Vertebral Column Flashcards
the ________ _______ or spine forms the central axis of the skeleton and is centered in the mid-sagittal plane of the posterior part of the trunk
vertebral column
5 groups of vertebral column
cervical vertebrae - 7
thoracic vertebrae - 12
lumbar vertebrae - 5
sacral vertebrae - 5
coccygeal vertebrae - 3 to 5 in adult
it is the most superior occupying the region of the neck
cervical vertebrae
it is the first two cervical vertebrae that is atypical because they are structurally modified to join the skull
atlas and axis
___ cervical vertebrae is also atypical because it is slightly modified to join the thoracic spine
7th cervical vertebrae
________ vertebrae lies in the dorsal or posterior portion of the thorax
thoracic vertebrae
_________ vertebrae occupying the region of the loin
lumbar vertebrae
________ vertebrae located in the pelvic region
sacral vertebrae
_________ vertebrae, terminal vertebrae also in the pelvic region
coccygeal vertebrae
the upper three regions are termed the _____ or movable vertebrae because they remain distinct throughout life
true or movable
the pelvic segment in the two lower regions are called false or ____ vertebrae because of the change they undergo in adults
false or fixed
2 vertebral curvature
lordotic
kyphotic
convexity anteriorly
lordotic curve
concavity anteriorly
kyphotic curve
abnormal lateral curvature of the vertebral column is called _______
scoliosis
articulation between the two vertebral bodies, cartilaginous symphysis joints which is slightly movable
intervertebral joints
articulation between articulation processes of the vertebral arches, synovial gliding joint which is freely movable
zygapophyseal joints
articulation between the atlas and occipital bone, synovial ellipsoidal joints
atlanto-occipital joints
articulation of anterior arch of the atlas that rotate around the dens of the axis, synovial gliding and synovial pivot articulations
atlantoaxial joint
articulation between the heads of the ribs and bodies of the thoracic vertebrae, synovial gliding which is freely movable
costovertebral joints
articulation between the tubercle of the ribs and the transverse process of the thoracic vertebrae
costotransverse joints
articulation between the sacrum and two ilia
sacroiliac joints
ATLAS & AXIS
demonstrates an AP projection of the atlas and axis through the _____ ______
if the patient has a deep head or a long mandible, the entire atlas is not demonstrated
if the patient cannot open the mouth, tomography may be required
AP projection - open mouth
ATLAS & AXIS
demonstrates a lateral projection of the atlas and
axis, atlanto-occipital articulations
lateral projection - R or L position
ATLAS & DENS
demonstrates a PA projection of the dens and atlas as seen through the foramen magnum
PA projection - judd method
DENS
AP projection recommended when its upper half is not clearly shown in the open-mouth position
SS: shows an AP projection of the dens lying within the circular foramen magnum
AP projection - fuchs method
CERVICAL VERTEBRAE
CR: directed through C4 at an angle of 15 to 20 degrees cephalad. The central ray enters at or slightly inferior to the most prominent point of the thyroid cartilage.
SS: Shows the lower five cervical bodies and the upper two or three thoracic bodies , the interpediculate space , the superimposed transverse and articular processes, and the intervertebral disk spaces.
Also used to demonstrate the presence or
absence of cervical ribs.
AP axial projection
CERVICAL VERTEBRAE
CR: horizontal and perpendicular to C4
SS: demonstrates a lateral projection of the cervical
bodies and their interspaces, the articular pillars, the lower five zygapophyseal joints, and the spinous processes.
Depending on how well the shoulder can be depressed, a good lateral projection must include C7; sometimes TI and T2 can also be seen.
lateral projection - grandy method
CERVICAL VERTEBRAE
This procedure must not be attempted until cervical spine pathology or fracture has been ruled out.
Performed to demonstrate normal anteroposterior movement or an absence of movement resulting from trauma or disease.
