Lumbar Spine Anatomy, Pathology, and Imaging Techniques

The zygapophyseal joints are on a ____________ angle off of MSP

30-60 degrees

Herniated nucleus pulpolsis is most commonly visualized in the lumbar region at the levels of

L5/S1

Match the letters on the image below with the anatomical landmarks: A

superior articular process

Match the letters on the image below with the anatomical landmarks: B

transverse process

Match the letters on the image below with the anatomical landmarks: C

pedicle

Match the letters on the image below with the anatomical landmarks: D

par interarticularis

Match the letters on the image below with the anatomical landmarks: E

lamina

Match the letters on the image below with the anatomical landmarks: F

inferior articular process

Which layers of the meninges allow cerebrospinal fluid to flow between them?

pia mater and the arachnoid layer

Which of the following is considered the largest nerve bundle of the body?

cauda equina

What is the name of the largest nerve in the body?

sciatic nerve

True/False: The filum terminale attaches the spinal cord and cauda equina to the sacral promontory

false

Which of the following ligaments runs within the vertebral column?

posterior longitudinal ligament

Match the letters on the image below with the anatomical landmarks: A

vertebral foramen

Match the letters on the image below with the anatomical landmarks: B

accessor process

Match the letters on the image below with the anatomical landmarks: C

superior articular process

Match the letters on the image below with the anatomical landmarks: D

spinous process

Match the letters on the image below with the anatomical landmarks: E

lamina

Match the letters on the image below with the anatomical landmarks: F

mamillary process

Match the letters on the image below with the anatomical landmarks: G

transverse process

Match the letters on the image below with the anatomical landmarks: H

pedicle

Match the letters on the image below with the anatomical landmarks: I

body

True/False: The inner portion of the intervertebral disc is called the nucleus fibrosis

false

What is the end of the spinal cord termed?

conus medullaris

The IVF of the lumbar spine are located on a ____________ angle off of MSP

90 degrees

Which spinal nerve is considered the motor nerve portion

efferent neuron

Compaction of the vertebral body due to traumatic injury or another pathological condition

compression fracture

Incomplete or partial dislocation of the bony structures of the spine

subluxation

Increased anterior convexity of the lumbar region

lordosis

Progressive cartilage deterioration in the synovial joints of the spine

Osteoarthritis

A loss of bone density in the vertebral bodies

osteoporosis

Breaking down or fracture of the pars interarticularis

Spondylolysis

Forward displacement of the vertebral body resulting in the breakage of the posterior ring

spondylolisthesis

Failure of the posterior encasement of the spinal cord and the laminae to close, resulting in protrusion of the cerebral spinal fluid and part of the meningeal layer

Meningocele

Which layer of the meninges surrounding the spinal cord is the innermost layer?

pia mater

Match the letters on the image below with the anatomical landmarks: A

superior articular process

Match the letters on the image below with the anatomical landmarks: B

transverse

Match the letters on the image below with the anatomical landmarks: C

lamina

Match the letters on the image below with the anatomical landmarks: D

spinous process

Match the letters on the image below with the anatomical landmarks: E

inferior articular process

Match the letters on the image below with the anatomical landmarks: F

pedicle

Match the letters on the image below with the anatomical landmarks: G

inferior vertebral notch

Match the letters on the image below with the anatomical landmarks: H

body

Match the letters on the image below with the anatomical landmarks: I

superior vertebral notch

At which vertebral level does the spinal cord end?

L1/L2

For the lateral lumbar spine projection, which body planes are perpendicular to the IR?

MCP and interiliac plane

Which of the following structures are not demonstrated in the lateral Lumbar spine?

transverse processes

If the Interiliac plane is perpendicular to the IR for the L5/S1 joint space, what is the tube angle, and in which direction is the CR?

perpendicular

What is the recommended SID for both the AP and Lateral lumbar spine?

48"

What is the recommended SID for all lumbar (except AP and lateral)

40"

Where does the CR enter for a lateral projection of the lumbar spine to include the sacrum?

MCP and L4/L5

What is the patient's position

RPO

The RPO position will demonstrate which of the following structures?

right zygapophyseal joints

Identify the following position for this patient

RAO

Which of the following projections of the lumbar spine are used to demonstrate function and movement?

lateral projection in hyperextension/flexion and AP right/let bending

Which projection will demonstrate both of the transverse processes the best at the same time?

AP projection

What is the tube angle and in which direction for the L5/S1 joint space for a female patient when her spine is not horizontal, and the top IC is tilted down towards the IR?

8 caudad

Which is the only projection of the lumbar spine that demonstrate the intervertebral disk spaces nearly parallel with the divergence of the beam (catches the beam)?

