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Name the divisions of the spinal chord, both as an infant and as an adult:
- 7 cervical vertebrae
- 12 thoracic/dorsal vertebrae
- 5 lumbar vertebrae
- 1 sacrum (infant's is divided into 5 segments)
- 1 coccyx (infant's is divided into 3-5 segments)
- therefore - 33 bones as an infant and only 26 as an adult.
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What is the SI joint?
- the joint between the sacrum and iliac of pelvis
- (where spine articulates with each hip bone)
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What accounts for 1/4 of the length of the spine?
disks of fibrocartilage
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Why does a person appear to shrink in later life?
the disks of fibrocartilage between the vertebrae, which make up 1/4 the length of the spine, wear down over time.
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What do ligaments do as opposed to tendons?
- ligaments: hold bones together
- tendons: attach muscle to bone
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Name what makes up the "true" vertebrae as opposed to the "false" vertebrae:
- True vertebrae: Cervical, Thoracic, and Lumbar spines
- False vertebrae: Sacrum and Coccyx (more stable, stationary)
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list the curves of the spine for each section (concave vs. convex, anterior and posterior):
- cervical spine: concave posteriorly and convex anteriorly
- thoracic spine: convex posteriorly and concave anteriorly
- lumbar spine: concave posteriorly and convex anteriorly
- sacrum&coccyx (pelvic spine): concave anteriorly
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Which are the primary curves and which are the secondary curves of the spine?
- primary: thoracic and pelvic
- secondary: cervical and lumbar
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Aside from "primary" and "secondary" name three more classifications of the spine curvatures:
- compensatory curves: cervical and lumbar
- lordotic curves: cervical and lumbar
- kyphotic curves: thoracic and pelvic (lumbosacral or sacrovertebral angle)
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What type of angle is the articulation of the lumbar vertebra and the sacrum?
an obtuse angle.
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an abnormal curvature of the thoracic spine, usually caused due to the fact that the anterior portion of the vertebral discs wears away more than the posterior portion (seen most often in the elderly):
kyphosis
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the condition of the spine that causes "swayback":
lordosis
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an abnormal lateral curvature of the spine:
scoliosis
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an adolescent form of kyphosis:
Scheuermann's Disease
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What is a common occurance of curvature of the thoracic spine?
a slight lateral curvature due to the increased muscle use of a dominant side
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Name this condition:
- scoliosis
- in addition to lateral curvature, vertebrae also rotate toward concavity
- then a secondary or compensatory curve develops in the opposite direction to keep the head centered over the feet
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What makes up the body of the vertebra?
cancellous bony tissue covered by a layer of compact tissue
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What makes up the vertebral arch?
two pedicles merge into two laminae that meet to form the spinous process
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Give three names for the area of the vertebrae where the spinal cord passes through:
- vertebral foramen
- neural canal
- spinal canal
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the lateral surface of the vertebrae is what shape?
concave
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label:
- A. annulus fibrosus
- B. nucleus pulposus
- C. spinal nerve
- D. transverse process
- E. superior articular process
- F. spinous process
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how many nerves come off the spinal cord?
31 pairs
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Give two common symptoms of an HNP injury:
- pain running down the leg
- numbness
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describe the pedicles of the vertebrae:
- short, thick, come off the posterior surface of vertebral body
- they have a notch or concave area that helps form the intervertebral foramina (where the arteries, veins, nerves pass)
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label:
- A. vertebral foramen
- B. spinous process
- C. vertebral arch
- D. lamina
- E. transverse process
- F. costal facet (articular facet for tubercle of rib)
- G. superior articular process
- H. pedicle
- I. superior costal facet
- J. body
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a congenital defect where the lamina failed to unite posteriorly at midline:
- spina bifida
- (in large defects, the spinal cord can protrude)
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failure of the laminae to close but without hernial protrusion:
- spina bifida occulta
- (mild version)
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with which projection (AP or PA) is the intervertebral disc space better visualized?
- PA projection
- because of the curvature of the spine
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label:
- A. transverse process
- B. facet for costal tubercle
- C. superior articular process
- D. pedicle
- E. superior costal facet
- F. body
- G. lamina
- H. spinous process
- I. inferior articular process
- J. vertebral notch
- K. inferior costal facet
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describe the joints that join the vertebrae:
- superior and inferior articulating processes join the vertebra above and below to form the zagapophyseal joints
- each process has a facet or area of fibrocartilage where the processes meet
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the superior part of the pedicle is not as _________ as the inferior part.
concave
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Give five names for the joints that join the vertebrae together:
- zygapophyseal joint
- facet joint
- interarticular facet joint
- interarticular zygapophoseal joint
- apophyseal joint
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The movable vertebrae are similar in structure except for:
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Name the "typical" cervical vertebrae:
C3-C6
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Why are C1 and C2 not considered "typical" C vertebrae?
- they are modified to join with the skull
- (C1 varies the most)
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What is the name of the joint between C1 and the skull?