CR: horizontal and perpendicular to C4
SS: shows the motility of the cervical spine when hyperflexed aand hyperextended, the intervertebral disks and the zygapophyseal joints are also shown
lateral projection - R or L position - hyperflexion and hyperextension
CERVICAL INTERVERTEBRAL FORAMINA
CR: directed to C4 at a cephalad angle of 15-20 degrees so that the CR coincides with the angle of foramina
SS: shows the intervertebral foramina and pedicles farthest from the IR and an oblique projection of the bodies and other parts of the cervical vertebrae
AP axial oblique projection - RPO or LPO positions
CERVICAL INTERVERTEBRAL FORAMINA
CR: directed to C4 at an angle of 15 to 20 degrees caudad so that it coincide with the angle of the foramina
SS: shows the intervertebal foramina and pedicles closest to the IR and an oblique projection of the bodies and other part of the cervical column
PA axial oblique projection - RAO and LAO positions
CERVICAL INTERVERTEBRAL FORAMINA
With this method the mandibular shadow is blurred or even obliterated by having the patient perform an even chewing motion of the mandible during the exposure. The exposure time must be long enough to cover several complete excursions of the mandible.
CR: perpendicular to C4 entering at the most prominent point of the thyroid cartilage
SS: shows an AP projection of the entire cervical column, with the mandible blurred if not obliterated
AP projection - ottonello method
CERVICOTHORACIC REGION
often called the swimmer’s lateral projection
SS: demonstrates a lateral projection of the lower cervical and upper thoracic vertebrae between the two shoulders
lateral projection - twining method - R or L position - upright
CERVICOTHORACIC REGION
often called the swimmer’s lateral projection
CR: directed at the interdisk of C7-T1 at an angle of 3-5 degrees caudal
SS: shows a lateral projection of the cervicothoracic vertebrae between the shoulders
lateral projection - pawlow method
THORACIC VERTEBRAE
CR: center should be approximately halfway between the jugular notch and the xyphoid process
SS: shows an AP projection of the thoracic bodies intervertebral disk spaces, transverse processes, costovertebral articulation and surrounding structures
AP projection
THORACIC VERTEBRAE
demonstrates their interspaces, the intervertebral foramina, and the lower spinous processes of the thoracic bodies, because of the overlapping shoulder the upper vertebrae may not be demonstrated in this position
lateral projection - R or L position
THORACIC VERTEBRAE
the thoracic zygapophyseal joints are examined using this projections, the joints are well demonstrated with either projection, the AP oblique demonstrates the joints farthest from the IR and the PA obliques demonstrate the joints closest to the IR
CR: perpendicular to IR exiting or entering the level of T7
SS: Shows oblique projection of the zygapophyseal joints. A greater degree of rotation from the lateral position is required to show the joints at the proximal and distal ends of the region in patients with an accentuated dorsal kyphosis.
AP or PA oblique projection - RAO and LAO or RPO and LPO - upright and recumbent positions
LUMBAR-LUMBOSACRAL VERTEBRAE
CR: perpendicular to the IR at the level of the iliac crests (L4) for a lumbosacral examination or 1 1/2 inches above the iliac crests (L3) for a lumbar examination
SS: Shows the lumbar bodies, intervertebral disk spaces, interpediculate spaces, laminae, and spinous and transverse processes. When the larger IR is used, the images include one or two of the lower thoracic vertebrae, the sacrum, coccyx, and the pelvic bones.
AP projection (PA projection optional)
LUMBAR-LUMBOSACRAL VERTEBRAE
it shows the lumbar lumbar bodies and their interspaces, the spinous processes, and the lumbosacral junction
this gives a profile image of the intervertebral foramina of L 1-4, the L5 intervertebral foramina are not usually well visualized in this projection because of their oblique direction
lateral projection - R or L position
L5-S1 LUMBOSACRAL JUNCTION
SS: shows a lateral projection of the lumbosacral junction the lower one or two lumbar vertebrae and upper sacrum
lateral projection - R and L position
ZYGAPOPHYSEAL JOINTS
Shows an oblique projection of the lumbar and/or
lumbosacral spine, demonstrating the articular processes of
the side closest to the IR.
When the body is placed in a 30—50 degree oblique,
and the lumbar is radiographed, the articular processes and
the zygapophyseal joints are demonstrated.
When the patient has been properly positioned,
images of the lumbar vertebrae have the appearance of
“Scottie dogs.”
Both sides are examined for comparison.
Shows an oblique projection of the lumbar and/or lumbosacral spine, demonstrating the articular processes of the side closest to the IR.
