SPINE I.A Flashcards
VERTEBRAL ANATOMY CONSIST OF _________ & _________
- POSTERIOR SURFACE OF BODY & ARCH FORM _________, WHICH CONTAINS ___________.
-WHAT MAKES UP THE VERTEBRAL ARCH?
BODY & ARCH
-POSTERIOR = VERTEBRAL FORAMEN, CONTAINS SPINAL CORD
-LAMINAE & PEDICLES = ARCH
WHAT IS ANOTHER NAME FOR C1?
WHAT IS DIFFERENT ABOUT C1?
WHAT IS ANOTHER NAME FOR C2?
WHAT ARE THE UNIQUE FEATURES FOR C-SPINE?
ATLAS
NO VERTEBRAL BODY OR SPINOUS PROCESS
AXIS = C2
-TRANSVERSE FORAMINA & BIFID SPINOUS PROCESS OF C3-C6
WHERE IS TRANSVERSE FORAMINA LOCATED? WHAT IS IT FOR?
WHERE ARE ZYGAPOPHYSEAL JOINTS?
WHAT PROJECTIONS ARE THE Z-JOINTS BEST SEEN?
IN TRANSVERSE PROCESS FOR VERTEBRAL ARTERIES & VEINS
- JUNCTION BTWN SUPERIOR AND INFERIOR ARTICULAR PROCESS’ OF ADJACENT VERTEBRAE
- LATERAL C SPINE, OBLIQUE T SPINE & OBLIQUE L SPINE
___________ - SHALLOW DEPRESSION ON UPPER SURFACE OF EACH PEDICLE
___________ - DEEP DEPRESSION ON LOWER SURFACE OF EACH PEDICLE
TOGETHER THESE CREATE __________ WHICH IS FOR __________
WHAT PROJECTION IS THIS BEST SEEN?
SUPERIOR VERTEBRAL NOTCH
INFERIOR VERTEBRAL NOTCH
INTERVETEBRAL FORAMEN FOR SPINAL NERVE PASSAGE
- OBLIQUE C-SPINE, LATERAL T & L SPINE
WHERE IS EAM LOCATED?
WHAT IS ANOTHER NAME FOR C7?
WHAT IS THE ANGLE FOR AP C-SPINE?
EAR ATTACHMENT TO HEAD
VERTEBRA PROMINENS
15-20* CEPHALAD AT C4
AP AXIAL CERVICAL SPINE - GUIDELINES
- C3 to T2 vertebral bodies demonstrated
- Mandible & base of the skull superimpose the C1 and C2
- Open intervertebral disk spaces
- Spinal processes are aligned in midline of the cervical bodies
- Articular pillars & pedicles symmetrical lateral to spine bodies
- Mandibular angle & mastoid tips are equal dist. from vertebra
** A line from the lower margins of the upper incisors to the mastoid tips should be perpendicular to the IR **
WHY DO WE ANGLE ON C-SPINE?
WHAT DOES ANGLE DEPEND ON? WHY?
LORDOTIC CURVE/SHAPE OF VERTEBRAL BODIES CAUSE DISK SURFACES TO SLANT UPWARD ANTERIORLY TO POSTERIORLY
- CR ANGLE DEPENDS ON DEGREE OF LORDOTIC CURVE
- SAME DIRECTION AS SLOPE OF VERTEBRAL BODIES.
- TO OPEN IV DISK SPACES
WHAT IS PATIENT POSITION &/OR DEGREE OF CURVATURE?
THE GREATER THE LORDOTIC CURVE, THE ______ THE ANGLE.
IMAGE 1 = UPRIGHT OR MORE LORDOTIC CURVE
IMAGE 2 = SUPINE OR LESS CURVE
IMAGE 3 = KYPHOTIC PATIENT
GREATER THE CEPHALIC ANGLE
ANALYZE AP AXIAL C-SPINE
INSUFFIENT CEPHALIC ANULATION
- CLOSED INTERVERT. DISCK SPACES
ANALYZE THESE AP AXIAL C-SPINES
IMAGE 1 = HEAD TILTED TOO FAR BACKWARD
- UPPER VERT. OBSCURED BY OCCIPITAL BASE
IMAGE 2 = CHIN TUCKED TOO FAR
- UPPER VERT. SUPERIMPO. BY MANDIBLE
- SPINE NOT ALIGNED WITH LONG AXIS OF IR
_______ - HEAD TILTED TOO FAR BACKWARD IN C-SPINE
HOW TO ADJUST/FIX:
________-CHIN TUCKED TOO FAR
HOW TO FIX/ADJUST:
CERVICAL EXTENSION - BRING HEAD FORWARD SLIGHTLY
ALIGN UPPER INCISORS & MASTOID TIP PERP TO IR
CERVICAL FLEXION - BRING HEAD BACK SLIGHTLY
ALIGN UPPER INCISORS & MASTOID TIP PERP TO IR
ANALYZE AP AXIAL C-SPINE
ROTATED
- THORAX IS ROTATED BUT HEAD IS IN GOOD POSITION.
