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Radiographic Procedures And Pathology. Prep Course 1 > Module 9 Vertebral Column > Flashcards

Module 9 Vertebral Column Flashcards

1
Q

VERTEBRAL COLUMN FUNCTION

A
  • Protect the spinal chord
  • Provide attachments to back muscles and ribs
  • Support the skull and trunk
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2
Q

SECONDARY VERTEBRAL CURVES

A
  • Cervical curve
  • Lumber curves

These develop because of weight bearing

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3
Q

PRIMARY VERTEBRAL CURVES

A

AKA kyphotic curves

  • Thoracic curve
  • Pelvic Curve

Present at birth

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4
Q

VERTEBRAL ARCH COMPOSITION

A
  • 2 Laminae
  • 2 pedicels
  • 4 articular processes
  • 2 transverse processes
  • 1 spinous process
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5
Q

UNIQUE FEATURES OF THE CERVICAL SPINE

A
  • Bifid tips on spinous processes

- Transverse foramina, which provide passage for the vertebral artery and veins

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6
Q

T SPINE VERTEBRAL IDENTIFICATION

A

Posterior slant of the transverse processes, as well as the longer spinous processes which have a more severe slant

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7
Q

VERTEBRAL COLUMN ARTICULATIONS

A
  • 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 )
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8
Q

AP AXIAL C SPINE PROJECTION

A
  • 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)
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9
Q

AP AXIAL C SPINE PROJECTION STRUCTURES DEMONSTRATED

A
  • C3 - T2
  • Open intervertebral disc spaces
    • Spinous processes to the pedicels
  • Demonstrate the presence or absence of cervical ribs
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10
Q

LATERAL C SPNE PROJECTION

A
  • 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
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11
Q

LATERAL C SPNE PROJECTION STRUCTURES DEMONSTRATED

A
  • 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
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12
Q

LATERAL C SPNE PROJECTION FLEXION / EXTENSION

A

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
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13
Q

LATERAL C SPNE PROJECTION FLEXION / STRUCTURES DEMONSTRATED

A

All 7 cervical spinous processes in profile, elevated and widely separated

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14
Q

LATERAL C SPNE PROJECTION / EXTENSION STRUCTURES DEMONSTRATED

A

All 7 cervical spinous processes in profile, depressed and closely spaced

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15
Q

AP OPEN MOUTH PROJECTION

A
  • 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
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16
Q

AP OPEN MOUTH PROJECTION STRUCTURES DEMONSTRATED

A
  • 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
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17
Q

AP C SPINE OBLIQUE PROJECTION STRUCTURES DEMONSTRATED

A
  • Intervertebral foramina and pedicels farthest from the IR
  • Open inter vertebral disc spaces C2-C3 to C7- T1

-

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18
Q

PA C SPINE OBLIQUE PROJECTION STRUCTURES DEMONSTRATED

A
  • The intervertebral foramina and pedicels closest to the IR

- C2-C3 to C7- T1 open intervertebral disc spaces

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19
Q

AP T SPINE PROJECTION

A
  • 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
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20
Q

AP T SPINE PROJECTION STRUCTURES DEMONSTRATED

A
  • Thoracic bodies and intervertebral disc spaces
  • Transverse processes
  • Spinous processes in the midline of the vertebral bodies
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21
Q

LATERAL T SPINE PROJECTION

A
  • 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)
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22
Q

LATERAL T SPINE PROJECTION STRUCTURES DEMONSTRATED

A
  • Thoracic bodies and interspaces,
  • Intervertebral foramina and pedicles
  • Lower spinous processes
  • Upper 4 thoracic vertebrae are not seen due to patients shoulders
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23
Q

LATERAL CERVICOTHORACICEGION PROJECTION

Swimmers Technique

A
  • 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
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24
Q

LATERAL CERVICOTHORACICEGION PROJECTION

( Swimmers Technique )

STRUCTURES DEMONSTRATED

A
  • Lateral C 5- T5 projected between the two shoulders
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25
Q

L SPINE AP PROJECTION

A
  • 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
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26
Q

L SPINE AP PROJECTION

STRUCTURES DEMONSTRATED

A
  • Lumber bodies
  • Open intervertebral disc spaces
  • Lamina, Spinous processes in the midline of the body, transverse processes
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27
Q

