Spine

spot films

"Coned-down" radiographs; sometimes request for better visualization of specific areas of the spine.

spondylo-

"Vertebra."

articular pillar

A column of bone formed by the articular processes of the vertebra.

disk herniation

A common cause of remote nerve symptoms.

hangman's fracture

A fracture of the neural arch of C2 with associated subluxation of C2-C3.

transverse foramen

A hole found in each cervical transverse process that form passages on each side for the vertebral artery and vein.

typical lumbar vertebra

A large, rounded body and a rather large, flat spinous process.

intervertebral disk

A pad of fibrocartilage between vertebral bodies that cushions vertebral motion and absorbs shock.

kyphotic curve, kyphosis

A posterior convex curvature of the spine.

vertebral arch

A ring of bone posterior to the vertebra body; formed by the pedicles and the laminae posteriorly.

anterior tubercle

A rounded process found on the atlas.

nucleus pulposus

A soft, pulpy center found inside intervertebral disks.

dens

A toothlike projection superior to the body of the axis; also called the odontoid process.

annulus fibrosus

A tough outer coving found on intervertebral disks.

posterior tubercle

A very short spinous process found on the atlas.

at the level between S1-S2

ASIS

C1 and C2

Accomodate the support and rotation of the skull.

structures seen on AP thoracic spine

All 12 thoracic vertebrae, particularly the bodies, disk spaces, and transverse processes. C7 and at least a portion of L1 are usually also seen.

structures seen on lateral lumbar spine

All five lumbar vertebrae and superior half of sacrum, including intervertebral foramina, spinous processes and profile of the bodies, and intervertebral disk spaces.

structures seen on AP oblique lumbar spine

All five lumbar vertebrae and upper portion of sacrum, including zygapophyseal joints and pars interarticularis on the side nearest the IR.

structures seen on AP or PA lumbar spine

All five lumbar vertebrae, intervertebral disk spaces, proximal portion of sacrum, and sacroiliac joints. This projection demonstrates the bodies, disk spaces, and transverse processes. The pedicle are seen on end.

structures seen on lateral cervical spine

All seven vertebrae and soft tissues of anterior neck, including spinal alignment, bodies, disk spaces, spinous processes, and zygapophyseal joints.

scoliosis

An abnormal lateral curvature of the spine; results from rotation of a lordotic and/or kyphotic curve.

lordotic curve, lordosis

An anterior convex (bowing outward) curvature of the spine.

CR for AP axial coccyx

Angled 10 degrees caudad and centered to IR. CR enters body in midline, midway between pubic symphysis and level of ASIS>

CR for PA oblique cervical spine

Angled 15 degrees caudad to center of IR through body of C4.

CR for AP oblique cervical spine

Angled 15 degrees cephalad to center of IR through body of C4.

CR for AP axial sacrum

Angled 15 degrees cephalad to center of IR through mid-sacrum. CR enters body at midline, midway between pubic symphysis and level of ASIS.

swimmer's technique

Another name for the lateral projection of the cervicothoracic region.

vertebral column

Another name for the spine; is made up of many irregularly shaped bones known as vertebrae.

vertebra (pl. vertebrae)

Any one of the 33 bones (26 in the adult) of the spinal column.

inferior articular processes of atlas

Articulate with similar processes on the superior aspect of C2.

superior articular processes of atlas

Articulate with the base of the skull.

anode heel effect

Because there is significant tissue density variation between the extreme ends of the thoracic spine, it is desirable to use the ____.

CR for AP axial (lower) cervical spine

Centered to IR at angle of 15 degrees cephalad through thyroid cartilage.

part position for AP axial coccyx

Coronal plane is parallel to IR with patient facing tube. Midsagittal plane is centered to midline of Bucky. When patient is supine, knees are flexed and supported with a bolster.

part position for oblique cervical spine

Coronal plane of body forms angle of 45 degrees with plane of IR. Sagittal plane of skull is perpendicular to coronal plane of body. Have patient elevate and, if necessary, protrude the chin so that mandible does not overlap spine.

structures seen on AP obliques

Demonstrates interbertebral formina on side farthest from IR.

structures seen on PA obliques

Demonstrates interbertebral formina on side nearest IR.

CR for lateral lumbosacral junction lumbar spine

Directed perpendicular to center of IR through lumbosacral joint. This centering point is 2" posterior to ASIS and 1" inferior to iliac crest on coronal line midway between ASIS and posterior prominence of sacrum. When spine cannot be supported, angle 5 degrees caudad for males and 8 degrees for females.

slipped disk

Disk herniation or herniated nucleus pulposus (HNP).

patient instructions for lateral thoracic spine

Do not move. Perform shallow breathing during exposure.

patient instructions for AP thoracic spine, lumbar spine, and lateral sacrum

Do not move. Suspend breathing on expiration.

above the C1

EAM

superior and inferior articular processes

Each lateral mass has ____.

structures seen on AP axial and later coccyx

Entire coccyx and distal portion of sacrum.

structures seen on lateral sacrum

Entire sacrum and lumbosacral junction. Coccyx is sometimes visualized.

structures seen on AP axial sacrum

Entire sacrum and sacroiliac articulations.

