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how does the body of the vertebrae differ in the LSpine from the C and T spines?
the body is larger, and it increases as it gets closer to the sacrum
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how is the transverse process different in the Lspine?
the laminae?
- transverse processes are smaller (the 1st three are straight, the rest project slightly superiorly)
- the laminae are thicker
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how is the zygapophyseal joint angled in the LSpine?
- the angle varies from 30-60°
- the 30° angle is more common in the more superior L vertebrae
- the 60° angle is more common in the more inferior L vertebrae
- (so we oblique the pt 45°; the average)
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the part of the laminae between the inferior and superior articulating processes:
Pars interarticularis
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describe the angle of the intervertebral notches of the L Spine:
- intervertebral notches are 90° from MSP
- therefore, best visualized in Lateral view
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label
- A. pedicle
- B. superior articular process
- C. transverse process
- D. laminae
- E. spinous process
- F. body
- G. vertebral notch
- H. pars interarticularis
- I. inferior articular process
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name the projection and position:
- AP oblique LSpine
- RPO position
- (theoretically could be LAO, but we don't usually do PA projections)
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label
- A. body
- B. pedicle
- C. transverse process
- D. lamina
- E. spinous process
- F. superior articular process
- G. vertebral foramen
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label
- A. the nose: transverse process
- B. the ear: superior articular process
- C. the eye: pedicle
- D. the body: laminae
- E. the neck: pars interarticularis
- F. the front leg: inferior articular process
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describe the sacrum (7):
- triangular, wider at top
- five segments fused into one
- the base is the top, the apex is the bottom
- the anterior surface is concave
- four pairs of foramina allowing the passage of blood vessels
- two horns (cornua) that project downward and align with cornua of coccyx
- male's is typically longer, more narrowed, less angled
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label:
- A. median sacral crest
- B. superior articular process
- C. base (body)
- D. promontory
- E. articular surface
- F. coccygeal horn (cornu)
- G. coccyx
- H. sacral horn (cornu)
- I. ala
- J. promontory
- K. base
- L. pelvic (anterior) sacral foramina
- M. coccyx
- N. sacrum
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what does the promontory of the sacrum help to form?
the true inlet of the pelvis
-
begins at the 1st sacral segment and continues down into sacrum:
sacral canal
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with which projection are the sacral horns best seen?
the lateral projection
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at what angle is the SI joint formed?
25-30°
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describe the coccyx (7):
- commonly know as the tailbone
- has 3-5 segments with an average of 4
- a fracture is painful, usually from a fall in a sitting position
- a common fracture site among skaters
- often deviates from midline
- has two cornua that project upward and align with two horns that project downward from sacrum
- the curvature is more pronounced in males, straighter in females
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Refer to the lab pictures for specific positioning info for LSpine, Sacrum, Coccyx, and SI joint projections. not gonna repeat it all again here!!
- so while looking up lab pictures, have fun with this:
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what difference will you see if comparing an image of an AP LSpine where the knees were bent with one where the knees were not bent?
the intervertebral disk spaces will be more open with knees bent.
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name the projection and label it:
- AP LSpine
- A. lamina
- B. pedicle
- C. spinous process
- D. body of L3
- E. 12th rib
- F. intervertebral disk space (L2-L3)
- G. psoas muscle
- H. transverse process
- I. sacroiliac joint
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what is the alternative if no sponge is used to align the spine for the lateral LSpine projection?
- angle the tube 5-8° caudal
- (8° for women, wider hips)
- (5° for men, narrower hips)
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name the projection and label it:
- lateral LSpine
- A. intervertebral disk space
- B. intervertebral foramen
- C. sacrum
- D. vertebral body of L1
- E. crest of ilium
- F. lumbosacral interspace
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what can happen if a lead strip is not utilized behind the patient's back on lateral spine projections?
without the lead strip, the AEC cells will collect scatter radiation, resulting in an underexposed image (because cell thinks it has received enough radiation when it has really not)
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name the projection and label it:
- lateral L5-S1 (spot) projection
- A. spinous process
- B. L5-S1 interspace
- C. iliac crests
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What structures are the focus of the AP oblique projections of the LSpine?
zygapophyseal joints (of down side)
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name the projection and label it:
- AP Oblique Projection (RPO); theoretically could be PA Oblique (LAO)
- A. transverse process (nose)
- B. pars interarticularis (neck)
- C. zygapophyseal joint of L1-L2
- D. inferior articular process (front foot)
- E. pedicle (eye)
- F. superior articular process of L4 (ear)
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name the projection and label it:
- SI Joints, AP Axial (also for lumbosacral junction)
- A. L5
- B. lumbosacral interspace
- C. sacrum
- D. sacro-iliac joint
- E. ilium
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how would you make adjustments if an image of the sacrum needed to be obtained as a PA instead of an AP?
angle 15° caudal and center to the sacral curve
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name the projection and label it:
- AP Axial Sacrum
- A. ala of sacrum
- B. SI joint
- C. sacrum
- D. pubic bone
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how would you make adjustments if an image of the coccyx needed to be obtained as a PA instead of an AP?
angle 10° cephalic and center to palpable coccyx
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name the projection and label it:
- AP Axial Coccyx
- A. sacrum
- B. SI joint
- C. coccyx
- D. pubic bone
- E. pubic symphysis
- F. ishium
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name the projection and label it:
- Lateral Sacrum
- A. sacrum
- B. coccyx
- C. ishia
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name the projection and label it:
- Lateral Coccyx
- A. sacrum
- B. coccyx
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on the AP oblique projections of the SI joints, which side is demonstrated?
the up side (elevated)
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on the PA oblique projections of the SI joints, which side is demonstrated?
the down side (not elevated)
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how are weight-bearing projections of the lumbar spine taken?
