TEST 2 (spine) Flashcards
1
Q
From a posterior view, C & L spine have ____ curves
A
concave
2
Q
From a posterior view, T & sacrum have ____ curves
A
convex
3
Q
Which spinal curves are primary
A
T & sacrum
4
Q
Which spinal curves develop soon after birth
A
T & Sacrum
5
Q
Which spinal curves are compensatory
A
C & L spine
6
Q
3 common terms to describe abnormality in spinal curve
A
lordosis
kyphosis
scoliosis
7
Q
What is Lordosis
A
Exaggerated concavity (Swayback)
8
Q
What is Kyphosis
A
Exaggerated convexity (Humpback)
9
Q
What is Scoliosis
A
Exaggerated lateral curvature
10
Q
Abnormal anterior concavity of lumbar spine is ____
A
Lordosis
11
Q
Abnormal increased convexity of thoracic spine is ___
A
Kyphosis
12
Q
Abnormal lateral curvature of spine is ____
A
Scoliosis
13
Q
3 parts of vertebral
A
body
vertebral arch
vertebral foramen
14
Q
Which structure attach superiorly and inferiorly to vertebral body
A
intervertebral disk
15
Q
Which structure extend posteriorly from vertebral body
A
vertebral arch
16
Q
Posterior surface of body & arch form _____
A
vertebral foramen
17
Q
Vertebral foramen contains _____
A
spinal cord
18
Q
Location of Pedicle
A
extend posteriorly from both side of vertebral body
19
Q
Which structure extend directly posterior off of the vertebral body
A
pedicle
20
Q
Which structure extend posteriorly from each pedicle and unite in the midline
A
Lamina
21
Q
The spinous process of cervical extends ____
A
posteriorly where 2 laminae unite
22
Q
What are components of the vertebral arch (4)
A
pedicle
lamina
transverse process
spinous process
23
Q
Lamina converge at ___
A
spinous process
24
Q
Pedicle continue mid line at the ____
A
laminae
25
Which structure join 2 vertebrae together
S/I articular process
26
Which joint is formed between S/I articular process of 2 vertebra
zygapophyseal joint
27
Other names for zygapophyseal joint
Apophyseal
Facet
28
What structure is formed between S/I vertebral notch
intervertebral foramen
29
Zygapophyseal joint is formed between ____
S/I articular process
30
Intervertebral foramen of L-spine is formed between _____
A. S/I articular process
B. S/I vertebral notch
S/I vertebral notch
31
Spinal nerves and blood vessels pass through ____
intervertebral foramen
32
spinal cord pass through ____
vertebral foramen
33
Intervertebral disk acts as a ____
shock absorber
34
2 parts of intervertebral disk (outer to inner)
annulus fibrosis - nucleus fibrosis
35
Herniated disk is caused by _____
nucleus fibrosis protrudes thru annulus fibrosis and press on the spinal cord ---> pain & numbness that radiate into upper & lower limbs
36
Which position would we best see cervical zygapophyseal joint
lateral
37
in C-spine, Zygapophyseal joint is ___ degree from AP. for which vertebra?
90
C2-7
38
in C-spine, Intervertebral foramen are seen:
___ degree from midsagittal
___ degree inferior angle
45
15
39
Which position would we see intervertebral foramen for c-spine?
Obliques
40
Is the tube angle needed to see intervertebral foramen?
YES
41
Tube angle to see intervertebral foramen
15 cephalad
42
The atlas is ____
The axis is ____
C1
C2
43
The transverse process arise from ___ & ____
pedicle & body
44
What are the 3 foramina of the cervical vertebra
2 transverse foramen
1 vertebral foramen
45
vertebral veins & arteries pass thru _____
transverse foramen
46
Bifid spinous processes are found on ___ through ___
C2 - C6
47
3 parts of C-spine?
transverse foramen
bifid spinous process
articular pillars
48
Articular pillars formed by ____
S/I articular processes
49
Articular pillars are called ____ ____ when refer to C1
lateral mass
50
Zygapophyseal joint for C1-C2 are seen in which position?