PA projection

Which projection of the lumbar spine will demonstrate the pars articularis?

AP/PA oblique projection

Which of the following structures must be demonstrated on an AP Lumbar spine radiograph?

T12 to S1 joints

The L5/S1 spot lateral projection is angled how many degrees and in which direction for a male patient when the spine cannot be positioned horizontally?

5 degrees caudad

Identify the structure labeled F

transverse process

Identify the structure labeled C

pedicle

Identify C

IVF

The LAO position of the lumbar spine will demonstrate which of the following structures?

right zygapophyseal joints

Where does the CR enter for an AP projection of the L-spine to demonstrate just the lumbar spine and not the sacrum?

at the level of L3

How many degrees are the lumbar obliques rotated?

30-60 degrees

How many degrees is the patient rotated to demonstrate the L5/S1 zygapophyseal joint space?

60 degrees

Where does the CR enter for the L5/S1 lateral projection?

1.5" below the IC and 2" posterior to ASIS

Identify F

sacrum

The AP projection of the lumbar spine is preferred over the PA because

the spine is closer to the IR and has less OID

How many lumbar vertebrae are in an average adult?

5

What distinguishes the lumbar spine from the rest?

Large bodies to support body weight (+ mamillary/accessory processes)

Where is the pars interarticularis located?

Part of the lamina between the superior and inferior articular processes

What structure cushions the vertebral bodies?

Intervertebral discs

The zygapophyseal joints of the lumbar form a ________ degree angle off the MSP.

30-60 (avg. 45)

What structure is located at right angles of the MSP?

IVFs

Why should we perform PA projections of the lumbar spine?

Places the intervertebral disc spaces parallel with the divergence of the beam and reduces gonadal dose

What are some things the patient must do prior to the exam?

A. Empty the bladder and any fecal material; B. Remove pants with any metal that will show up on the x-rays; C. Let the technologist know of any recent surgeries, pregnancy or unable to lie on the table

What is the recommended SID for the AP projection? Why?

48 inches to reduce distortion and open up the joint spaces (IVD)

Why is it important for the patient to flex their knees for the AP projection?

Reduces the lordotic curve of the spine and for patient comfort

If using a 14 x 17 IR, where should the CR enter?

MSP and L4 (at IC)

If using an 11 x 14 IR, where should the CR enter?

MSP and L3 (1.5" above the IC) (shows just the lumbar spine)

What structure must be on the IR for the AP or PA projection?

T12 through entire SI joints

How can you tell if the patient is rotated for the AP projection?

Rotation of the vertebral bodies and transverse processes and uneven iliac crests

What type of IR is taken for a trauma pt to demonstrate the AP lumbar spine?

14x17 or 16x16 to show lumbar spine and sacrum

What is the preferred method of the lateral projection of the lumbar spine?

Patient on their side, upright or recumbent, and the L-spine is built up or completely parallel (horizontal) to the IR so that the CR can be perpendicular

How do you place the patient in the true lateral position?

Build up their lower back above the pelvis to make the spine parallel to the IR, place a small sponge between the knees to straighten out the pelvis, prevent rotation, and for patient comfort. Flex the arms to the right angle of the body to prevent rotation.

Which body plane lies parallel (_____) to the IR and which lies perpendicular (____)

MSP; MCP and interiliac planes

What must the super technologist do to the patient to place the spine in a true lateral position?

Add a small sponge under the lower back just above the pelvis and a lead rubber strip behind the patient.

What are the reasons for placing the lead strip behind the pt for the lateral projection before the exposure?

To prevent premature shut off of the automatic exposure control (AEC) due to scatter radiation (this would make your image too light) and prevent scatter radiation from reaching the IR to decrease image quality. (this would make it too grey and yucky)

Can you shield a female patient? A male?

Yes, for both, down low in front for female

Name the structures demonstrated in the lateral lumbar projection

Bodies, IVD, IVF, pedicles, spinous processes

Where should the CR enter when using a 14 x 17 IR?

MCP and L4 (IC)

Where should the CR enter when using an 11 x 14 IR?

MCP and l3 (1.5" above the IC)

What type of breathing instructions should be given to the patient? Why?

At the end of expiration to raise the diaphragm to the highest point to see t12/l1 better

Which intervertebral foramina are demonstrated in the lateral projection?

L1 - l4

True/False: The L5 IVF is usually not well demonstrated in the lateral projection because it is on a slight oblique angle

true

The lateral projection (spot) is done to demonstrate

L5/S1 junction

What size IR is necessary for a lateral spot projection?

Small IR plate, 8x10 if possible (10x12 if necessary)