Thoracic Spine Anatomy

Question 1

Where is the thoracic spine located?

Answer 1

At the behind of the neck and towards the bottom of the spine. At the vertebra prominensandspinous process of TXII

Question 2

Name all of the surface anatomy in order, from top to bottom.

Answer 2

Ligamentum nuchae
Vertebra prominens
Acromion of scapula
Spine of scapula
Inferior angle of scapula
Spinous process of TXII
Iliac crest
Sacral dimple at posterior superior iliac spine

Question 3

Explain the surface markings of T1

Answer 3

T1: 5cms above sternal (jugular) notch

Question 4

Explain the surface markings of T2/3

Answer 4

At level of sternal (jugular) notch

Question 5

Explain the surface markings of T4/5

Answer 5

At level do sternal angle/midway between sternal notch and xiphoid process

Question 6

Explain the surface markings of T7

Answer 6

At level of inferior scapular angle

Question 7

Explain the surface markings of T9/10

Answer 7

At level of xiphoid process

Question 8

How many thoracic vertebrae are there?

Answer 8

T1-T12

Question 9

What is there to remember about thoracic vertebrae?

Answer 9

They increase in size from T1 - T12

Question 10

Why are thoracic vertebrae larger than the cervical vertebrae?

Answer 10

due to the increased amount of weight they support

Question 11

How are thoracic vertebrae characterised?

Answer 11

By their articulations with the ribs

Question 12

What are the 2 bilateral partial facets? Explain them

Answer 12

Superior facet: articulates with the head of the associated rib

Inferior facet: articulates with the head of the rib below

Question 13

What is the additional facet?

Answer 13

it is there for the tubercle of the associated rib on each transverse process

Question 14

How many Demi facets does the typical vertebra have?

Answer 14

There are 3. Superior, inferior and transverse costal. However this isn’t always true.

Question 15

What are the 3 different thoracic vertebrae articulations?

Answer 15

T1: The rib doesn’t articulate with C7 but the structure of the vertebra is typical.
T9 and T10: Only articulates with its own rib and has no inferior demifacet.
T11 and T12: Only articulates with the head of its own rib. Has no transverse costal facet and only 1 single facet on each side of the body.

Question 16

How are costovertebral joints formed?

Answer 16

The ribs articulate with the appropriate demifacets on the respective vertebral bodies to the form cosfovertebral joints.

Question 17

What are the 3 associated ligaments?

Answer 17

Costotransverse ligament
Superior costotransverse ligament
Lateral costotransverse ligament

Question 18

How do you decide which lateral to do?

Answer 18

To check if lateral should be L or R, do an AP first.

If it is noted on the AP that the patient is suffering from a scoliosis of the thoracic spine

then it is important to select the correct lateral in order to maximise the effects of the diverging beam passing through the joint spaces.

If it is concluded from the AP projection that the patient has a scoliosis to the left then the patient should have a left lateral in order that the divergent beam passes through the joint spaces.

This will not happen if the patient lies on their right

Question 19

How do you know for a lateral it the beam will pass through the joint spaces

Answer 19

Note how the diverging beam will or will not pass through the joint spaces

Question 20

What is a main imaging issue when imaging the thoracic spine?

Answer 20

the lateral projection

usually the patient would hold their breath during the exposure

however there is an issue of the ribs obscuring the vertebrae due to their position in relation to the vertebrae

Question 21

How do you fix the imaging issues with the thoracic spine?

Answer 21

a long exposure time is selected and the patient is asked to breath normally.

This has the effect of ‘blurring’ the ribs

and minimising the issue of superimposition over the vertebral bodies.

Question 22

What are the 2 common pathologies?.

Answer 22

Kyphosis
osteoporotic wedge fracture

Question 23

What is kyphosis?

Answer 23

This is an excessive curvature of the thoracic spine giving the patient a ‘hunchback’.

Question 24

How can kyphosis affect imaging? How do we fix this?

Answer 24

This can lead to the AP projection being difficult for the patient in terms of comfort.

Technique may need to be adapted by either using foam pads to support the patient or by imaging the patient erect