AP open mouth
51
Zygapophyseal joint for C3-C7 are seen in which position
lateral
52
To open & demonstrate cervical intervertebral foramen radiographically, what must be done?
rotate patient 45 oblique
15-20 cephalad tube angle
53
3 anatomical parts of C1
superior facets
anterior arch
posterior arch
54
What structure C1 lack but other Cervical spines have?
body & spinous process
55
[C1] instead of the body, what structure is present anteriorly?
anterior arch
56
[C1} instead of the spinous process, what structure is present posteriorly
posterior arch
57
anterior and posterior arch of C1 terminates at ___
tubercle
58
Which structure of C1 join with the skull
superior facets
59
(spine) Superior facet is a surface located on ____
superior articular process
60
Function of lateral mass of C1
support weight of head & assist in head rotation
61
What is the distinctive feature of C2
odontoid process (dens)
62
Location of odontoid process
posterior to anterior arch of C1
63
On the oblique positions for cspine, which structure we are looking for
intervertebral foramina
64
On a posterior oblique, which side will have the intervertebral foramina open
upside (side farthest away from IR)
65
On anterior oblique, which side will have the intervertebral foramina open
the downside (side closest to IR)
66
[C-spine] Tube angle for
anterior oblique: ____
posterior oblique: ____
15-20 caudad
15-20 cephalad
67
[C] in LPO which intervertebral foramina is opened
RIGHT
68
Routine for C-spine
AP
AP open mouth
LT Lateral
RPO
LPO
69
Positioning parameter for AP C-spine
Positioning?
CR?
SID?
supine or erect
slightly extend chin
15-20 cephalad tube angle
CR: mid-sagittal
SID: 40"
70
Tube angle for AP C-Spine
15-20 Cephalad
71
CR for AP C-spine
C4 (level of thyroid cartilage)
72
Why do we need tube angle for AP C-spine
direct beam between overlapping cervical vertebral bodies to see intervertebral disk better
73
[AP C-spine] CR angle:
supine: ___
erect: ____
15 cephalad
20 cephalad
74
Kyphotic patient will need an angle of ____ for AP C-spine
more than 20
75
AP Open mouth is best for which cervical spine
C1-C2
76
Position patient for AP Open mouth
mouth open
lower margin of top incisors is in line (perpendicular) with base of skull
77
What indicate no rotation of head during AP Open Mouth
equal distances from lateral mass of C1 to condyle of mandible
78
Which joint do we need to see for AP Open mouth
atlantoaxial joint (C1-C2)
79
What anatomy are demonstrated through AP open mouth (4)
dens
vertebral body of C2
lateral mass & transverse process of C1
atlantoaxial joint between C1-C2
80
Positioning parameter for RPO/LPO C-spine
the patient can be sitting or standing, rotates 45 degrees, with the arms placed at side
81
CR & Tube angle for RPO/LPO C-spine
CR: C4
Tube: 15-20 cephalad
82
Oblique positions for C-spine show which structure?
intervertebral foramen
83
RPO/LPO shows intervertebral foramina ____ IR
farthest from
84
RAO/LAO shows intervertebral foramina ____ IR
closest to
85
What way to prevent mandible from superimpose vertebrae
protract chin
86
what will cause the superimposition of base of skull over the posterior arch of C1
excessive skull and neck extension
87
CR & Tube anlge for RAO/LAO of C spine
CR: C4
tube: 15-20 caudad
88
RPO C-spine looks for ____ intervertebral foramen
LEFT
89
RAO C-spine looks for ____ intervertebral foramen
RIGHT
90
SID for Lateral C-spine
60-72"
91
Position patient for Lateral C-spine
erect or x-table
depress shoulders with patient straight
slightly extend chin
92
CR for lateral c-spine
C4
93
Lateral C-spine looks for ____
C7-T1 (top)
94
Why do we INcreased SID from Ap to Lateral C-spine
To decrease OID due to the patient shoulder
95
CR for Xtable C-spine
C4 (top IR: 1-2" above EAM)
96
If we cant see C7-T1 on lateral, what other position we do ?