-UPPER VERT. IN AP BUT LOWER ARE ROTATED
AP OPEN MOUTH C-SPINE - GUIDELINES
- Odontoid process and vertebral body of C2, lateral masses and transverse processes of C1 through the open mouth
- Open atlantoaxial joints seen through the open mouth
- Lateral masses of atlas at equal distances form the dens
- Spinous processes of axis aligned with midline of axis’ body
**A line from the lower margins of the upper incisors to
the mastoid tips should be perpendicular to the IR
WHAT TO DO If the teeth are superimposed on the dens slightly?
IS TEETH OR BASE OF SKULL OVER DENS ACCEPTABLE IN OPEN MOUTH?
HYPEREXTEND NECK OR ANGLE CR 5* CEPHALIC
NO - DENS FREE OF SUEPRIMP.
COMPARE THE OPEN-MOUTH C-SPINE
IMAGE 1: HEAD TILTED TOO FAR BACK (EXTENSION)
- DENS AND ATLANTOAXIAL JOINT SUPERIMPOSED BY INCISORS
IMAGE 2: HEAD TOO FLEXED FORWARD
- UPPER INCISORS INFERIOR TO OCCIPITAL BASE
ANALYZE OPEN-MOUTH C-SPINE
DOES IT NEED ADJUSTING? IF SO WHAT?
HEAD POSITIONING
- ATLANTOAXIAL JOINT OPEN & FREE OF SUPERIMPOSITION
- UPPER INCISORS & OCCIPITAL BASE ALIGNED BUT TIP OF DENSE IS OBSCURED
ANGLE CR 5* CEPHALIC
ANALYZE OPEN-MOUTH C-SPINE
DOES IT NEED ADJUSTING? IF SO WHAT?
ROTATION
FACE IS ROTATED TOWARD RIGHT SIDE
SPACE BTWN LATERAL MASS AND DENS IS SMALLER ON LEFT SIDE
ADJUST PATIENT HEAD INTO PROPER AP
LATERAL C-SPINE - GUIDELINES
- C1- C7 / T1 intervertebral joint spaces are CLEARLY SEEN
- Zygapophyseal joints
- Mandibular rami do not superimpose C1 and C2
- Spinous processes & posterior arch of C1 in profile
- The R and L articular pillars and Z-joints should be
superimposed for each vertebra
**AML- acanthiomeatal line parallel to the floor
COMPARE THE LATERAL C-SPINES
IMAGE 1 = INADEQUATE SHOULDER DEPRESSION
- NEED SUSPENDED ON EXPIRATION
IMAGE 2 = CHIN NOT ELEVATED ENOUGH TO PLACE AML PARALLEL TO FLOOR
- MANDIBULAR RAMI SUPERIMPOSE BODY OF C1 & C2
COMPARE THE LATERAL C-SPINES
IMAGES SHOW ROTATION
- RIGHT & LEFT Z-JOINTS & ARTICUALR PILLARS ARENT SUPERIMPOSED
- ONE SIDE MOVES ANTERIOR TO THE OTHER SIDE
- MANDIBULAR RAMI NOT SUPERIMPOSING EACHOTHER
COMPARE LATERAL C-SPINES
IMAGES SHOW TILTING
- Z JOINTS ONE IS LOWER THAN THE OTHER
IMAGE 1 = TILTED AWAY
- POSTERIOR ARCH OF C1 REMAINS IN PROFIE
IMAGE 2 = TILTIED TOWARD IR
- VERT FORAMEN OF C1 IS DEMONSTRATED
ARE C-SPINE OBLIQUES DONE AP OR PA?
WHAT IS THE ANGLE? THE CR?
WHAT IS THE DEGREE OF OBLIQUITY?
SID?