EAM

External auditory meatus.

part position for upright lateral lumbar spine

Feet are shoulder-width apart with equal weight bearing, and torso is stabilized against upright IR holder. Arms are crossed over chest with hands supported on shoulders. Alternatively, arms may be supported out of radiation field by having patient grasp a pole.

spondylosis

Fixation or fusion of vertebrae.

sacrum and coccyx

For ____ examinations precise gonad shielding should be used for males, but not for females.

thoracic spine

For ____ examinations use a lead half-apron for shielding.

zygapophyseal joints

Found between the articular processes posteriorly.

intervertebral joint/disk

Found between the vertebrae bodies anteriorly and are amphiarthrodial.

sacral formina

Four pairs of openings found on the sacrum that allow passages for nerves.

clay shoveler's fracture

Fracture with an avulsion of the spinous process of C7.

compression fractures

Fractures often found of the vertebral bodies.

pathologic fractures

Fractures that occur with little or no trauma caused by bones weakened by disease processes.

part position for upright AP oblique lumbar spine

From AP position, patient is rotated 45 degrees toward side being radiographed. Feet are shoulder-width apart with equal weight bearing, and torso is stabilized against upright IR holder.

part position for recumbent AP oblique lumbar spine

From supine position, patient is rotated 45 degrees toward side being radiographed. Take care that there is no torsion (twist) of spine.

at the level of C3

Gonion

at the level of L4

Iliac crest

scoliosis

It is sometimes desirable to demonstrate the spinal column as a whole; it is useful for the evaluation of ____.

at the level between T2-T3

Jugular notch

structures seen on AP open mouth (upper) cervical spine

Lateral masses and transverse processes of atlas, dens, and upper half of body of axis, seen between upper and lower teeth.

at the level of L3

Lower costal margin

at the level of C1

Mastoid tip

part position for AP axial sacrum

Midsagittal plane is perpendicular to IR and centered to it. Knees are flexed and supported with a bolster.

part position for AP thoracic spine

Midsagittal plane of body is perpendicular to IR and centered on it, with patient facing tube. Superior border of IR is aligned 1" above spinous process of C7. When patient is supine, it is helpful to place a bolster under knees. When patient is standing, feet should be shoulder-width apart with equal weight bearing, and patient's back should be firmly against IR holder.

part position for AP axial (lower) cervical spine

Midsagittal plane of both body and head are aligned perpendicular to center of IR, with patient facing tube. Head position adjusted so that a line between mental point and base of skull makes an angle of 15 degrees with horizontal plane. When patient is recumbent, patient's head rests on table. Head is placed firmly against IR holder when upright.

part position for lateral cervical spine

Midsagittal planes of body and head are parallel to IR with infraorbitomeatal line parallel to floor. Shoulders must be relaxed and depressed. IR is positioned so that upper margin is level with top of ear.

at the level of T7-T8; 3" below sternal angle

Midthoracic

stenosis

Narrowing of a passageway, such as an intervertebral foramen.

transitional vertebra

Occurs when a vertebra of one spinal region takes on characteristics of the adjacent region.

sacralization of L5

One or both spinous processes of L5 become fused to the sacrum.

patient instructions for AP open mouth cervical spine

Open mouth as wide as possible. Stop breathing. Do not move.

part position for AP open mouth (upper) cervical spine

Patient faces tube with midsagittal plane of both body and head perpendicular to center of IR. Position of head is adjusted so that a line between lower surface of upper teeth (occlusal plane) and base of skull is parallel to horizontal plane. When patient is upright, patient's head is placed firmly against IR holder or a radiolucent wedge sponge for stability.

part position for AP lumbar spine

Patient faces tube with midsagittal plane perpendicular to IR and centered to it. When patient is supine, knees are flexed and may be supported with a bolster. When patient is standing, feet are shoulder-width apart with equal weight bearing, and torso is stabilized against upright IR holder.

position for lateral in flexion cervical spine

Patient is positioned as for routine lateral projection. Patient is then instructed first to "tuck" chin close to neck and then to flex neck, attempting to look at a spot mid-sternum.

position for lateral in extension cervical spine

Patient is positioned as for routine lateral projection. Patient is then instructed to extend neck, looking at a spot on ceiling directly above head.

part position for PA lumbar spine

Patient stands facing IR or lies prone, with midsagittal plane perpendicular to IR and centered to it.

