W17 / L-spine, Sacrum, Coccyx

Structures Included - AP LSP

• T12 - full SIJ

• bilateral SI joints

CR - LSP

perp

CP - AP LSP

midline at L3

Alignment - AP LSP

LA of spine // LA of IR

Rotation - AP LSP

no shoulder / pelvic rotation

• MAIN: SP mid VB and equi from peds

• sacrum centered within the pelvic inlet

F/E - AP LSP

no waist F/E, sufficient knee flexion

• IV disk spaces open, except L5-S1

• VB with no distortion

• minimal foreshortening of sacrum

IQ - AP LSP

psoas muscles demonstrated

Structures Included - LAT LSP

• T12 - Sacrum

• SPs

CP - LAT LSP

mid-axillary plane at L3

Rotation - LAT LSP

no shoulder / pelvic rotation

• MAIN: VB post.margs SI ant/post

• open IVF

• T12 rib pairs and pelvic alas SI adeq

Tilt - LAT LSP

no tilt

• MAIN: open IV joints, VB SI sup/inf

Respiration - LAT LSP

sufficient suspended expiration

• L1 inf to diaphragm

• diaphragm not demonstrated indicates sufficient suspension

Structures Included - LAT L5/S1

L5 and upper sacrum

CR - LAT L5/S1

• perp

• 5 degrees caud

CP - LAT L5/S1

L5-S1 lumbosacral disk space

Rotation - LAT L5/S1

no rotation

• MAIN: post.margs of L5 VB SI ant/post = open IVF

• L5 peds SI and in profile

• SAP of sacrum SI ant/post

• greater sciatic notches nearly SI ant/post

BTP/ Tilt - LAT L5/S1

• MAIN: lumbosacral IV Space open

• L5 peds SI sup/inf

• SAP SI inf/sup

• pelvic alae nearly SI sup/inf

Structures Included - AP/PA OBL LSP

• T12 - sacrum, SI joints

• AP: Z-joints of the side in contact

• PA: Z-joints of the raised side

CP - AP/PA OBL LSP

level of L3 at mid spine

Rotation - AP/PA OBL LSP

good 45 OBL

• MAIN: Z-joints open and in straight line

• pedicle halfway between mid VB and lateral border of VB

Insufficient Rotation - AP/PA OBL LSP

pedicle → lateral border of VB

Excessive Rotation - AP/PA OBL LSP

pedicle → midline of VB

Structures Included - AP/PA AXIAL SACRUM

• L5 - entire sacrum

• PS

• bilateral SI joints

CR - AP/PA AXIAL SACRUM

• AP: 15 ceph

• PA: 15 caud

CP - AP/PA AXIAL SACRUM

midline at S3

Alignment - AP/PA AXIAL SACRUM

LA of sacrum // LA of IR

Rotation - AP/PA AXIAL SACRUM

• median sacral crest and coccyx aligned with PS

• ischial spines are equally aligned with the pelvic brim

BTP - AP/PA AXIAL SACRUM

• S1-S5 segments are not foreshortened

• sacral foramina equally spaces

• no SI of PS on sacrum

Structures Included - AP AXIAL COCCYX

• S5 → coccyx

• PS

• pelvic brim

CR - AP AXIAL COCCYX

10 degrees caud

CP - AP AXIAL COCCYX

midline at mid coccyx

Rotation - AP AXIAL COCCYX

• coccyx aligned with PS

• coccyx equi from lateral walls of the pelvic inlet

BTP - AP AXIAL COCCYX

coccyx seen without foreshortening and without SI from PS

Structures Included - LAT SACRUM/COCCYX

sacrum: L5- coccyx

coccyx: entire coccyx

CP - LAT SACRUM/COCCYX

• sacrum: S3

• coccyx: C2

Rotation - LAT SACRUM/COCCYX

no rotation

• MAIN: greater sciatic notches are SI ant/post

• femoral head are SI ant/post

BTP/Tilt - LAT SACRUM/COCCYX

MAIN

• open lumbosacral joint

• greater sciatic notches SI sup/inf

• pelvic ala nearly SI