CAN BE DONE AP OR PA
AP = 15-20* CEPHALIC
PA = 15-20* CAUDAD
CR = LEVEL OF C4
45* OBLQUE
40-72 SID
OBLIQUE C-SPINE - GUIDELINES
- Intervertebral disc spaces & intervertebral foramina of interest (C2-C7) are open and are uniform in size and shape
- The pedicles of interest in full profile 3. Opposite pedicles aligned with anterior cervical body
- AP oblique projections = foramina and pedicles on side further from IR, Side UP (RPO- left and LPO- right)
- PA oblique projections = foramina and pedicles on side closer to the IR, Side Down (RAO-right and LAO-left)
ANALYZE C-SPINE OBLIQUES
IMAGE 1: UNDER ROTATED (INSUFFICIENT OBLIQUE)
- INTERVETERBAL FORAMINA & PEDICLES ARE NARROW OR OBSCURED
IMAGE 2: OVER ROTATED (EXCESSIVE OBQLIQUITY)
- PEDICLES FORESHORTENED & OPPOSITE SIDE ALIGNED AT MIDLINE OF CER/ BODY
- Z JOINTS SEEN (SHOULDNT ON OBLIQUE)
ANALYZE C-SPINE IMAGES
IMAGE 1: HEAD TILTED TOO FAR BACKWARD
IMAGE 2: ROTATION PRESENT
ANALYZE C-SPINE SIMAGES
IMAGE 1: MANDIBLE SUPERIMPOSING C3
IMAGE 2: INSUFFICIENT OBLIQUITY
LABEL THE IMAGE
A. Odontoid process (dens)
B. Transverse process of C1
C. Lateral mass of C1
D. Inferior articular surface of C1
E. Atlantoaxial joint
F. Body of C2
G. Superior articular surface of C2
LABEL THE IMAGE
A. Odontoid process
B. Posterior arch of the atlas
C. Body of C3
D. Zygapophyseal joint btw C4 and C5
E. Body of C7
F. Spinous process of C7, vertebra prominens
LABEL THE IMAGE
A. Posterior arch of C1
B. Intervertebral foramen btw C4 and C5
C. Pedicle of C6
D. Body of C7
AP T-SPINE - GUIDELINES
- Spinous processes aligned with the midline of the vertebral bodies
- Distance from the spine to the sternal clavicular ends and from the pedicles to the spinous processes are equal on two sides
- Intervertebral disc spaces are open
- C7 to L1 should be demonstrated
ANALYZE AP T-SPINE
ROTATION. (LOOK AT SC JOINTS)
- UPPER THORAX ROTATED TO LEFT
- SMALLER DISTANCE BTWN PEDICLES TO SPINOUS
PROCESS ON ELVATED RIGHT SIDE
-LOWER THORAX NOT ROTATED
- SIBTLE SCOLI
LATERAL T-SPINE - GUIDELINES
- T1 to T3 are not well visualized
- Intervertebral disk space should be open
- Intervertebral foramina demonstrated
- Pedicles in profile
- Less than half an inch of space btw posterior ribs (due to OID of one side of the ribs)
- Thoracic vertebral bodies, intervertebral foramina and open intervertebral disc spaces demonstrated
ANALYZE LATERAL T-SPINE
IMAGE 1: If the elevated R side was rotated posteriorly, more than 1 in of space btw posterior ribs
IMAGE 2: If the elevated R side was rotated anteriorly, only a slight rotation of posterior ribs
L-SPINE ANATOMY:
SUPERIOR & INFERIOR NOTCHES CREATE OPENINGS BTWN PEDICLES CALLED ________. USED FOR:
THIS FORMS A _____* ANGLE TO MSP, BEST DEMONSTRATED ON A ______ PROJECTION
INTERVETEVRAL FORAMINA -
- PASSAGE OF BLOOD VESSELS & NERVES
90* ANGLE TO MSP
LATERAL PROJECTION
WHAT JOINT IS VISUALIZED ON AP LUMBAR OBLIQUES?
__________- PART OF LAMINA BETWEEN SUPERIOR & INFERIOR ARTICULAR PROCESS
BEST SEEN ON ______ PROJECTION.
DOWNSIDE Z-JOINT (RPO = RIGHT, LPO = LEFT)
-PARS INTERARTICULARIS
- OBLIQUE
LABEL THE L-SPINE VERTEBRA
A. Spinous process
B. Lamina
C. Pedicle
D. Vertebral foramen
E. Body
F. Transverse process
LABEL THE L-SPINE VERTEBRA
A. Body
B. Inferior vertebral notch (upper portion of the
intervertebral foramen)
C. Inferior articular process
D. Spinous process
E. Superior articular process
F. Pedicle
AP L-SPINE - GUIDELINES
- Approximately T11 to distal sacrum included
- Intervertebral disc spaces are open
- Spinous processes in midline of vertebral
bodies- Equal distances from pedicles to spinous processes on both sides
ANALYZE AP L-SPINE
ROTATION
- ROTATED TO LEFT SIDE (LPO)
- SIDE ELEVATED HAS SMALLER DISTANCE FROM SPINOUS PROCESS TO PEDICLES (RIDE SIDE IS UP)
WHAT IS DIFFERENCE BETWEEN 2 IMAGES? WHY DONE?
