Chapter 8

Where are the articular pillars located, and what is another name for this part of the cervical anatomy?

A short column of bone located between the superior and inferior articular processes. Also called lateral mass

What is a transitional vertebra?

A vertebra that takes on characteristics of the region above or below it - such as a rib on a cervical or thoracic vertebra

What is the first image take in a cervical spine series?

ALWAYS the lateral

What are the usual routine images for a t.spine?

AP, lateral, swimmers

How do you keep the chin away from the c.spine?

Adjust a line from the chewing surface of the teeth & back of skull | to IR

How should the patient breath for AP T.spine?

Expiration

Which vertebra has no body?

First cervical vertebra

What is the purpose of the articular processes?

Forms one of the joints between the vertebrae

What is the appearance of a Clay Shoveler's fracture

Fracture of spinous processes anywhere from C6 - T1

What should be done if a flexion - extension images are ordered on a patient on a back board in a c.collar?

STOP. - Do not attempt until after speaking with the physician. Cannot be done until the c.spine is cleared by a physician (no fracture)

What is the difference between the upper and lower thoracic vertebrae?

Size - the upper are much smaller than the lower thoracic vertebrae

What purpose does the intervertebral foramina serve?

Passage for spinal nerves and blood vessels

What forms most of the sides of the vertebral arch

Pedicles

The hangman's fracture occurs in which part of the cervical spine.

Pedicles of C2

What lies in place of the laminae and spinous process in C1

Posterior arch with posterior tubercle

What vertebrae part(s) border the vertebral foramen?

Posterior vertebral body & vertebral arch

What position would you place your patient in to demonstrate the left cervical intervertebral foramina?

RPO with a 45⁰ rotation

What 3 things have to be lined up for the lateral t.spine?

Shoulders, hips, and flexed knees

What is the purpose of the intervertebral foramina?

Spinal nerves are transmitted to and from the spinal cord through these.

What is the posterior extension of the vertebrae called?

Spinous process

Where does the spinal cord start? End?

Starts below the medulla oblongata ( goes through C1); ends at the lower border of L1

The inferior articular process of T10 articulates with what?

Superior articular process of T11

Where is the CR centered for an AP thoracic spine?

T7 - 3" to 4" below the jugular notch

The facets and partial facets on each side of the thoracic vertebral bodies articulate with the head of each rib, forming the ____joint

costovertebral

Normal appearance of the C1-C2 is symmetric, but rotation of the ______ can cause the appearance to imitate an injury

skull

How should the patient breath for lateral T.spine?

Breathing technique with long exposure time

Which image on the c.spine shows the zygapophyseal joints C-3 - C7?

Lateral

What forms the intervertebral foramina? How many are associated with each vertebra?

The vertebral notches, when the vertebrae are stacked. Two per vertebra, one on each side

which joint is NOT synovial?

Intervertebral joints

For a lateral c.spine with the light field opened portrait 10 x 12, where should the top of the light field be?

1 - 2" above the EAM (ear hole)

What are the joints of the spine? (3 types, describe each) Describe each

1. Intervertebral joints - between the vertebral bodies - location of the vertebral disks 2. Zygapophyseal - joints between the articular processes. Sometimes called facet joints, but facets are actually the articular surfaces of the articular processes 3. Costal joints - only in thoracic vertebrae, location where the posterior ribs articular with the vertebraa

What are the 3 unique characteristics of most cervical vertebrae?

1. Transverse foramina - 2. Bifid (double-pointed) spinous process tip 3. Overlapping vertebral bodies

For an AP axial c.spine, how is the x-ray tube angled?

15 - 20 degrees cephalad

If the patient is in the RPO position, for an oblique c.spine, how is the x-ray tube angled?

15 - 20 degrees cephalad

How many articular processes does each typical vertebra have?

4

The cervical intervertebral foramina are located at a ___ degree angle to the midsagittal plane, and a ___ degree inferior angle.

45, 15

How much must the body be rotated to visualize thoracic zygapophyseal joints?

70-75⁰ oblique from midsagittal plane

What is the SID for the routine cervical spine images?

72" - lateral, obliques 40" - AP, open mouth

The cervical zygapophyseal joints are located at a ____degree angle to the midsagittal plane.

90

What is the angle of the thoracic intervertebral foramina to the midsagittal plane, and what position demonstrates the intervertebral foramina?

90⁰ to midsagittal plane (right angles) Lateral

What is the mentomeatal line (MML)

A line from the tip of the chin (mentum) to the external auditory meatus (ear hole)

What are the two parts of the intervertebral discs and what are their characteristics?