CR for lateral cervicothoracic (swimmer's technique) cervical spine

Perpendicular to IR at C7-T1 interspace. Central ray enters at base of neck in midcoronal plane at level of C7 spinous process.

CR for lateral thoracic spine

Perpendicular to center of IR at T7. Central ray enters at inferior angle of scapula through middle of posterior half of thorax.

CR for AP thoracic spine

Perpendicular to center of IR at T7. This point is midline at approximate midpoint of sternum.

CR for AP or PA and lateral lumbar spine (30x35cm/11x14in IR)

Perpendicular to center of IR through L3, in midline 1 1/2" superior to level of iliac crest.

CR for AP oblique lumbar spine

Perpendicular to center of IR through L3. CR enters at point 2" medial to ASIS farthest from IR and 1 1/2" superior to iliac crest.

CR for AP or PA and lateral lumbar spine (35x43cm/14x17in IR)

Perpendicular to center of IR through L4, in midline at level of iliac crest.

CR for lateral coccyx

Perpendicular to center of IR through center of coccyx. CR enters at point 2" inferior to ASIS level and 3 1/2" posterior to ASIS.

CR for lateral sacrum

Perpendicular to center of IR through center of sacrum. CR enters at point 3 1/2" posterior to ASIS.

CR for lateral cervical spine (including flexion and extension)

Perpendicular to center of IR, through body of C4.

CR for AP open mouth (upper) cervical spine

Perpendicular to center of IR, through midpoint of open mouth.

transverse processes

Project laterally and slightly downward from the lateral masses.

sacral cornua

Projections on the posterior inferior aspect of the sacrum that are joined to the coccygeal cornua.

spinous process

Projects posteriorly and inferiorly from the junction of the lamina.

body position for sacrum and coccyx

Recumbent or supine.

spina bifida

Results when the posterior portions of the neural arches fail to close during development of the embryo.

part position for lateral coccyx

Sagittal plane is parallel to IR. When patient is recumbent, knees are flexed and may be separated by a sponge or cushion.

part position for lateral thoracic spine

Sagittal plane of body is parallel to IR. Arms may be raised overhead or anterior to body with shoulders rounded anteriorly. Take care that entire length of thoracic spine is parallel to IR.

part position for lateral cervicothoracic region (swimmer's technique)

Sagittal planes of body and head are parallel to IR. Arm nearest IR is raised above head and shoulder is rounded anteriorly. Opposite shoulder is depressed and slightly posterior.

body position for lateral cervical spine

Seated or standing.

body position for AP and lateral thoracic spine

Seated, standing, or recumbent.

body position for oblique and swimmer's technique cervical spine

Seated, standing, or recumbent.

body position for AP axial (lower) and AP open mouth (upper) cervical spine

Seated, standing, or supine.

spina bifida vera

Spina bifida that is less common where the defect may be quite large, leaving the spinal cord unprotected.

spina bifida occulta

Spina bifida that is relatively insignificant and produces no symptoms; most commonly seen at L5.

part position for recumbent lateral lumbar spine and recumbent lateral sacrum

Spine is aligned parallel to center of Bucky with arms anterior to body. Radiolucent sponges may be used to elevate waist and/or hip to keep spine level. Knees are flexed. A pad between knees helps keep pelvis lateral and maintain lateral position of spine.

body position for AP or PA and lateral lumbar spine

Standing or recumbent.

at the level between T4-T5

Sternal angle

1 1/2" above the jugular notch

T1

structures seen on lateral thoracic spine

T3 through T12 with blurring of ribs and lung markings when breathing technique is used.

lumbar spine

The 5 vertebrae located inferior to the thoracic spine.

atlas

The C1 vertebra; a ringlike structure with no vertebral body and a very short spinous process.

anteroposterior (AP) projection

The C1-C2 articulations are best seen in the ____.

anteroposterior (AP) projection

The C1-C2 articulations differ in position and direction and are best seen in the ____.

axis

The C2 vertebra; the vertebra on which the atlas rotates so the head can turn from side to side.

vertebrae

The ____ are named according to spinal region and numbered from the top down.