Occipitoatlantal Joint
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Why is C7 not considered a "typical" C vertebra?
it joins the thoracic spine
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What are C1 and C2 commonly referred to as?
- C1: the atlas
- C2: the axis
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Describe the C1 vertebra:
- a ring-like structure with no body
- short spinous process
- an anterior and posterior arch
- two lateral masses
- two transverse processes (longer than the rest)
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What fits into the concave superior processes of C1 vertebra?
the condyles of the occipital bone of the cranium
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Transverse foramena are located only on the:
cervical vertebrae
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the transverse atlantal ligament supports the:
- dens (odontoid tip)
- fits anteriorly (cord posterior, turning into medulla oblongata)
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name the vertebrae and label:
C1 vertebra
- A. posterior arch
- B. transverse foramen
- C. transverse process
- D. lateral mass
- E. tubercle (points of attachment for transverse atlantal ligament)
- F. anterior arch
- G. superior articular process
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describe the C2 vertebrae:
- "axis"
- has the dens, which comes off the body
- acts as a pivot for C1 (which fits into the anterior arch)
- thicker laminae than C1, but still small spinous process
- it's superior articular process joins with C1's inferior articular process
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name the vertebrae and label:
C2 vertebra
- A. lamina
- B. superior articular process
- C. dens (odontoid process)
- D. body
- E. spinous process
- F. inferior articular process
- G. vertebral notch
- H. transverse process
- I. transverse foramen
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What does the open mouth projection show?
the zygapophyseal joint of C1 and C2
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When the vertebrae is pushed forward and partial dislocation occurs, this is called:
sublaxation
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name the vertebra and label:
typical cervical vertebra
- A. superior articular process
- B. spinous process
- C. lamina
- D. transverse process
- E. pedicle
- F. transverse foramen
- G. body
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what is the function of the transverse foraminae?
- the vertebral artery and vein pass through it
- (the upper surfaces of the transverse processes are concave for the passage of spinal nerves)
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Where do bifid spinous processes occur?
only on the typical cervical vertebrae
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the area between the superior articulate process and the inferior articulate process of one vertebra:
articular pillar
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how are the zygapophyseal joints of the c spine angled?
- 90° to the MSP
- therefore, they show up on a lateral projection
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how are the intervertebral foraminae of the c spine angled?
- 45° to the MSP
- with a 15° inferior slope
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how are the intervertebral foramina of the cervical spine best visualized?
- on the 45° oblique view
- (tube is also angled 15° longitudinally because of inferior slope of body)
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describe how the different oblique positions affect which side is better visualized when it comes to the intervertebral foramina of the cervical spine:
- an AP oblique better visualizes the up side. (45°)
- a PA oblique better visualizes the down side. (45°)
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how are the zygapophyseal joints of the cervical spine best visualized?
lateral projection
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how are the intervertebral foramina of the thoracic spine best visualized?
lateral projection
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how are the zygapophyseal joints of the thoracic spine best visualized?
70° oblique view
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describe how the different oblique positions affect which side is better visualized when it comes to the zygapophyseal joints of the thoracic spine:
- an AP oblique better visualizes the up side (15-20°)
- a PA oblique better visualizes the down side (15-20°)
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which vertebrae make up the "typical" thoracic vertebrae?
- T3-T9
- (they are triangular in shape)
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describe how the facets for the ribs are arranged on the body of the thoracic spine vertebrae that are not "typical:"
- T1: whole facet above for 1st rib, demifacet below for 2nd rib
- T10-T12: whole facets above, none below
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The zygapophyseal joints of the thoracic region (except for the inferior articular processes of the 12th vertebra) angle in what direction and by how much?
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why do you raise the arms when imaging the thoracic spine?
to elevate the ribs so they do not cross the intervertebral foramina
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where are costal facets found?
- on the transverse processes of T1-T10
- (for the tubercles of the ribs to articulate)
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what are the two types of cartilagenous joints of the spine, and of the two, which are the joints between vertebral bodies?
- symphysis* (intervertebral)
- synchondrosis
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Name five joints of the spine that are diarthrodial:
- atlanto-occipital
- atlanto-axial
- zygapophyseal
- costovertebral
- costotransverse
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Name a joint of the spine that is amphiarthrodial:
intervertebral
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What types of movement can occur with the atlanto-occipital joint?
- ellipsoidal/condyloid:
- flexion, extension
- abduction, adduction
- circumduction
- NO rotation
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what types of movement can occur with the atlantoaxial joint?
- lateral masses: gliding (plane - slide glide ability in one plane)
- dens: pivot (trochid - only rotation around a single axis)
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list the movement types for the following joints:
costovertebral
costotransverse
intervertebral
zygapophyseal
SI
- costovertebral: gliding/synovial
- costotransverse: gliding/synovial
- intervertebral: symphysis/cartilagenous (only a little movement)
- zygapophyseal: gliding/synovial
- SI: synovial, but act like cartilagenous, permitting little movement
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what should be visualized in the AP open mouth projection of the cervical spine?