Swimmer
97
Positioning parameter for C-spine Swimmer
raise arm closest to IR
depress arm farthest from IR
98
For Swimmer C-spine, a 3-5 caudad tube angle can do what
separate 2 shoulders farthest from IR
99
For C-spine flexion & extension, patient is placed in ____ position
lateral
100
Position parameter for C-spine flexion
depress chin until it touches the chest
101
Position parameter for C-spine extension
elevate chin & tilt head back as much as possible
102
which T-spine are cervical like
T1-4
103
which T-spine are thoracic like
T5-8
104
which T-spine are lumbar like
T9-12
105
T-spine has _____ spinous process
inferior projecting
106
Key distinguish feature of thoracic spine
facets for rib articulations
107
facets of thoracic vertebra accept the ____ of a rib to form ____
head
costovertebral joint
108
to form costovertebral, the facets for rib articulation located on ____
body vertebra
109
facets of thoracic vertebra articulate with tubercle of rib 1 - 10 to form _____
costotransverse joints
110
Rib 11 - 12 articulate at ____
costovertebral joint
111
to form costotransverse joint in T-spine, the facets for rib articulation located on ____
transverse process
112
In T-spine, zygapophyseal joint is ____ degree from AP
70-75
113
In T-spine, intervertebral foramen is ____ degree from AP
90
114
Position parameter for AP T-spine, include CR & breathing technique
supine
knee flexed
suspend respiration on expiration
CR: T7
115
Mastoid tip is at ____
C1
116
Jugular notch is at ___
T2/3
117
Sternal angle is at ___
T4/5
118
1" inferior to EAM is ____
C1
119
Gonion is at ____
C3
120
2 topographic landmarks for C-spine
mastoid tip (C1)
gonion (C3)
121
3 topographic landmarks for T-spine
jugular notch (T2/3)
sternal angle (T4/5)
Xiphoid tip (T9/10)
122
For AP T-spine collimate to ____
4-5"
123
position parameter for Lateral T-spine, include CR
lateral recumbent
knee flexed
CR: T7 & 3" anterior from spinous process
124
why do we suspend respiration on expiration for AP T-spine
decrease lung volume
125
Breathing technique for Lateral T-spine helps ___
blur ribs & pulmonary marking
126
If T1-3 not well visualized, which position should be done to obtain the images
Swimmers
127
Position parameter for swimmer T-spine, include CR
pt in lateral
arm closest to IR raise above head
arm farthest from IR depress
CR: 1" above jugular notch
128
For Swimmer T-spine, an angle of ___ can be used if needed
3-5 caudal
129
3 characteristics of L-spine
Smaller transverse process
Bulkier spinous process
pars interarticularis
130
Zygapophyseal joint for L-spine can be seen in which position
Oblique
131
[L-spine] ____ degree from MSP you will see zygapophyseal joint
30-50
132
Intervertebral foramen of L-spine can be seen in which position
Lateral
133
[Scotty dog]
the nose is ___
transverse process
134
[Scotty dog]
the eye is ___
pedicle
135
[Scotty dog]
the ear is ___
superior articulating process
136
[Scotty dog]
the leg is ___
inferior articulating process
137
[Scotty dog]
the neck is ___
pars interarticularis
138
[Scotty dog]
the part between ear & leg is ___
zygapophyseal joint
139
fracture of the scotty dog's neck results = fracture in ___
pars interarticularis
140
SID & kVp for L-spine
40"
75-90
141
Position patient for AP L-spine, include CR & breathing instruction
Pt supine
Knee bent
CR: L3 or L4
suspend on expiration
142
L3 is ____
L4 is ____
1.5" above crest
at crest
143
CR for Lateral L-spine
L3 to L4 based on IR
3" anterior to spinous process
144
L-spine is ___ anterior to ____
3" spinous process
145
Position parameter for posterior oblique L-spine, include CR
45 posterior
CR: L3 & 2" medial to upside ASIS
collimate
146
RPO of L-spine shows _____
A. Left intervertebral foramen
B. Right intervertebral foramen
C. Right zygapophyseal joint
D. Left zygapophyseal joint
C. RIGHT zygapophyseal joint
147
For which spine and position, if done correctly, would we see scotty dog
L-spine
Obliques
148
CR for L5/S1 spot
CR: 1 1/2" below crest & 2" posterior to ASIS
5-8 caudal tube angle
(parallel with interiliac line)
149
Why would we do a lateral L5/S1 spot ?
because superimposition of bilateral ilium --> high contrast
150
Which position can be used in Scoliosis series
Erect & recumbent
151
If patient has scoliosis, the ___ should be stationary and used as a ___
pelvis
fulcrum
152
for Lateral Bending, which position patient is in?