L SPINE LATERAL PROJECTION

A
  • 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
28
Q

L SPINE LATERAL PROJECTION

STRUCTURES DEMONSTRATED

A
  • Lumber bodies and intervertebral joint spaces
  • Superimposed posterior margin of each vertebral body
  • Spinous processes, Lumpsacral junction
  • Superior 4 intervertebral foramina
29
Q

L5/ S1 LATERAL PROJECTION

LUMBOSACRAL JUNCTION

A
  • 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
30
Q

AP OBLIQUE LSPINE PROJECTION

A
  • 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
31
Q

AP OBLIQUE LSPINE PROJECTION

STRUCTURES DEMONSTRATED

A

Scotty dogs- Apophyseal joints closest to the IR

32
Q

PA OBLIQUE LSPINE PROJECTION

A
  • 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
33
Q

PA OBLIQUE LSPINE PROJECTION

STRUCTURES DEMONSTRATED

A

Scotty dogs, Apophyseal joints farthest from the IR

34
Q

SPINAL FUSION STUDIES

FLEXION

LATERAL PROJECTION

A

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
35
Q

AP AXIAL SI joint PROJECTION

A
  • 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

36
Q

AP OBLIQUE SI JOINTS PROJECTION

A
  • 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
37
Q

APAXIAL SACRUM PROJECTION

A
  • 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

-

38
Q

APAXIAL SACRUM PROJECTION

STRUCTURES DEMONSTRATED

A

Sacrum free of superimposition

39
Q

LATERAL SACRUM PROJECTION

A
  • 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
40
Q

LATERAL SACRUM PROJECTION

STRUCTURES DEMONSTRATED

A

Lateral sacrum

41
Q

AP AXIAL PROJECTION COCCYX

A
  • 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
42
Q

AP AXIAL PROJECTION COCCYX

Structures demonstrated

A

Coccyx free from superimposition of the symphysis pubis

43
Q

LATERAL PROJECTION COCCYX

A
  • 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
44
Q

LATERAL PROJECTION COCCYX

STRUCTURES DEMONSTRATED

A

Lateral coccyx

45
Q

SCOLIOSIS

A

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
46
Q

SCOLIOSIS TREATMENT

A
  • Curves 25-40 degrees, bracing is common, custom made for the patient
  • Curves greater than 40 degrees surgery , Harrington rods are often required
47
Q

PA SCOLIOSIS PROJECTION

A
  • 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
48
Q

LATERAL SCOLIOSIS PROJECTION

A

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
49
Q

KYPHOSIS

A

An exaggerated convex curvature of the thoracic spine that results in a stooped posture and reduction in height

50
Q

JEFFERSON FRACTURE

A
  • 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
51
Q

HANGMANS FRACTURE

A

Fracture of the vertebral arch of C2 anterior to the inferior facet

Rad appearance =

  • on lateral c spine , C2 will demonstrate anterior subluxation
52
Q

CLAY SHOVELERS #

A

Avulsion # of the spinous processes in the lower cervical spine
Rad appearance =

  • on lateral c spine , C2 will demonstrate anterior subluxation
53
Q

LORDOSIS

A

An exaggerated concave curve of the lumber spine

54
Q

OSTEOPHYTES

A

Bony spurs

55
Q

OSTEOPOROSIS

A

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

56
Q

OSTEOPOROSIS RADIOGRAPHIC APPEARANCE

A
  • 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
57
Q

ANKLYLOSING SPONDYLITIS

A
  • Progressive form of arthritis
  • Joints and articulations become stiff
  • Mostly affects males between 10-30 years
58
Q

ANKLYLOSING SPONDYLITIS

RADIOGRAPHIC APPEARANCE

A
  • 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
59
Q

SPINA BIFIDA

A

Incomplete closure of the posterior neural arch

60
Q

SPINA BIFIDA OCCULTA

A

Loss of neural arch at L5- S1 level

  • usually associated with muscular abnormalities, lack of bladder or bowel control
61
Q

SPINA BIFIDA MENINGOCELE

A

Large defects in the lumber or cervical spine with associated meningeal herniation

62
Q

SPINA BIFIDA MYLOMENINGOCELE

A

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
63
Q

SPINA BIFIDA RADIOGRAPHIC APPEARANCE

A

On AP projection = Increased interpedicular distance

On lateral = Herniated spinal contents

64
Q

SPONDYLOLYSIS

A

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
65
Q

SPONDYLOLISTHESIS

A

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

Radiographic Procedures And Pathology. Prep Course 1 (18 decks)

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