- joint spaces on both sides
- tip of dens/odontoid process
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Give two general guidelines for adjustments if the tip of the odontoid is clipped in an image:
- if teeth are over the odontoid, extend the chin more.
- if occipital bone is over the odontoid, depress chin down more.
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name the projection and label:
cervical spine: AP open mouth
- A. dens/odontoid process
- B. mandibular ramus
- C. teeth
- D. base of skull (occipital bone)
- E. atlantoaxial articulation
- F. axis
- G. atlas
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what projection is commonly used if the tip of the odontoid is unobtainable with the AP open mouth? describe projection specifics:
- fuchs method
- raise chin to form an imaginary line from the tip of the chin to the mastoid tip that is perpendicular to the IR.
- perpendicular CR centered to just below tip of chin
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what projection can be done to visualize the odontoid tip of a trauma patient who is wearing a c-collar?
- the reverse waters
- a lateral projection where the tube is angled, utilizing an imaginary line from the tip of the chin (MML) to the earhole (EAM)
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where does the fuchs method place the odontoid tip for visualization?
- within the foramen magnum
- (joint spaces not visualized)
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what is the alternate projection for a visualization of the odontoid tip that is a PA projection where the chin rests on the table, the MML is near perpendicular, and the CR is parallel to the MML (going through midoccipital, to about 1" inferoposterior to mastoid tips and mandibular angles)?
the Judd Method (PA odontoid)
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For the AP axial projection of the cervical spine, what vertebrae are visualized and where should the CR be?
- visualize C3-T2
- CR exits at C4 (15-20° cephalic)
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what is the name of the projection that is the common lateral cervical spine projection?
Grandy Method
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what is a functional study for anteroposterior movement of the neck?
- c-spine lateral projections: hyperflexion and hyperextension
- (pathology or fracture should be ruled out before attempting)
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what movement from lateral should the patient make for the hyperflexion projection?
drop head forward, placing chin as close to chest as possible
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what movement from lateral should the patient make for the hyperextension projection?
elevate chin as far as possible (looking up to ceiling)
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name the projection:
- RPO/LAO
- demonstrates left intervertebral foramina and pedicles
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what is advantageous about the PA axial obliques of the cervical spine, as opposed to the AP axial obliques?
less exposure to the thyroid
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name the projection:
- RAO/LPO
- demonstrates right intervertebral foramina and pedicles
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what is especially important to remember with a trauma patient needing cervical spine images?
- DO NOT move the pt's head, you could be liable.
- make the ER doctor do it.
- also, must have doctor's permission to pull the shoulders down. it's illegal otherwise.
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lateral images of the cervical spine show which zygapophyseal images best?
down side (side closest to IR)
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list things you need to know about a trauma AP axial oblique projection (5):
- film should be placed off center to compensate tube angle
- tube angle 45° medial, 15° cephalic
- no grid because of double angle (grid cutoff)
- enter pt's right side, left intervertebral foramina demonstrated.
- enter pt's left side, right intervertebral foramina demonstrated.
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name the projection:
- RPO/LAO
- demonstrates left intervertebral foramina and pedicles
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which vertebrae should be visualized in the swimmers projection?
C5-T5
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what is the name of the swimmers projection done on the table vs. the swimmers projection done at the wall bucky?
- table: Pawlow Method
- wall: Twining Method
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name the projection:
- LPO/RAO
- demonstrates right intervertebral foramina and pedicles
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name the projection and label:
lateral c-spine
- A. inferior articular process
- B. superior articular process
- C. zygapophyseal process
- D. vertebral prominens
- E. mandibular rami
- F. body of C3
- G. intervertebral disk space
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name the projection and label:
swimmers lateral
- A. elevated humerus
- B. C6
- C. elevated clavicle
- D. depressed clavicle
- E. depressed humerus
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if the anode hill effect is degrading image quality of a t-spine, what can be used to improve the image?
a wedge compensating filter
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name the projection:
LPO/RAO
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what method is the "wagging jaw" method? describe the method.
- Ottonello Method
- AP supine
- perpendicular CR directed to C4
- pt is instructed to make an even chewing motion
- long exposure time
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which c-spine projection is taken at a 20-30° angle centered at C7, with the neck hyperextended?
- vertebral arch (pillars)
- "lateral mass projection"
- AP axial projection
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a fracture of the spinous process of C7, caused from hyperflexion:
- clay-shovelers fracture
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a fracture of the ring of C1, caused by an injury causing the head to compress unnaturally:
jefferson fracture
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a fracture of the arch of C2, usually causes sublaxation of C2 over C3:
- hangman's fracture (hyoid bone is often broken by this type of injury as well)
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suggestion: go over check-off pics of c-spine and t-spine as well as these cards. i'm tired. good luck on the test!
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