Chapter 8: Vertebral Column (lumbar, sacrum, and coccyx)
lower spine
A radiolucent support should be placed under where for a lateral L-spine?
PA (AP) upright, lateral upright, PA (AP) with lateral bending, and PA (AP) recumbent
A typical scoliosis exam may include what 4 projections?
ASIS
At what level should the IR be centered for an AP oblique SI joint?
intervertebral disk spaces
Beside the intervertebral foramina, what else should be open for a lateral?
ischia and ilia
For a lateral sacrum/coccyx, the posterior margins of what should be nearly superimposed?
under rotated
For the AP oblique L-spine, if the joint is not open and pedicle is anterior on body, the patient is (over rotated / under rotated)?
over rotated
For the AP oblique L-spine, if the joint is not open and the pedicle is posterior on lthe body, the patient is (over rotated / under rotated)?
3-4"
For the scoliosis PA thoracolumbar (ferguson) the first radiograph is taken like a PA and the second Pa is taken with the patients convex side elevated how much?
crossed
How are the arms positioned for an AP L-spine?
45 degree posterior oblique
How is the spine positioned for an ap oblique L-spine?
5
How many lumbar vertebrae are there?
5
How many sacral segments make up the sacrum?
1"
How much of the iliac crests need to be included on a soliosis radiograph?
30-35 degrees cephalically
How should the CR be abled for an AP Axial ferguson?
15 degrees cephalic
How should the CR be angled for an AP Axial sacrum?
10 degrees caudal
How should the CR be angled for an AP axial coccyx?
5-8 degrees caudally
How should the CR be angled if the spine is not horizontal for a lateral L-spine?
5-8 degrees caudally
How should the CR be angled if the spine is not horizontal for a lateral L5-S1?
perpendicular
How should the MCP be in relation to the IR for a lateral of L5-S1?
90 degrees with elbows flexed
How should the arms be positioned for a lateral L-spine?
90 degrees with flexed elbows
How should the arms be positioned for a lateral L5-S1?
extended
How should the hips be positioned for a lateral L5-S1?
flexed
How should the hips/knees be positioned for a lateral sacrum/coccyx?
flexed and superimposed
How should the knees be positioned for a lateral L-spine?
superimposed and slightly flexed
How should the knees be positioned for a lateral L5-S1?
extended
How should the legs be positioned for the AP axial ferguson?
males
In general for the L-spine (when angling) use less of an angle for (males / females)
females
In general for the L-spine (when angling) use more of an angle for (males / females)
posterior margins, iliac crests
No rotation has occured on the lateral L-spine when the ___ ____ of the vertebral bodies are superimposed and the ___ ____ are nearly superimposed.
primary and compensatory
Scoliosis bending studies are used to differentiate between what two types of curves?
fixation devices
Scoliosis radiography can also be used to evaluate what? (besides curvature)
L5
Spondylolysis commonly occurs on which lumbar vertabra?
35 degrees caudad
The AP axial projection of the SI joints may alos be performed with the patient in prone position with what CR angle?
closer to
The AP oblique L-spine shows the zygapophyseal joints (farther from / closer to) the IR?
zygapophyseal joints
The AP oblique L-spines show what?
farther from
The AP obliques of the SI joints demonstrate the SI joint (farther from / closer to) the IR?
perpendicualar, on MCP at iliac crests (L4)
The CR for a lateral L-spine should be ____ entering the patient where?
perpendicular, 1.5" above iliac crests
The CR for an AP L-spine should be _____, entering where?
1.5"
The CR for an AP oblique L-spine enteres L3 which is how many inches above the iliac crests?
perpendicular, 2" medial to elevated ASIS at L3
The CR for an AP oblique L-spine should be ______ and entering the patient where?
perpendicular, 1" medial to elevated ASIS
The CR for an oblique SI joint should be ______, entering where?
L1
The cauda equina is at what level?