AP: ____
PA: ____
recumbent
erect
153
What do you need to ensure for lateral bending
Ensure no rotation - patient bend laterally
154
Flexion have pt bend _____
Extension have pt bend ____
forward
backward
155
[ L-spine] what is CR for Scoliosis
L4 or higher
156
which vertebra is the strongest
lumbar
157
the intervertebral foramina of L-spine is formed by ____
superior/inferior vertebral notch
158
the lamina between superior and inferior articular process formed ____
pars interarticularis
159
Pars interarticularis is best seen on which position
oblique
160
AP of L-spine demonstrated ____
spinous process superimpose vertebral bodies
161
which structure protrude laterally of the vertebral body
transverse process
162
front leg of scottie dog above and ear of scottie below will form____
zygapophyseal joint
163
WHat is the purpose of flexing the knee for L-spine
reduce lumbar curvature
164
why L-spine is not taken in PA?
increased magnification unsharpness
165
[L-spine] with bigger IR size, CR is directed to ____
iliac crest
166
[L-spine] with smaller IR size, CR is directed to ____
L3 (1.5" above crest)
167
[L-spine] If patient has a wider pelvis & narrow thorax, what is the CR?
CR: crest with a 5-8 degree caudal tube angle
168
[L-spine] if patient has scoliosis, which position should the patient be in?
lateral - which places the convexity down
169
[L-spine] which structure can indicate if there is rotation when in lateral?
sciatic notch of ileum
170
CR angle for L5/S1 spot must ____
parallel to iliac spine
171
Sacrum has how many fused vertebrae
5
172
Sacrum has 4 sets of _____
sacral foramen
173
On S1, the prominent anterior portion is ___
promontory
174
Sacral canal is a continuation of ____
vertebral foramen
175
the _____ is where L5 ends
sacral canal
176
what is considered as the vertebral foramen for sacrum
sacral canal
177
If the segment of _____ still separated, it will be the spinous processes of sacrum
median sacral crest
178
SI joint is the articulation between
iliac and auricular surface of sacrum
179
what structure of sacrum synonymous to inferior articular processes
sacral horn
180
More of pelvis muscles & tendons attach themselves to ____
coccyx
181
how many segments for coccyx
3-5 fused segments
182
Coccyx has transverse process ___
posteriorly
183
Coccyx has ____ & ___ that similar to patella
apex
head
184
Routine for Sacrum/Coccyx
AP & Lateral
185
kVp for Coccyx
80
186
Position parameter for AP sacrum, include CR
pt supine
CR: MSP & 2" superior to symphysis pubis OR 2” below ASIS
tube angle: 15 cephalad
187
Why do we need cephalad tube angle for AP Sacrum
flatten out normal concavity of sacrum
188
how do we intentionally distort sacrum for AP
15 cephalad tube angle
189
why sacrum & coccyx are ordered together
superimposition of coccyx over sacrum
190
To determine rotation for AP Sacrum, ____ should be in line with ____& ____
median sacral crest
coccyx - symphysis pubis
191
CR for Lateral Sacrum
at ASIS & 3-4" posterior
192
No rotation on lateral sacrum is determined by _____
greater sciatic notch superimposed
193
CR for AP Coccyx
2" superior to symphysis pubis
or
2" below ASIS
tube angle: 10 caudal
194
Why caudal tube angle for Coccyx
project pubis away to see unobstructed view of coccyx
195
Why can the sacrum get fractured?
its role with the articulation of the lower appendicular skeleton to the axial
196
Which structure of sacrum are lateral to first sacral segment
Alae
197
Articular process of sacrum located
superiorly
198
Zygapophyseal joint between L5/S1 is formed by_____
superior articular process of sacrum & inferior articular process of L5
199
Anterior sacrum dominate ___ curve
Lateral sacrum dominate ____ curve
concave
convex
200
Promontory is best seen on ____
lateral
201
greater curvature of coccyx requires ___ CR angle
greater
202
LPO = ___ SI joint
RIGHT
203
What is myelography
study of spinal cord and nerve root branches with contrast used
204
where is contrast injected into for myelography
subarachnoid space of spinal canal
205
Why myelography is performed
when lesions are detected in the spinal canal OR may protrude into the canal
Cord impingement
206
5 contraindications to myelography
1. Sensitive to iodine
2. recent LP
3. blood in CSF
4. arachnoiditis
5. increased intracranial pressure
207
how long ago was the recent LP must be considered to perform a myelogram
2 weeks
208
Why myelogram cannot be performed on patient with recent LP
extravasation of contrast medium outside subarachnoid space thru the hole by puncture
209
what is the tissue encase the spinal cord called
menenges
210
what are the 3 tissue layers of spinal menenges ? (outer to inner)
dura matter
arachnoid
pia matter
211
where does CSF flow?