Annulus fibrosis=outer portion, fibrous Nucleus pulposus=inner part, semi-soft gelatinous

In C 1, what lies in place of the cervical body

Anterior arch with an anterior tubercle

Where are the arms placed for a lateral t.spine?

At a 90 degree angle to the body

What is the large, oval part of each vertebra called?

Body

Rotation of the head primarily occurs between:

C1 & C2

If the patient is in a c-collar, so not allowed to tilt the head back for a Fuchs or Judd, how do we adjust the x-ray tube?

CR parallel to the MML

How many of each type of vertebrae are there? Cervical? Thoracic? Lumbar? Sacral? Coccyx? Include segments of sacrum and coccyx

Cervical=7 Thoracic=12 Lumbar=5 Sacral=5 segments in the 1 sacrum Coccyx=average of 4 segments in the 1 coccyx

What type of facture demonstrates a collapsed vertebral body?

Compression fracture

Which spinal curves are convex? Concave?

Concave=cervical, lumbar Convex=thoracic, sacral

What is the term for the termination of the spinal cord?

Conus Medullaris

What does the abbreviation HNP stand for, and what does this mean?

Herniated nucleus pulposus (slipped disk) - when the inner portion protrudes through the outer layer, pressing on spinal cord, causing pain & numbness.

How should the patient breath during a lateral cervical spine image?

Hold on expiration, shoulders relaxed

A crush fracture from landing on their head occurs in the arches of C1. What is the name of this fracture?

Jefferson fracture

Abnormal convex curvature of the thoracic spine

Kyphosis

What are the differences between Kyphosis, Lordosis, Scoliosis

Kyphosis=exaggerated thoracic curvature Lordosis=exaggerated lumbar curvature Scoliosis=exaggerated lateral curvature

What forms the posterior aspect of the vertebral arch

Lamina

In what position of the cervical spine are the zygapophyseal visible? What is the exception?

Lateral; Exception is between C1 & C2 (atlantoaxial joints) - visible only in the AP open mouth projection.

What is another term for the concave curves of the cervical and lumbar spine?

Lordotic

What is perpendicular to the IR for a Fuchs or Judd image for the dens?

MML

What can we use as a landmark to assure that the incisors are aligned with the back of the skull?

Mastoid tips

which joint is a troic or pivot joint

Medial atlantooccipital joint (between the odontoid process of C2 and the anterior arch of C1)

What characteristic of C1 makes it different than all other vertebra, and what is its other name?

No body, Also called the atlas

In what position of the cervical spine are the cervical intervertebral foramina visualized, how much is the patient rotated, and what is the tube angle?

Oblique, 45-degree rotation, 15 degree tube angle (NOTE: cephalad or caudad depends on the projection - it's not always a cephalad angle as noted on this page).

In what image is the intervertebral joints seen in the cervical spine?

Obliques

C1 articulates with the ________ condyles superiorly, and this is known as the _________ joint.

Occipital, Atlantooccipital

What are the 2 terms used to describe the process in the 2nd cervical vertebra, also known as the axis?

Odontoid process Dens

Where are the superior and inferior articular notches located?

On the upper and lower surfaces of each pedicle.

How should the patient breath during a lateral swimmer's image?

Orthostatic breathing (long exposure time, keep breathing)

What is another name for the wagging jaw method to blur out the mandible?

Ottonello method

What are the special PA and AP methods to image the dens if it's not seen well on the open mouth image?

PA - Judd AP - Fuchs

The long spinous process of the thoracic vertebra will superimpose what on the AP image?

The body of the vertebra below it

Where are the costotransverse joints located

The transverse processes of the FIRST 10 thoracic vertebrae only

Why do we need to angle the CR cephalad for the AP axial c.spine?

To open up the space between the overlapping cervical vertebrae

What do we need to do the AP open mouth image?

To see C1 and C2, the dens, and the C1-C2 Zygapophyseal joint

How is odontoid process of C2 held into place with C1?

Transverse atlantal ligament

What projects to the sides of the junction of each pedicle and lamina?

Transverse processes

What is another name for the 7th cervical spinous process, which can be palpated and used for positioning?

Vertebra prominens

To view the intervertebral spaces on the lower 4-5 cervical vertebra, does there need to be a tube angle? If so, how much and in which direction? Why?

Yes. 20⁰ cephalad. Lower 4-5 have a slightly lipped appearance.