3 to 5
The coccyx is formed by the fusion of how many rudimentary vertebrae?
intervertebral foramina
The lateral L-spine shows what?
lateral recumbent
The lateral projection of L5-S1 should be done in what patient position?
hips and knees
The lordosis of the L-spine can be reduced for an AP by flexing what?
transverse processes
The lumbar are unique because their _____ _____ are smaller than the T-spine's.
mamillary process
The lumbar vertebrae have a _____ _____ which is a smoothly rounded projection on the back of each superior articular process.
accessory process
The lumbar vertebrae have an ____ _____ which is at the back fo the root of the transverse process.
posterior abdominal
The lumbar vertebrae occupy the ____ ____ region.
MCP
The patient is in a true lateral position for the lateral L-spine when what line/plane is vertical?
sacral nerves
The sacral canal is contained within the bone and transmits what?
coccygeal coruna
The sacral coruna project inferiorly to join what?
4 pairs
The sacrum has how many of pelvic sacral formaina?
ilium
The sacrum is wedged between which pelvic bones?
scoliosis
The upright position for L-spine is prefered to check for what?
1" posterior to elevated ASIS and tip of coccyx
To shield for a lateral sacrum/coccyx, place the shield anteriorly of the lane that connects where?
lower T-spine to sacrum
What all should be included on an AP L-spine?
SI joints
What are demonstrated on the AP obliques of the SI joints?
spinous processes
What are in profile on a lateral L-spine?
AP, 2 AP obliques, lateral, and lateral L5-S1
What are the 5 essential projections of the L-spine?
coccygeal coruna
What are the hornlike processes that project off the coccyx called?
pelvic sacral foramina
What are the perforations on the anterior and posterior walls of the sacrum that allow for passage of the sacral nerves and blood vessels?
AP axial and 2 AP obliques
What are the three essential projections for the SI joints?
AP axial and lateral
What are the two essential projections for both the sacrum and coccyx?
sacral coruna
What are the two processes that project inferiorly from the posterolateral aspect of the last segral segment called?
25-30 degree posterior oblique position
What body position should the patient be in for an AP obique SI joints?
Sacrum
What bone is formed by the fusion of five segments into a curved, trianglar bone?
lead
What can be used in a lateral L-spine to help reduce scatter?
scoliosis radiography
What demonstrates the amount/degree of curvature that occurs with the force of gravity acting on the body?
Jefferson
What is a comminuted fracture of the ring of C1?
Osteoarthritis or degenerative joint disease
What is a form of arthritis marked b progressive carilage deterioration in synovial joints and vertebrae?
Hangman's
What is a fracture of the anterior arch of C2 owing to hyperextention?
Compression
What is a fracture that causes commpaction of bone and a decrease in length or width?
multiple myeloma
What is a malignant neoplasm of plasma cells involving the bone marrow and causing destruction of bone?
Herniated nucleus pulposus
What is a rupture or prolapse of the nucleus pulposus into the spinal canal?
metastases
What is a transfer of a cancerous lesion from one area to another?
pars interarticularis
What is a unique feature of the lumbar vertebrae defined as part of the lamina between the superior and inferior articular processes?
lordosis
What is abnormally increased concavity in the cervical and lumbar spine?
kyphosis
What is abnormally increased convexity in the thoracic vertebrae?
Clay shoveler's
What is an avulsion fracture of the spinous process in the lower cervical and upper thoracic region?
Harrington rod
What is an example of a fixation device?
subluxation
What is an incomplete or partial dislocation?
MSP
What is centered to the midline for an AP L-spine?
spina bifida
What is failure of the posterior encasement of the spinal cord to close?
spondylolisthesis
What is forward displacement of a vertebra over a lower vertabra, usually L5-S1?
osteopetrosis
What is increased density of atypically soft bone?
Scheuermann disease or adolescent kyphosis
What is kyphosis with onset in adolescence?
scoliosis
What is lateral deviation of the spine with possibe vertebral rotation?
osteoporosis
What is loss of bone density?
ankylosing spondylitis
What is reheumatoid arthritis variant involving the SI joints and spine?
lamina
What is the body of the scottie dog?
spondylolysis
What is the breaking down of the vertebra?
sacral canal
What is the continuation of the vertebral canal located directly behind the bodies of the sacral segments?
superior articular process
What is the ear of the Scottie dog?
pedicle
What is the eye of the scottie dog?
inferior articular process
What is the foot of the scottie dog?
upright
What is the general patient position for most scoliosis exams?
auricular surface
What is the large articular process at the superoanterior part of the lateral surface of each sacal ala called?
sacral ala
What is the large, winglike lateral mass located on each side of the sacral base called?
sacroiliac joints (SI)
What is the name of the joint formed by the articulation of the sacrum and pelvis?