subarachnoid space under arachnoid layer
212
CSF starts off in ____ of the brain
lateral ventricle
213
Trendelenburg is when head is _____ than feet
LOWER
214
6 equipment required for Myelogram
1. Tilted xray table with shoulder braces & foot board
2. myelogram tray
3. x-table cassette holder
4. grid cassette
5. pillow for abdomen
6. signed informed consent
215
What is ideal contrast used in myelogram
water soluble- nonionic due to its low osmolality
216
What is the important note marked for contrast used?
intrathecal use!
217
How long does it take for contrast to absorb after injection
30minutes
218
Contrast is radiographically undetectable after _____
24hrs
219
what are 2 common location for puncture sites
lumbar (L3-L4) through interspinous space
cervical (C1-C2)
220
2 positions for myelogram
X-table & AP Scout
221
myelogram is usually done by ___
radiologist
222
most of the time, contrast injection is done at which puncture site? why
Lumbar because spinal cord branches and not solid
223
what is important note for cervical stick
injected slowly 1-2 minutes
224
Why injected contrast slowly for cervical [myelogram]
to avoid excessive mixing of contrast & CSF
225
for lumbar puncture, patient is in ___ or ___
prone
left lateral with spine flexed
226
flexion of the spine will _____
widen interspinous space
227
for cervical stick, patient will be _____ or ____ with ___ flexed to open interspinous space
erect sitting
prone
neck/head
228
to reduce risk for spinal cord trauma, CSF must be ____
free flow rather than drawing it out with syringe
229
for lumbar injection in prone position, putting a pillow under abdomen will help ____
open disc spaces
230
When would we do cervical injection instead of lumbar injection
if lumbar is contraindicated
231
To prevent contrast enter the head for cervical injection, patient should _____
hyperextend neck
232
for cervical injection, patient will first _____ neck and then ____ neck after injection
flex
extend
233
What could happen to patient when LP is performed
elevated CSF (blood present)
234
For LP, patient is tilted _____ & ____
fowler
trendelenburg
235
[myelogram] If patient is prone, what is the puncture site? routine?
cervical - Xtable, Xtable swimmer
236
[myelogram] If patient is supine, what is the puncture site? routine?
thoracic - lateral, xtable, AP/PA
237
[myelogram] If patient is semierect, what is the puncture site? routine?
lumbar - xtable, xtable lateral, AP/PA, obliques
238
What are the post myelogram care
bandage injection site
place patient semi erect 30-45 for 1-2 hours
restricted to bed
239
why patient is placed in 30-45 post exam for 1-2 hours after myelogram
allow body to absorb contrast because it could go up spinal canal and into the brain
240
What are complications to myelogram (5)
air into ventricles
spinal needle irritate nerves
excessive subarachnoid bleeding
contrast into ventricular areas (causes seizures)
reaction to contrast
241
RAO of L-spine shows ___
A. Right intervertebral foramen
B. Left zygapophyseal joint
C. Left intervertebral foramen
S. Right zygapophyseal joint
B
242
[AP open mouth] if teeth superimpose upper dens, what does it mean and how to fix it
too much flexion
fix by hyperextension or angle CR slightly cephalic
243
[AP open mouth] if base of skull superimpose upper dens, what does it mean and how to fix it
too much extension
fixed by hyperflexion or angle CR slightly caudal
244
posterior to acetabulum is ___
ischial spine
245
superior to ischial spine is ___
inferior to ischial spine is ____
greater sciatic notch
lesser sciatic notch
246
characteristics of female pelvis (4)
wide pelvis
flared ilia
rounder pelvic inlet
obtuse pubic arch angle
247
characteristics of male pelvis (4)
narrow pelvis
less flared ilia
oval pelvis inlet
narrow pubic arch angle
248