- erect PA (more parallel with disk spaces), centered to L3 (1½" above crest) with one bending to the right and one bending to the left (as far as naturally possible without lifting a foot)
- possibly required: erect lateral, centered to L3, with one bending forward and one bending backward
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what is the purpose of weight-bearing projections of the lumbar spine?
- to study mobility of the intervertebral joints (less motion in a pt with disk protrusion in the area of the lesion)
- to visualize the lower thoracic interspaces to all of the sacrum
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name the various causes of scoliosis that we discussed:
- disease
- surgery
- trauma
- idiopathic (we don't know why)
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list the full series of films the scoliosis series may include:
- erect PA (orAP)
- erect PA (or AP) with lateral bending
- erect lateral (with or without bending)
- supine PA (or AP)
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what are the purposes of scoliosis projections?
- demonstrates the degree of curvature occuring with the force of gravity acting on the body (erect)
- evaluation of spinal fixation devices, like Herrington rods
- differentiation of primary and compensatory curves. primary curves do not change with bending, but secondary curves will
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if available, what size film is preferred for scoliosis projections?
14x36
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name some things that can be used/done to reduce patient dose during scoliosis projections and name why this is especially important for scoliosis patients:
- compensating filters
- collimation/shielding
- breast shields
- use high kVp (over 90)
- increase SID to 72"
- important because scoliosis pts are likely to be radigraphed often
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give the specifics of the Ferguson Method projection and what it is used for:
- 14x36
- erect is best
- AP, PA, or Lateral
- bottom of cassette centered to 1" below crest on MSP/MCP
- 2nd image taken elevating the foot by 3-4" on the side where the primary curve is convex (in hospitals, usually two images are taken, one for the elevation of each foot)
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in this projection, which foot would need to be elevated for the Ferguson Method and why?
- elevate the left foot
- because the primary (lumbar) curve is convex on the pt's left side
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give the specifics of radiographs taken to evaluate spinal fusion of the lumbar spine:
- AP supine with right and left bending centered to L3
- move heels and hold with sand bags; move shoulders without moving pelvis
- use compression band
- lateral supine with bending (fetal position and fully extended body)
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when or for what purposes are lumbar spinal fusion radiographs taken?
- used for early scoliosis patients to determine structural change
- used to localize a herniated disk (limited motion on site of lesion)
- used to demonstrate whether there is motion in the area of a spinal fusion - usually taken 6 months after surgery.
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an inflammatory condition that usually begins in the sacroiliac joints and progresses up the vertebral column:
ankylosing spondylitis
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describe the characteristics of ankylosing spondylitis:
- vertebral column becomes fused
- takes on the appearance of bamboo
- the anterior longitudinal ligaments calcify
- most common in males in their 30s
- no known cause
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name possible causes of compression fractures of the lumbar spine:
- trauma
- osteoporosis
- metastatic disease
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a condition in which the superior and inferior surfaces of the vertebral body are driven together producing a wedge shaped vertebra:
- compression fracture
- (rarely causes a neurologic deficit)
- (usually happens more anteriorly on the vertebral body)
-
a condition resulting from a hyperflexion force, causing
fracture through the vertebral body and posterior elements.
chance fracture
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give a common cause of chance fractures:
wearing lap-type seat belts because the belt acts as a fulcrum during sudden deceleration
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a condition in which the soft inner part of the intervertebral disk protrudes through the fibrous outer layer, pressing on the spinal cord or nerves:
herniated nucleus pulposus
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describe some characteristics of a herniated nucleus pulposus:
- called HNP or a slipped disk
- usually due to trauma or improper lifting
- most frequently occurs at L4-L5 causing sciatica
- not demonstrated on plain films, but they can rule out other processes
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a condition in which primary malignant neoplasms that spread to distant sites via blood and lymphatics:
- metastases
- (the vertebrae are common sites of metastatic lesions)
-
destructive metastatic lesions with irregular margins:
osteolytic
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proliferative bony lesions of increased density:
osteoblastic
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what occurs with the combination of osteolytic and osteoblastic lesions?
a moth-eaten appearance of the bone
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a condition in which there is forward movement of one vertebra in relation to another:
spondylolisthesis
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describe some possible causes of spondylolisthesis:
commonly due to a developmental defect in the pars interarticularis or may result from spondylolysis or sever osteoarthritis
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describe some characteristics of spondylolisthesis:
- most common at L5-SI, but also occurs at L4-L5
- severe cases require spinal fusion
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a condition in which there is dissolution of a vertebra, such as from aplasia (lack of development) of the vertebral arch and separation of the pars interarticularis of the vertebra:
spondylolyiss
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describe some characteristics of spondylolyiss:
- the neck of the scotty dog appears broken
- most common at L4 or L5
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