PA projection

The ____ is preferred for a full spine examination because patients who require this procedure must often be radiographed repeatedly, care is taken to shield sensitive tissue.

spondylolisthesis

The anterior displacement of one vertebra on another; occurs most commonly at the lumbosacral joint.

facet

The articular surface of intervertebral joints. Facets are located on each of the four articular processes that extend superiorly and inferiorly from the vertebral arch.

lateral masses

The atlas consists of two ____ connected by an anterior arch and and a posterior arch.

body

The block-like anterior portion of a typical vertebra; consists of cancellous bone with a thin cortex.

spondylolysis

The breakdown of the structure of the bone; occurs with osteoporosis, metastatic lesions, and with other conditions that causes atrophy and bone destruction.

sacral base

The broad, flat superior surface of the sacrum.

spine

The central portion of the skeletal system; provides the supporting framework for the body; surrounds and protects the spinal cord.

bifid

The cervical spinous processes are ____, that is, they are split into two posterior projections, forming a shape somewhat like a fish tail.

vertebral notches

The concave superior and inferior surfaces of the pedicles.

sacral base angle

The degree of the sacral base anteriorly; is greatest in females; greater when standing and least when supine with knees flexed.

cervical, thoracic, lumbar, sacrum and coccyx

The different spinal regions.

thoracic spine

The dorsal spine, which consists of 12 vertebrae with a kyphotic curve; located inferior to the cervical spine.

sacrum

The five vertebral segments inferior to the lumbar vertebrae, which fuse together in adulthood to form a solid bony structure.

vertebral foramen

The hole in the ring of the vertebra body; provides passage for the spinal cord.

90 degrees

The intervertebral foramina (for the thoracic and lumbar vertebrae) lie at an angle of ____ to the sagittal plane and so are seen from the lateral perspective.

15 degrees

The intervertebral foramina of the cervical spine are also oriented inferiorly at an angle of ____ to the horizontal plane.

45 degress

The intervertebral foramina of the cervical spine are oriented anteriorly at an angle of ____ to the sagittal plane.

costal or costovertebral joints

The joints of the thoracic vertebrae that are facets and/or demifacets that articulate with the ribs.

OID

The lateral projection of the cervical spine results in a large ____. To minimize magnification and improve detail on this projection, a 72" SID is used.

structures seen on lateral lumbosacral junction lumbar spine

The lower one or two lumbar vertebrae, the upper sacrum, and an open lumbosacral junction.

C1-C2 and the lumbosacral junction

The most common areas for coned-down radiography.

coccyx

The most inferior section of the vertebral column, consisting of three to five vertebral segments; also called the tailbone.

cervical spine

The most superior section of the vertebral column; it consists of 7 vertebrae with a lordotic curve; supports the head and the structures of the neck.

pars interarticularis

The narrow segment of bone between the superior and inferior articular processes found on the lumbar vertebrae.

pedicle

The right and left anterior portions of the vertebral arch on either side of the vertebral body.

lamina (pl. laminae)

The right or left posterior portion of the vertebral arch.

sacroiliac joints

The sacrum articulates with the ilia of the pelvis on either side, forming the sacroiliac joints.

intervertebral foramina

The spaces formed by joining with the vertebral notches above and below which allow passage of spinal nerves and blood vessels.

spondyloschisis

The term for a congenital fissure (split or cleft) in the neural arch; ex. spina bifida occulta.

30 degrees to 60 degrees

The zygapophyseal joints of the lumbar spine lie at an angle of ____, open posteriorly, to the sagittal plane.

20 degrees

The zygapophyseal joints of the thoracic spine are aligned at an angle of ____ posterior to the coronal plane.

at the level between C4-C5

Thyroid cartilage

at the level between C6-C7

Top of shoulders

spondylitis

Tuberculous disease of the vertebrae; also called Pott disease; also seen with rheumatoid arthritis.

transverse processes

Two projections extending laterally from the junction of the pedicles and lamina.

coccygeal cornu(a)

Two small bony projections that extend superiorly from the posterior aspect on each side of the first coccygeal segment.

AP open-mouth or odontoid projection

Used to demonstrate the upper cervical vertebrae.

structures seen on AP axial (lower) cervical spine

Vertebrae C3 through T2, including bodies, articular pillars, and intervertebral disk spaces.

structures seen on lateral cervicothoracic (swimmer's technique) cervical spine

Vertebrae C6 through T3 (C5 through T5 with larger IR) in lateral projection without significant rotation. Bodies, disk spaces, spinous processes, and zygapophyseal joints are demonstrated between shoulders.

oblique projection

When radiographed in the ____, the lumbar vertebrae demonstrate a configuration that resembles a Scottie dog.

4

When viewed from the side, the spine has ____ curves.

alae

Winglike structures found on the lateral portions of the first sacral segment.

degenerative disk disease (DDD)

With advancing age and repeated minor traumas to the spine, the disks tend to degenerate. Without adequate cushioning, the joint becomes inflamed, and the surrounding bony structures show the characteristic signs of degeneration: sclerotic (hardened), irregular bone margins with hypertrophic lipping and spurring; usually associated with osteoarthritis.

lateral aspect

With exception of the C1-C2 articulation, the cervical zygapophyseal joints are best seen from the ____.

at the level between T10-T11

Xiphoid tip