips and knee with superimposition
- Respiration suspended
- CR perpendicular to the level of the ASIS
LATERAL SACRUM PROJECTION
STRUCTURES DEMONSTRATED
Lateral sacrum
AP AXIAL PROJECTION COCCYX
- Patient supine with MSP in-line with the mid line of the table
- Respiration suspended
- CR 10 deg caudad entering 5 cm superior to the symphysis pubis
AP AXIAL PROJECTION COCCYX
Structures demonstrated
Coccyx free from superimposition of the symphysis pubis
LATERAL PROJECTION COCCYX
- Patient in true lateral position
- Centre the MCP 9cm from the MCP and centred to the IR
- Place arms at right angles to the long axis of the body
- Flex the hips and knee with superimposition
- Respiration suspended
- CR perpendicular 5 cm inferior to the ASIS
LATERAL PROJECTION COCCYX
STRUCTURES DEMONSTRATED
Lateral coccyx
SCOLIOSIS
An exaggerated lateral curvature of the spine
Causes could be =
- Idiopathic, - no known cause
- Neuromuscular- poliomyelitis, cerebral palsy, muscular dystrophy
- Congenital- Spinal defects, such as hemivertebra, wedge vertebrae
- FunctionL- Bad posture, different leg lengths
SCOLIOSIS TREATMENT
- Curves 25-40 degrees, bracing is common, custom made for the patient
- Curves greater than 40 degrees surgery , Harrington rods are often required
PA SCOLIOSIS PROJECTION
- Patient standing with arms hanging by sides
- Adjust height of cassette to include 2,5 cm of iliac crest
- Centre MSP to midline of IR
LATERAL SCOLIOSIS PROJECTION
Used to demonstrate posture
- Done erect with patient in true lateral position
- Arms at 90deg to each other
- CR. Mid spine
- Include the entire spine
KYPHOSIS
An exaggerated convex curvature of the thoracic spine that results in a stooped posture and reduction in height
JEFFERSON FRACTURE
- Maybe caused by direct blow to the top of head e,g diving accident
- Comminuted fracture of C1
- Involves both the anterior and posterior arch of C1
- Rad appearance= on an odontoid image the lateral mass of C1 will be displaced laterally in relation to C2
HANGMANS FRACTURE
Fracture of the vertebral arch of C2 anterior to the inferior facet
Rad appearance =
- on lateral c spine , C2 will demonstrate anterior subluxation
CLAY SHOVELERS #
Avulsion # of the spinous processes in the lower cervical spine
Rad appearance =
- on lateral c spine , C2 will demonstrate anterior subluxation
LORDOSIS
An exaggerated concave curve of the lumber spine
OSTEOPHYTES
Bony spurs
OSTEOPOROSIS
Generalised or localised deficiency of bone matrix.
- There is decreased bone mass, increased chances of bone fractures
This is usually caused by increased activity of the osteoclasts which remove old bone
OSTEOPOROSIS RADIOGRAPHIC APPEARANCE
- Thin cortical bone, irregularity and resorption of the endosteal surface
- Bone appears more radiolucent than normal
- Pelvis ad spine a more susceptible to fracture
- the cortex appears as a relatively dens thin line producing
ANKLYLOSING SPONDYLITIS
- Progressive form of arthritis
- Joints and articulations become stiff
- Mostly affects males between 10-30 years
ANKLYLOSING SPONDYLITIS
RADIOGRAPHIC APPEARANCE
- Narrowing and fuzziness of the SI JOINTS
- Progresses up the spine
- Ossification of vertebral ligaments
- Spine becomes rigid block of bone, ( bamboo spine)
- Callus bridging on anterior aspects of vertebral bodies
- Narrowed intervertebral disc spaces
SPINA BIFIDA
Incomplete closure of the posterior neural arch
SPINA BIFIDA OCCULTA
Loss of neural arch at L5- S1 level
- usually associated with muscular abnormalities, lack of bladder or bowel control
SPINA BIFIDA MENINGOCELE
Large defects in the lumber or cervical spine with associated meningeal herniation
SPINA BIFIDA MYLOMENINGOCELE
Large defects of the lumber or cervical spine with associated meningeal spinal cord/ nerve roots herniation
- there is neurologic deficits at and below the site of protrusion
SPINA BIFIDA RADIOGRAPHIC APPEARANCE
On AP projection = Increased interpedicular distance
On lateral = Herniated spinal contents
SPONDYLOLYSIS
Loss of bony continuity of the neural arch of a vertebrae.
- Usually in the Pars Interarticularis
- Most common area affected L4-L5
- May lead to Spondylolisthesis
- Demonstrated in the oblique projection
SPONDYLOLISTHESIS
The forward movement of one vertebrae on another
- Most common affected area is L5
- Demonstrated on the lateral projection
- treated with back support , spinal fusion