Francis
What is the name of the method that suggests an alternatve CR aligned with the interiliac plane for the lateral L5-S1?
Ferguson
What is the name of the method used for the AP axial SI joint?
pars interarticularis
What is the neck of the scottie dog?
transverse process
What is the nose of the Scottie dog?
supine
What is the patient position for the SI joints?
lateral recumbent
What is the patient position for the lateral sacrum/coccyx?
sacral promontory
What is the prominent ridge at the base of the sacrum on the superior anterior margin?
suspended at end of expiration
What is the respiration used for the AP L-spine?
cauda equina
What is the terminal end of the spinal cord and nerves called?
36", 60-72"
What is the usual size of the IRs used in scoliosis radiography? The SID?
paget disease
What is thick, soft bone marked by bowing and fractures?
interiliac plane
What line/plane should be perpendicular to the IR for a lateral sacrum/coccyx?
recumbent
What patient position is prefered for all of the L-spine images except the AP?
supine or prone
What patient positions can be used for an AP axial sacrum & coccyx?
psoas muscles
What set of abdominal muscles should you collimate to for a AP L-spine?
SI joints
What should be equidistant from the spine on an AP L-Spine?
L5 and upper sacrum
What should be included for a lateral L5-S1?
LS junction and sacrum
What should be included for an AP axial ferguson?
lower thoracic to coccyx
What should be included on a lateral L-spine?
spinous processes
What should be located in the center of the vertebral bodies for an AP L-spine image?
L5-S1 intervertebral space
What should be open for an AP axial ferguson?
intervertebral joints
What should be open on the AP L-spine?
SI joints
What should be penetrated for an AP axial ferguson?
shoulders and hips
What should lie at the same horizontal plane for an AP L-spine?
8x17
What should you collimate down to for an AP L-spine?
8x17"
What should you collimate to for a lateral L-spine?
6x8
What should you collimate to for a lateral L5-S1?
6x10
What should you collimate to for an AP oblique SI joint?
6x6
What should you collimate to for coccyx projections?
10x12
What should you collimate to for the sacrum projections?
synovial ellipsoidal
What type of articulation is formed between the atlas and occipital bone?
short-scale
What type of contrast is needed for the sacrum and coccyx projections?
synovial pivot
What type of joint is formed by atlas and axis?
cartilaginous symphysis joints
What type of joints are the intervertebral joints?
synovial gliding joints
What type of joints are the zygapophyseal joints?
S1-S2
What vertebrae lies at the level of the ASIS?
L4-L5
What vertebrae lies at the level of the iliac crest?
L2-L3
What vertebrae lies at the level of the inferior costal margin?
coccyx
What vertebrae lies at the level of the pubic symphysis?
trauma
When is it okay to leave the collimater open over the entire abdomen for an AP L-spine?
perpendicular, 2" posterior to ASIS and 1.5" inferior to iliac crest
When the spine is horizontal, the CR for a lateral L5-SI should be ______, entering where?
1.5" above pubic symphysis
Where does the CR enter for an AP axial ferguson?
3.5" posterior and 2" inferior to ASIS
Where should the CR enter for a lateral coccyx?
3.5" posterior and 1" inferior to ASIS
Where should the CR enter for a lateral sacrum/coccyx?
3.5" posterior and at the level of ASIS
Where should the CR enter for a lateral sacrum?
MSP at 2" superior to pubic symphysis
Where should the CR enter for the AP axial for both the sacrum and coccyx?
MSP at sacral curve
Where should the CR enter for the PA axial for both the sacrum and coccyx?
coccyx
Which bone curves inferioly and anteriorly from the articulation with the sacrum?
T12-L1 and L1-L2
Which intervertebral joint spaces are open for the AP oblique L-spine?
L5-S1 intervertebral joint
Which joint should be open for a lateral L5-S1?
Ferguson
Who specified that elevation must be sufficient to require patient to expend effort to maintain their position for a PA thoracolumbar?
