Chapter 8,9: cervical, thoracic, lumbar spine and sacrum and coccyx

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AP Axial cervical vertebrae

• Spinous processes at midline of vertebral bodies

• each spinous process visualized at the level of its inferior disk space

• disk spaces open

• occipital base mandibular mentum are superimposed

• mastoid tips and mandibular angle equal distances from cervical vertebrae.

• articular pillars and pedicles are symmetric and lateral to vertebral bodies

• Third cervical vertebra is demonstrated in its entirety

Atlas, Axis: AP open mouth

• Atlas is symmetrically seated on axis, with the atlas’
lateral masses at equal distances from the dens
• Spinous process of the axis is aligned with the
midline of the axis’ body
• Mandibular rami are visualized at equal distances
from the lateral masses
• Upper incisors and occipital base are seen superior
to the dens and the atlantoaxial joint
• Atlantoaxial joint is open

Cervical vertebrae: Lateral projection

• Anterior & posterior aspects of the right & left articular pillars
and the right and left zygapophyseal joints of each cervical
vertebra are superimposed
• Mandibular rami are superimposed
• Spinous processes are in profile
• Superior & inferior aspects of the right and left articular pillars
and zygapophyseal joints of each cervical vertebra are
superimposed
• Intervertebral disk spaces are open
• Posterior arch of C1 and spinous process of C2 are in profile
without occipital base obstruction
• The bodies of C1 & C2 are seen without mandibular
superimposition

Cervical vertebrae Oblique

Second through seventh intervertebral foramina are open, demonstrating uniform size and shape
• LPO & RAO: right pedicles are shown in profile and left pedicles
are aligned with anterior vertebral bodies
• RPO & LAO: left pedicles are shown in profile and right pedicles are aligned with anterior vertebral bodies
• Inferior outline of the outer cranial cortices demonstrate about ¼”
between them
• Inferior mandibular rami demonstrate about ½” between them
• Posterior arch of the atlas and vertebral foramen are seen
• Intervertebral disk spaces are open
• Cervical bodies are seen as individual structures and are uniform
in shape

head turned: C1-3 demonstrated without mandibular superimposition, the right and left posterior cortices of the
mandible are aligned

head not turned: C1-3 demonstrated with mandibular superimposition

Cervicothoracic Swimmers

Right & left cervical zygapophyseal joints,
the articular pillars, and the posterior ribs
are superimposed
• Humerus that is elevated above the head is aligned with vertebral column
• Fifth through seventh cervical vertebrae
are demonstrated without shoulder superimposition
• Intervertebral disk spaces are open
• Vertebral bodies are demonstrated without
distortion

AP thoracic

Spinous processes are aligned with the midline of
the vertebral bodies
• Distances from the vertebral column to the sternal
clavicular ends and from the pedicles to the spinous processes are equal on the two sides
• Intervertebral disk spaces are open
• Vertebral bodies are seen without distortion

Lateral thoracic

Intervertebral foramina are clearly demonstrated
• Pedicles are in profile
• Posterior surfaces of each vertebral body are superimposed
• No more than ½” of space is demonstrated between the posterior ribs
• Humeri or their soft tissue are not obscuring
vertebrae
• Intervertebral disk spaces are open
• Vertebral bodies are demonstrated without distortion

AP Lumbar

Psoas muscles are demonstrated
• Spinous processes are aligned with midline of
vertebral bodies, with equal distances from the
pedicles to the spinous processes on both sides
• Sacrum & coccyx are centered within the inlet pelvis
• Intervertebral disk spaces are open
• Vertebral bodies are seen without distortion
• Long axis of the lumbar column is aligned with
the long axis of the exposure field

Lumbar AP oblique

Superior & inferior articular processes are in profile
• Zygapophyseal joints are demonstrated
• Pedicles are seen halfway between the
midpoint of the vertebral bodies and the
lateral border of the vertebral bodies

Lumbar Lateral

Intervertebral foramina demonstrated & spinous
processes are in profile
• Right & left pedicles and posterior surfaces of
each vertebral body are superimposed
• Intervertebral disk spaces are open
• Vertebral bodies are seen without distortion
• Lumbar vertebral column is in neutral position,
without lumbar flexion or extension

L5-S1 Lateral Junction (Spot image mayhaps)

L5-S1 intervertebral foramen is demonstrated
• Right & left pedicles are superimposed and in profile
• Greater sciatic notches are nearly superimposed
• L5-S1 intervertebral disk space is open
• L5 vertebral body and sacrum are demonstrated without distortion
• Pelvic alae are nearly superimposed

Sacrum AP Axial

No evidence of urine, gas, or fecal material superimposing the sacrum
• Ischial spines are equally demonstrated and
are aligned with pelvic brim
• Medial sacral crest and coccyx are aligned
with symphysis pubis
• 1st – 5th sacral segments are seen without
foreshortening
• Sacral foramina demonstrate equal spacing
• Symphysis pubis is not superimposed over
any portion of the sacrum

Sacrum Lateral

L5-S1 intervertebral foramen is open
• Median sacral crest is in profile
• Greater sciatic notches are superimposed
• Femoral heads are aligned
• L5-S1 intervertebral disk space is open
• L5 vertebral body and sacrum are demonstrated
without foreshortening
• Pelvic alae are nearly superimposed

AP Coccyx

No evidence of urine, gas, or fecal material is
superimposed over the coccyx
• Coccyx is aligned with the symphysis pubis
and is at equal distances from the lateral walls
of the inlet pelvis
• 1st – 3rd coccygeal vertebrae are seen without
foreshortening and without symphysis pubis
superimposition

Lateral Coccyx

Median sacral crest is in profile
• Greater sciatic notches are superimposed
• Coccyx is seen without foreshortening