Radi 106 C,T,L spine, sacrum and coccyx

What is the vertebral column

Spine, complex succession of many bones

Where is the vertebral column located

In the midsagittal plane, forming the posterior aspect of the bony trunk of the body

Spinal canal

Begins at the base of the skull and extends distally into the sacrum, constrain the spinal cord and is filled with cerebrospinal fluid

Spinal cord

Begins with the medulla oblongata of the brain. Passes through the foremen magnum of the skull and continues through the first cervical vertebra all the way down to the first lumbar vertebra where it tapers off to a point called the conus medullaris

Intervertebral disks

Each vertebra are separated by tough fibrocartilaginous disks. Cushion like disks are tightly bound to the vertebrae for spinal stability but also allows for flexibility and movement of the vertebral column

The spine is divided into how many sections

5

List the spines sections in order

• Cervial- seven

• Thoracic- twelve

• Lumbar- five, the largest and strongest

• Sacrum- five, these fuse later to form one

• Coccyx- 3 to 5, these fuse later to form one

Convex

Rounded outward or elevated surface

Concave

Rounded inward or depressed surface (like a cave)

What type of curvature is cervical and lumbar regions from a posterior perspective

Concave curvature and are described as lordotic

What type of curvature does thoracic and sacral regions have from a posterior perspective

Convex curvatures and are described as kyphotic

Lordosis

Bent backward, norma anterior concavity of the C and L spines, but also described abnormally increased swayback curvature involving the lumbar spine

Kyphosis

Humpback, describes an abnormal humpback curvature

Scoliosis

Abnormal lateral (side to side) curvature

A typical vertebra is composed of two main parts

• body

• Vertebral arch

Body

Anterior mass of bone

Vertebral arch

Posterior ring like portion

The body and vertebral arch enclose a space called the

Vertebral foramen

What is the vertebral arch formed by

Two pedicles and two laminae that support four articular processes, two transverse processes and one spinous process

Intervertebral joints

Slightly moveable joints between vertebral bodies

Zygapophyseal joints

Formed by the articulation of the four articular processes (2 superior and 2 inferior)

Costal joints

These are joints only found on the bodies of the thoracic vertebrae where the ribs articulate with the spine

• only on the thoracic vertebrae where (Costotransverse and costovertebral)

Intervertebral foramina

Formed from areas on the pedicles, allows for passage of important spinal nerves and blood vessels

Superior and inferior vertebral notches

Upper and lower surface of each pedicle half moon shape, when they are stacked, the half moon shape notches line up to form a full moon

Intervertebral disk

Fibrocartilaginous disks located between the bodies of the vertebrae.

Two parts:

• annulus fibrous- outer portion

• Nucleus purposus- soft inner portion

When the inner portion of the intervertebral disk protrudes through the fibrous layer it is termed as a

Herniated nucleus pulposus (HNP) (herniated disk)

What are the first two cervical vertebra that are structurally modified to join the skull called

Atlas (c1) and Axis (c2)

Atlas

Derived from the Greek god who bore the world upon his shoulders

• least resembles a typical vertebra

• Anteriorly there is no body, just a thick arch of bone called the anterior arch

Axis

Has a conical process projecting upward called the dens (odontoid process)

• odontoid process goes up through C1 and is held in place by the transverse Atlanta ligament

• Rotation of the head primarily occurs between C1 and C2 with the dens acting as a pivot

Why are C1 and C2 clinically important

Injury that high in the spinal canal can result in paralysis and death

What is the major difference between C7 and the rest of the cervical vertebrae

Long spinous process, easily palpable at the posterior base of the neck

All cervical vertebrae contain three foramina that run vertically

• the left and right transverse

• Vertebral foramen

pedicles of the typical cervical vertebra project

Laterally and posteriorly from the body

The laminae of the C-Spine are

Narrow and thin

The spinous process of the C-spine are

Short and have double pointed (bifid) tips

Cervical zygapophyseal joints

Demonstrated on true lateral views only (C2-C7), however the joint between C1-C2 is only seen on a true AP position

Cervical intervertebral foramina

Only seen when the pt is rotated 45 degrees from AP. Directed at a 15 degree inferior angle

Transverse processes of the thoracic vertebrae project

Obliquely, laterally, and posteriorly

The laminae of the the T-spine

Broad and thick and they overlap the subject lamina

The spinous processes of the T-spine are

Long, from the 5th and 9th vertebrae, they overlap each other. Above and below, they are less vertical with no overlapping