- An xray of left posterior oblique (LPO) projection of the lumbar spine reveals that the downside pedicle is projected too far posterior on the vertebral body. What specific positioning error is present on this radiograph?
a. Excessive rotation of the spine
b. Insufficient rotation of the spine
c. Tilt of the spine
d. Incorrect CR placement - The initial radiographs demonstrate potential pathology involving the L5-S1 zygapophyseal joint. Which of the following positions and/or projections would best demonstrate this joint space?
a. Lateral L5-S1 position
b. Right and left 30° oblique projections
c. Right and left 50° oblique projections
d. Closely collimated and lateral position of L5-S1 region
IMAGE 1: PT LEGS STRAIGHT
IMAGE 2: PT LEGS FLEXED/KNEES BENT
- DONE TO REDUCE LORDOTIC CURVE
- A. excessive rotation of spine
- B. Right & Left 30* Oblique (lower = less)
- An AP lumbar projection obtained with the patient rotated
toward the right side demonstrates:
a. the spinous processes positioned closer to the left pedicles.
b. the sacrum and coccyx rotated toward the left side.
c. closed intervertebral disk spaces.
d. both a and b - What is shown in the image? Label:
- Scottie Dog
A. Nose - Transverse process
B. Eye – Pedicle
C. Neck – Pars interarticularis
D. Leg – Inferior articular process
E. Ear – Superior articular process
F. Z- joint
OBLQIUE L-SPINE - GUIDELINES
- Z-JOINTS DEMONSTRATED
- PEDICLES (EYE OF SCOTTY DOG) SEEN HALFWAY BTWN MIDLINE & LATERAL BORDER OF VERT. BODY
- AP SHOWS SIDE CLOSE IR, PA SHOWS SIDE AWAY
WHAT DIRECTION DO SCOTTY DOGS FACE?
WHAT POSITION IS PATIENT IN?
OF JOINT BEING DEMONSTRATED
AKA: IF NOSE POINTING TO LEFT, LEFT Z JOINT IS DEMONSTRATED
-LPO OR RAO
- LEFT Z JOINT DEMONSTRATED
L-SPINE OBLIQUE RAO SHOWS _______ JOINT.
LABEL THE IMAGE
- RAO = LEFT SIDE Z-JOINT PA AWAY
- 12th rib
- Zygapophysial (facet) joint L I – L II
- Superior articular process of L III
- Pedicle of vertebral arch L III (eye of “Scottie dog”)
- Transverse process of L III (snout of “Scottie dog”)
- Superior articular process of sacrum
- Inferior articular process of L II
- Transverse process of L III
- Zygapophysial (facet) joint L II – L III
- Lamina of vertebral arch L IV
ANALYZE L-SPINE OBLIQUE
ROTATION
IMAGE 1: EXCESSIVE OBLIQUE
- PEDICLES CLOSER TO VERT. BODY MIDLINE
- LESS PEDICLE SEEN
- Z-JOINT CLOSED
IMAGE 2: INSUFFICIENT OBLQIUE
- PEDICLES CLOSER TO LATERAL BORDER
- MORE LAMINA SHOWN
- Z-JOINTS CLOSED
LATERAL L-SPINE - GUIDELINES
CR:
- INTERVETEBRAL FORAMINA DEMONSTRATED
- INTERVETEBRAL DISC SPACES OPEN
- R & L PEDICLES SUPERIMPOSED AND IN PROFILE
- LEAD MAT BEHIND TO REMOVE SCATTER
CR: ILLIAC CREAST
ANALYZE THE LATERAL L5-S1 IMAGE
L5-S1 INTERVETEBRAL DISK SPACE CLOSED
L5 VERT. BODY IS DISTORTED
ANALYZE AP L-SPINE IMAGE
- ROTATION TOWARD LEFT (LPO POSITION)
- GREATER FISTANCE FROM PEDICLE TO SPINOUS PROCESS ON LEFT SIDE
ANALYZE OBLQIUE L-SPINE IMAGE
- EXCESSIVE OBLIQUITY (NOT UNIFORM)
- SCOTTY DOG EYE CLOSER TO MIDLINE
-LESS PEDICLE SEEN
-Z-JOINTS CLOSED
AP AXIAL SACRUM - GUIDELINES
AP SACRUM CR:
- FREE SUPERIMP. BY PUBIS
- CENTERED, ALIGNED WITH PUBIC SYMPHYSIS
-CR: 15* CEPHALIC, 2IN SUPERIOR TO PUBIC SYMPHASIS
OR 2 IN INFERIOR TO ASIS
ANALYZE THE AP AXIAL SACRUM IMAGES
IMAGE 1: ROTATION TO LEFT (LPO)
- SACRUM MOVES TO RIGHT
IMAGE 2: EXCESSIVE CEPHALIC ANGLE
- SACRUM SUPERIMPOSED BY PUBIS. PUBIC SYMPH.
ANALYZE THE AP AXIAL COCCYX IMAGES
IMAGE 1: ROTATION TO RIGHT (RPO)
- COCCYX MOVES TO LEFT
- NOT ALIGNED WITH PUBIC SYMPH.
IMAGE 2: INSUFFICIENT CAUFAL ANGLE
- COCCYX SUPERIMP. BY PUBIS/PUBIC SYMPH.
