Module 3 - Lumbar Normal Anatomy and Lines

AP lumbar

ID view

Lateral lumbar

ID view

To find instability

Why do we take lumbar flexion-extension projections?

Pars interarticularis

Why do we take oblique lumbar projections?

Shield

A _____ is used to decrease the dose to the reproductive system. Physicists are going away from them because they are not very effective

Recumbent (lying down)

What position is the patient in?

Weight bearing (standing)

What position is the patient in?

Lateral lumbar

What view do we see lumbar IVFs?

L4 lamina

ID 1

L4 pedicle

ID 2

L4 inferior articular process

ID 3

L4 superior articular process

ID 4

L4 vertebral body

ID 5

L4 transverse process

ID 6

L4 pars interarticularis

ID 7

L4 other inferior articular process

ID 8

Pars interarticularis

A break in the _____ occurs as a stress fracture in adolescence, usually in very active children that do sports with repetitive hyperextension (gymnasts, wrestlers, football players, etc.)

Left

LPO --> _____ Pars

Right

RPO --> _____ Pars

Right

LAO --> _____ Pars

Left

RAO --> _____ Pars

L1

L1/L2 IVF nerve root

L2

L1/L2 disc herniation

L2

L2/L3 IVF nerve root

L3

L2/L3 disc herniation

L3

L3/L4 IVF nerve root

L4

L3/L4 disc herniation

L4

L4/L5 IVF nerve root

L5

L4/L5 disc herniation

L5

L5/S1 IVF nerve root

AP sacrum

ID view

Lateral sacrum

ID view

50-60˚

Normal lumbar lordosis

Angle created by the superior endplate of L1 and the superior endplate of S1

How is the lumbar lordosis measurement line drawn?

Line drawn from the superior endplate of the sacrum met by a horizontal line

How is the lumbosacral angle drawn?

Ferguson's angle, sacral base angle

Another term for lumbosacral angle

26-57˚

Normal lumbosacral angle

Facet syndrome & spondylolisthesis

Significance of an increased lumbosacral angle

Hyperlordosis

ID lumbar lordosis

Sway back

ID lumbar lordosis

Antalgic hypolordosis/list

ID lumbar lordosis

Lumbosacral disc angle

The _____ measures the lumbosacral disc

Inferior L5, superior S1

What landmarks are used for the lumbosacral disc angle?

10-15˚

Normal lumbosacral disc angle measurement

Facet syndrome

Significance of an increased lumbosacral disc angle

Ullmann's Line

ID spondylolisthesis measurement

Line drawn across the top of the sacrum, 90˚ angle at anterior tip

How is Ullmann's Line drawn?

Myerding's Method

ID spondylolisthesis measurement

Determine the grade of spondylolisthesis

What is the purpose of Myerding's Method?

I

Grade _____: <25% degree of displacement

II

Grade _____: 26-50% degree of displacement

III

Grade _____: 51-75% degree of displacement

IV

Grade _____: 76-100% degree of displacement

V

Grade _____: >100% degree of displacement

Lumbar gravity line

ID lateral lumbar projection

Vertical line from the center body point of L3. Should intersect with anterior 1/3 of the sacral base (<10 mm anterior to base)

How is the lumbar gravity line drawn?

Eisenstein's Method

_____ is a sagittal canal measurement

Lines joining the tips of the superior and inferior articular processes at a given level. Distance between line and back of vertebral body measured

How is Eisenstein's Method drawn?

>15 mm

Normal Eisenstein's Method measurement

Central canal stenosis

An Eisenstein's Method measurement <15 mm means there is _____

Wider

The interpedicular distance should get _____ as you descend the lumbar spine

Space occupying lesion, congenital anomaly, burst fracture

If the interpedicular distance above is wider, it may be secondary to a _____, _____, or a _____ at that segment

Achondroplasia

_____ is when the interpedicular space narrows as you descend the lumbar spine

Stenosis

People with achondroplasia are prone to _____

Congenital dwarfism

People with _____ typically exhibit achondroplasia