When the body is placed in a 30—50 degree oblique, and the lumbar is radiographed, the articular processes and the zygapophyseal joints are demonstrated.
When the patient has been properly positioned, images of the lumbar vertebrae have the appearance of “Scottie dogs.” Both sides are examined for comparison
AP oblique projection - RPO and LPO positions
ZYGAPOPHYSEAL JOINTS
Shows an oblique projection of the lumbar orlumbo sacral vertebrae, demonstrating the articular processes of the side farther from the IR.
The T12-L1 articulation between the 12th thoracic and 1st lumbar vertebrae, having the same direction a those in the lumbar region, is shown on the larger IR. The fifth lumbosacral joint is usually well demonstrated in oblique position.
PA oblique projection - RAO and LAO positions
INTERVERTEBRAL FORAMEN
FIFTH LUMBAR
CR: Directed along the straight line extending from the superior edge of the uppermost crest of ilium through L5 to the inguinal region of the dependent side. Depending on the alignment of spine, angulation of CR may vary from 15-30 degrees caudal.
SS: shows the L5 intervertebral foramen, both side are examined for comparison
PA axial oblique projection - kovacs method - rao and lao positions
LUMBOSACRAL JUNCTION AND SACROILIAC JOINTS
CR: ferguson originally recommended an angle of 45 degrees, AP axial - directed through the lumbosacral joint at an average angle of 30-35 degrees cephalad entering 1 1/2” superior to symphysis pubis
SS: shows the lumbosacral joint and symmetric image of both sacroiliac joints free from superimposition
AP or PA axial projection
LUMBOSACRAL JUNCTION AND SACROILIAC JOINTS
CR: perpendicular to the center of the IR, entering 1 inch medial to the elevated ASIS.
AP axial oblique - the CR is directed at an angle of 20 to 25 degrees cephalad, entering I inch (2.5 cm) medial and 1 ½ inches distal to the elevated ASIS.
SS: show the sacroiliac joint farthest from the IR and an an oblique projection of the adjacent structures
AP oblique projection - RPO and LPO positions
LUMBOSACRAL JUNCTION AND SACROILIAC JOINTS
CR: perpendicular to the IR and centered 1 inch medial to the ASIS closest to the IR
PA axial oblique, the CR is 20 to 25 degrees caudal to enter the patient at the level of the transverse plane passing 1 ½ inches distal to spinous process of L5 and exit at the level of ASIS.
SS: shows the sacroiliac joint closest to the IR
PA oblique projection - RAO and LAO positions
SACRUM AND COCCYX
The colon should be free of gas and fecal material for examination of the sacrum and coccyx. The urinary bladder should be emptied before the examination.
SS: demonstrates the sacrum or coccyx free of superimposition
AP and PA axial projections
SACRUM AND COCCYX
CR: the elevated ASIS provides a standardized reference point from which to center the sacrum and coccyx
SS: shows a lateral projection of the sacrum or coccyx
lateral projections R or L position
________ is an abnormal lateral curvature of the vertebral column with some associated rotation of the vertebral bodies at the curve commonly detected in adolescent years. If not detected or treated may progress to the point of debilitation.
scoliosis
___ and __________ upright projections demonstrate the amount/degree of curvature that occur with the force of gravity acting on the body
PA or AP and lateral upright projections
______ et al recommended a lateral upright position to show spondylolisthesis or exaggerated degree of kyphosis & lordosis
young et al
________ studies are often used to differentiate primary from compensatory curves. Primary curves will not change when the patient bend ; secondary curve will.
bending studies
THORACOLUMBAR SPINE: SCOLIOSIS
The patient should be in PA position to reduce radiation exposure to selected radiosensitive organ.
SS: PA projection of the thoracic and lumbar used for comparison to distinguish the deforming or primary
curve from the compensatory curve in patient with scoliosis.
PA projection - ferguson method
LUMBAR SPINE-SPINAL FUSION SERIES
CR: Perpendicular to the level of the third lumbar vertebra, 1 to 1 ½ inches (2.5 to 3.8 cm) above the iliac crest on the MSP
SS: AP projection of the lumbar vertebrae made in maximum right and left lateral bending.
AP projection R and L bending
