Radiology: normal spine

- 7 vertebral segments

- lordosis

- neck

spine, cervical

- 12 vertebral segments

- ribs

- kyphosis

spine, thoracic

- 5 segments

--> can have transition vertebral body

- lordosis

-low back

spine, lumbar

- sacrum (5), fused

- coccyx (3-5), fused

spine, sacrum and coccyx

contains spinal cord, nerve roots, epidural fat, vessels, CSF contained by dura in thecal sac

spinal canal

termination of spinal cord, usually around T12 or L1/L2

conus medullaris

do in conus medullaris, starting at L2/L3 or below

spinal tap

nerve roots in thecal sac surround by CSF

cauda equina

vertebral body

what is the blue arrow pointing to?

pedicle

what is the pink arrow pointing to?

laminae

what is the red arrow pointing to?

vertebral arch

what is the black arrow pointing to?

transverse processes

what is the yellow arrow pointing to?

they allow space for vertebral arteries, injury occurs when spaces are not align or smaller

why are transverse foramina of c-spine important?

spinous process

what is the blue arrow pointing to?

R articular processes

what are the red arrows pointing to?

facet joint

what is the pink arrow pointing to?

spine abnormalities occur to degeneration of joints, synovial joint

- come from articular processes of bodies

facet joints

L C5-6 disc space

what disc space is being indicated?

name with vertebra above and one below, needs to include "disc"

how to name a intervertebral disc

intervertebral foramina

where do nerves and vessels of the spinal cord exit through?

neural foramina

--> large and good spinal for spinal nerves

what are the pink arrows, and what is noticeable about these?

connects anterior vertebral bodies

anterior longitudinal ligament

connected posterior vertebral bodies

posterior longitudinal ligament

connected laminae

- canal stenosis when enlarged

ligamentum flavum

1. TP to TP

2. SP to SP

3. tips of SP

1. intertransverse

2. interspinous

3. supraspinous ligaments

- no body

- 2 lateral masses for occipital condyles

- no SP, tubercle instead

- transverse processes have foramina for vertebral a.

cervical spine, C1

- dens, held in place posteriorly by transverse ligament

--> without functional ligament you don't breathe, very important

- allows head to rotate

cervical spine, C2

C7

largest spinous process of C vertebrae

ribs

thoracic spine

lumbar bodies large for weight baring

lumbar spine

- no vertebral bodies

- fused anteriorly and posteriorly

--> anterior and posterior neural formaina

sacrum

screening, first line, don't see disc herniation

imaging modalities for spine, x-ray

good for bony fracture, bony degenerative changes, some bone tumors, not good for discs

imaging modalities for spine, CT scan

- disc and soft tissue

- spinal cord and bone marrow abnormalities

- metastases

imaging modalities for spine, MRI scan

- if no MRI or bad MRI

- just outline, cannot see intrinsic abnormalities

- inject contrast into thecal sac through lumbar puncture

myelography

- bone scans, phosphate accumulates where issue is (non specific)

- prostate and breast cancer

- sacral stress fractures

- spondylolysis

imaging modalities, nuclear medicine

- AP

- Lateral

- 2 obliques

- Open mouth odontoid (OMO)

cervical spine, x-ray

axial, sagittal, coronal places

cervical spine, CT

sagittal and axial, sometimes coronal, multisequence

cervical spine, MRI

lateral c-spine

what is this imagine?

- less than 5 mm soft tissue at C2

- less than 22 mm soft tissue at C5

5 at 2; 22 at 5

radioluscent

disc spaces are what?

facet joint at C3-4

what is the red arrow pointing at?

spinous process of C3

what is the yellow arrow pointing at?

C6

what is the pink arrow pointing at?

C6-7 disc space

what is the blue arrow pointing at?

should all line up nicely

cervical spine lines

oblique c-spine, R

what is this image?

to look at neural foramina

why do we do oblique views

R pedicle C6

what is the blue arrow pointing to?

L neural foramina C4-5

what is the blue circle indicating?

L C5 nerve root

what exits through the L neural foramina C4-5?

oblique c-spine, L

what is this image?

red= L pedicle

green= R neural foramina

what are the red circles indicating?

what are the green circles indicating?

OMO

what is this image?

R lateral mass C1

what is the blue arrow pointing to?

dens of C2

what is the black circle indicating?

transverse foramen of C vertebrae for vertebral a.

what is the purple circle indicating?

AP c-spine

what is this image?

L C4-5 uncovertebral joint

what is the light blue arrow pointing to?

uncinate processes for degenerative disease

lung apexes to pick up cancer

two things to look at on AP c-spine

C7 spinous process

what is the dark blue arrow pointing to?

R pedicle of T3

what is the red arrowing pointing to?

the ribs

how to distinguish between C and T vertebra

degenerative disc disease of L C5-6

--> smaller than rest of discs

what is the blue circle indicating?

CT C1 axial

what is this image?

dens of C2

what is the light blue arrow indicating?

L C1 transverse foramina

what is the dark blue arrow indicating?

neural: nerve roots, fat

transverse: vertebral a.

what exits through the neural foramina and transverse foramina?

axial c-spine CT neural foramina

--> blue arrow showing neural foramina

what is this image?

sagittal CT c-spine midline

what is this image?

sagittal CT c-spine off midline

--> blue arrow showing facet joint

what is this image?

coronal CT c-spine

--> o is dens

what is this image?

when looking for spinal cord abnormalities

when do you get an MRI instead of CT?

CSF is white/bright around cord

why can you see the spinal cord so well in MRI?

MRI c-spine sagittal

--> blue arrow showing C6-7 disc space

what is this image?

axial MRI c-spine

--> blue arrows showing neural foramina

what is this image?

- AP

- Lateral

- swimmers view

thoracic spine, x-rays

cervicothoracic junction

--> only C7- T5

--> if you cannot see C7, do swimmers

--> arm closest to detector is up

what is the purpose of the swimmers view?

axial, sagittal, coronal

thoracic spine, CT

lots of radiation, going from T1-T12 is a long distance

issue with thoracic spine

lateral T-spine

--> red circle is indicating intervertebral disc space in thoracic vertebrae, cannot determine level bc ribs are not seen

what is this image?

swimmers view t-spine

what is this image?

AP T-spine

--> can determine levels bc of ribs

what is this image?

upper arrow: L T-8 pedicle

lower arrow: spinous process of T9

what are the black arrows indicating?

MR T2 sagittal T-spine

--> blue is spinal cord

--> white is spinous process

--> red is disc space

what is this image?

what are the arrows indicating?

- lateral

- AP

- cone down lateral

- obliques

lumbar spine

to see L5/S1 really well

purpose of cone down lateral

"scotty dog", see facet joints

lumbar oblique imaging

AP lumbar spine

what is this image?

lateral L-spine

--> L3

--> L3-4 disc space

what is this image?

what is the black arrow pointing to?

what is the space below the black arrow?

cone down lateral l-spine

what is this image?

oblique l-spine, "scotty"

what is this image?

scotty dog

ear- superior articular process

eye (blue arrow)- pedicle

neck- pars interarticularis

feet- inferior articular process

what is this image?

chronic spondylolysis in L4/L5, very important to find neck**

what is the purpose of the pars interatricularis in scotty?

MR SAG T2 L-spine

what is this image?

MR L-spine off midline

--> blue arrows showing nerve root

--> L L5SN getting compressed, no fat around it

what is this image?

what is between the blue arrows?

what abnormality is seen on this image?

sag L-spine reformat CT

what is this image?

no contrast present

sag L-spine reformat CT

what is this image?

post myelogram, contrast present