Thoracic zygapophyseal joints

Only seen when the pt is at a 70-75 degree oblique position

Thoracic intervertebral foramina

Seen when the pt is in a true lateral position

Lateral C-spine

• C1-7 demonstrated

• Rami of mandible not superimposed over C1-2

AP Open Mouth

• Atlas, Axis, and dens seen in entirety

• C1-2 zygapophyseal joint space open

• Upper incisors superimposing base of skull

AP Axial C-Spine

• C3 to T1 region demonstrated

• Intervertebral disk spaces open

• Base of skull will superimpose C1-2

Oblique C-Spine

• C3-7 intervertebral foramina are open and clearly seen

• Cervical pedicles well demonstrated

• Base of skull not superimposed over C1

Swimmer’s Lateral C-Spine

• C4 to T3 clearly demonstrated

• Numeral heads separate

• Vertebral rotation to a minimum

Lateral Hyperflexion

• C1-7 visualized

• Spinous processes well separated

Lateral Hyperextension

• C1-7 visualized

• Spinous processes in close proximity

AP Fuch Method and PA Judd Method

• dens within foramen magnum

• Correct extension of head

AP Thoracic Spine

• C7 to L1 demonstrated

• Vertebral bodies well penetrated

Lateral Thoracic Spine

• T1-L1 demonstrated

• Intervertebral disk spaces open

Lumbar spine

Strongest and carry most of the body weight; injuries to disks are most common here

L5

Considerably deeper in front than behind, gives a wedge shaped appearance that adapts it for articulation with the sacrum

Lumbar spine; spinous process

Smaller and shorter

Lumbar spine; transverse process

Much thicker than those of the upper lumbar vertebrae but smaller

Intervertebral foramina of the L-Spine are seen

In a true lateral position

Zygapophyseal joints of L-Spine are seen

45 degree oblique, should see Scotty dogs

ear of Scotty dog

Superior articular process

Nose of Scotty dog

Transverse process

Eye of the Scotty dog

Pedicle

Neck of the Scotty dog

Pars interarticularis

Leg of the Scotty dog

Inferior articular process

Spondylolisthesis

Acquired bony defect occurring in the area of the lamina between the two articular processes. Exclusively involves the Lumbar Spine. Involved the forward slipping of one vertebra compared to another

Spondylolysis

Bony defect where there is a lack of development in the vertebral arch, the Scotty dogs neck appears broken

Sacrum

Formed by the fusion of the five sacral segments into a curved, triangular bone

Wedge between the iliac bones of the pelvis

In males or females is the bone usually longer narrower and more evenly curved

Males

Superior portion of the sacrum is called the

Base

Inferior portion of the sacrum is called the

Apex

Sacral promontory

Prominent ridge on the superior margin of the base

Sacral canal

Located behind the sacral bodies and is a continuation of the vertebral canal

Alae of sacrum

Large masses of bone lateral to the 1st sacral segment

Pelvic sacral foramina

4 sets, provide a passage for sacral nerves and blood vessels

Auricular surface of sacrum

Larger articular process or articulation of similar shaped processes on iliac bones of the pelvis

Median sacral crest

Formed by the fused spinous process of the sacral vertebrae on posterior side

Sacral horns

Small tubercles representing the inferior articular process projecting inferiorly from each side of the fifth segment

Coccyx

Tailbone, composed of three to five vertebrae that have a tendency to fuse into one in adulthood

• diminishes in size from its base (superior) to its apex (inferior)

• Curves inferiorly and anteriorly

Is the coccyx more curved anteriorly in males or females

Males

AP Lumbar Spine

• T11 or T12 to sacrum visualized

Oblique L-Spine

• T11 to S1 demonstrated

• “Scotty dogs” and open zygapophyseal joints

• Pedicle near center of vertebral body

Lateral Lumbar Spine

• T12 to distal sacrum demonstrated

• Intervertebral disk spaces open

• Intervertebral foramina open

Lateral L5-S1

• L4, L5, and S1 demonstrated

• L5-S1 joint space open

AP Axial L5-S1

• L5-S1 joint space demonstrated

PA Scoliosis and Lateral Scoliosis

• Thoracolumbar spine demonstrated

• 1-2 in iliac crest demonstrated

AP Flexion/ Bending and Lateral Flexion/ Extension are done to see

Range of motion

If Pedicle is anterior in an oblique that means the patient is

under-rotated

If pedicle is posterior in an oblique that means the patient is

Over-rotated

LPO and RPO demonstrate

Downside zygapophyseal joints

AP Axial Sacrum

• Sacrum not foreshortened

• Sacral foramina visualized

AP Axial Coccyx

• free of superimposition

• Coccyx region free of gas and feces

Lateral Sacrum

• Lateral profile of sacrum centered

• Coccyx and sacrum for a lateral are combined

Lateral coccyx

• coccyx in profile centered

• Segment interspaces open

AP Axial SI joints

• Sacroiliac joint centered to collimation field

• Sacroiliac joint spaces and L5-S1 junction open

Posterior oblique SI joints

• sacroiliac joint of interest is open

• Ala of ilium not overlapped over sacrum

Lateral C-Spine demonstrate

Zygapophyseal joints

Anterior Obliques reduce dose to

thyroid

Posterior Oblique (RPO/LPO) C-Spine demonstrates the intervertebral foramina (and pedicles) on the side of the patient ____

furthest from the IR

If you cannot separate the shoulders for the Swimmer’s view, what tube angle would you do

3-5 degree caudad tube angle

What breathing technique do you do for a Lateral T-spine

Orthostatic

What does the Lateral T-spine demonstrate

Intervertebral foramina