Lesson 17: Skeletal - Flexion & Extension

Why preform a Lumbar flexion/extension?

-Determine if motion present in an area of spinal fusion -Help localize a herniated disk

Why preform Lumbar Spine Lateral Bending views?

-Done to evaluate the lumbar and lower thoracic intervertebral disks -Helps localize herniated disks -Indicates the presence of structural change when bending in scoliosis patients -Demonstrates motion in area of spinal fusion

What is shown on the Flexion / Extension cervical spine views?

-Shows the anterior and posterior movement vs. the absence of movement due to trauma or disease.

Lumbar Spine Lateral Side Bending - Patient Position

-Upright, standing -MSP perpendicular to the IR, no rotation Right bending: bend upper body to right, cross left leg over the right (pelvis is fulcrum) Left bending: bend upper body to left, cross right leg over the left

Lumbar Spine: Flexion/Extension - Patient Position

-Upright, standing -Place the patient in a true lateral position, MSP parallel with IR -No rotation. Weight equally distributed on both feet. ***Motion must occur in the lumbar vertebrae only! (Hold hips) Flexion: Curl forward, arching lower back WITHOUT "bending" at pelvis. Extension: Arch backward, using the lower back, pushing the chest forward - similar to performing a back dive.

Thoracic Spine Flexion/Extension - Patient Position

-Upright, standing or sitting -Patient is in a true lateral, MSP parallel to the IR -No rotation -Check for rotation at the hips and shoulders -Use FILTER over lung field (open through shoulder area and below diaphragm). ***Movement must occur in the thoracic area only! Flexion: Roll shoulders and upper thoracic area forward, arching the back like a cat. Extension: Roll and arch the shoulders back, pushing the chest forward.

Lumbar Spine Flexion/Extension Critique:

Arm superimposing spine

Lumbar Spine Flexion/Extension Critique:

Arm tissue close to superimposing

Lateral Flexion and Extension- Mayo vs Book

Book - 60-72" SID Mayo - 48" SID

Lumbar Spine Flexion/Extension Critique:

CR too superior otheriwise looks good!

Cervical Spine Flexion/Extension Critique:

CR: Too superior/posterior

Cervical Spine: Flexion / Extension

Cassette: 10x12 lengthwise Bucky: yes SID: 48" or 72"-120" where available Marker: Flexion-marker in upper posterior corner (behind head) arrow indicating direction of movement Extension- Left marker in upper anterior corner (front of face) arrow indicating direction of movement CR: thyroid cartilage (C4-C5) Measure: average technique on chart (base of the neck) Respiration: expiration to help depress shoulders and see all 7 vert.

Lumbar Spine: Flexion/ Extension:

Cassette: 14x17 Bucky: yes SID: 48" Marker: lower anterior margin, arrow indicating movement CR: along mid axillary line, 1" above crest Measure: L5 Respiration: suspended expiration

Thoracic Spine Flexion/Extension

Cassette: 14x17 lengthwise Bucky: yes SID: 48" Marker: lower anterior margin with an arrow pointing in the direction of movement CR: through the posterior ½ of the thorax at the T7 level-film ½ inch above C7 Measure: just inferior to the humeral head Respiration: shallow breathing

Lumbar Spine Lateral Side Bending

Cassette: 14x17 lengthwise Bucky: yes SID: 48" Marker: right bending, use left marker on upper left corner with arrow pointing rightleft bending, use right marker on upper right with arrow pointing left Tube Angle: none CR: along midsagital plane at iliac crest Measure: at xyphoid (thickest part) Respiration: suspended on expiration

Lumbar Spine Flexion/Extension Critique:

Clipped L1 CR too inferior

Cervical Spine Flexion/Extension Critique:

GOOD: -C1 throught the too of T1 visible -shoulders stable -CR is at C4-5

Lumbar Spine Flexion/Extension Critique:

Good!

Cervical Spine Flexion/Extension Critique:

Good: -Just barely got the top of T1

Lumbar Spine Flexion/Extension Critique:

Good: -L1 through part of sacrum -Foramen visible -Open intervertebral spaces

Cervical Spine Flexion/Extension Critique:

Good: -all necessary anatomy -no motion -good centering

Cervical Spine Flexion/Extension Critique:

Shoulders are not stabilized or the patient is very kyphotic

T or F: Flexion/Extension views cannot be done on TRAUMA patients.

True MUST be at least 10 days after trauma

T or F: Whatever mAs value was used on the lateral c-spine should be used for the flexion and extension views.

True Manually enter the mAs value

T or F: Use the same mAs value as the lateral lumbar spine for the flexion/extension views.

True manually enter mAs

T or F: Use the same mAs value as the thoracic lateral spine for the flexion/extension views.

True manually enter mAs

Cervical Spine: Flexion / Extension - Patient Position

Upright-standing or patient sitting up straight-no slouching -MSP parallel to the film -Relaxed shoulders (sandbags strapped to wrists). -Be certain that the motion is occurring through the cervical vertebrae ***Hold the shoulders stationary. Flexion: Patient should drop their chin to their chest Extension: Patient should tip their chin toward the ceiling