RAD 124 - L. Spine

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RAD 124 - L. Spine Powered By Docstoc
					  Chapter 8
Lumbar Spine

   RAD 124
                 Lumbar Spine

   5 lumbar vertebrae, 1 sacrum, 1 coccyx

   Typical lumbar vertebrae:
       Have no transverse foramen as cervical do
       Have no rib facets as thoracic do
                  Lumbar Spine

   Body
       Superior & inferior surfaces flattened or
        slightly concave to fit disc
       Anterior & lateral surfaces concave from top
        to bottom
       Posterior surface flattened
                  Lumbar Spine

   Transverse processes
       Superior 3 pair directed almost exactly
       Inferior 2 pair directed slightly superiorly

   Pedicles
       Directed posteriorly with superior & inferior
        vertebral notch to form ????
                  Lumbar Spine

   Laminae: thicker & longer than the
       Posteriorly lamina fuse to form the spinous
       Pars interarticularis: portion of lamina
        between the superior and inferior articular
                 Lumbar Spine

   Spinous process: large, thick & blunt
       Project posteriorly almost in a horizontal
       Tip corresponds to interspace below the
        vertebra that it projects from
       Used to evaluate positioning accuracy on AP
              Lumbar Spine

   Mamillary process: smoothly rounded
    projection found on the superior
    articulating process

   Accessory process: found at back of the
    root of the transverse process
                     Lumbar Spine

   Zygapophyseal joint: best demonstrated
    in oblique projection
       Incline posteriorly from coronal plane forming
        an average angle of 30-60 degree angle to
        the MSP of body
            Rotate upper L. spine 60 degrees from anatomical
             position and lower L. spine to 30 degrees
             specifically (45 degree obliques are acceptable)
       Zygapophyseal joints are essential for spine
                       Lumbar Spine
   Intervertebral foramina: opening in which spinal nerves
      Superior 4 pairs demonstrated in true lateral position
        Last pair requires a slight oblique projection
   Spondylolysis: acquired bony defect in pars interarticularis.
    This can result in
   Spondylolisthesis: defect of the pars seen with anterior
    displacement of one vertebra over another
      Best demonstrated on oblique views to demonstrate “neck
       area” (pars) of Scottie dog
           Almost always exclusively seen in lumbar spine – generally 5th
            lumbar over sacrum

   5 fused sacral segments: curved
    triangular bone wedged between iliac
    bone of pelvis
       Base is superior; apex is inferior
          Males: bone is longer, narrower, more curved and
           vertical in position
          Females: bone is more acutely angled with most of
           its curve in lower half of sacrum
                Also has sharper angle at the junction of the lumbar and
                 pelvis curves
   Lumbosacral junction: formed by superior
    base of sacrum to inferior L5 vertebra
       1st sacral segment resembles lumbar
       Last pair of intervertebral foramina formed by
        pedicles of 1st sacral segment and last lumbar
       Superior articular process of 1st sacral
        segment articulates with inferior articular
        process of last vertebra
   Sacral promontory: prominent ridge found
    at superior anterior margin of base of
   Sacral canal: found between anterior &
    posterior walls of sacral segments
       Is a continuation of the vertebral canal
   Pelvic sacral foramina: 4 pairs perforations
    for the passage of the sacral nerves

   Ala: large wing like lateral masses
   Auricular surface: articular process for
    auricular surface of iliac bones of the
   Apex: inferior portion of sacrum
   Sacral cornua: 2 processes that join with
    the coccygeal cornua
   3-5 vertebrae that fuse into 1
   Curves inferiorly and anteriorly
   Coccygeal cornua: project superiorly from 1st
    coccygeal segment to join sacral canal
   Topographical landmarks:
       L2-L3: lower costal margin
       L4-L5: iliac crest
       ASIS: midsacrum
       Symphysis pubis: coccyx
            Vertebral Articulations
   Intervertebral joints: cartilaginous-symphysis
   Zygapophyseal joints: synovial gliding joint
       Found between superior & inferior articular processes

       The combination of these two joints result in
        flexion, extension, lateral flexion and rotation.
          Vertebral Articulations
   Atlanto-occipital articulation: between atlas and
    occipital bone of skull is a synovial ellipsoidal
   Atlantoaxial joint: articulation of C1-C2 that
    allows rotation is a synovial gliding and a
    synovial pivot joint
   Costovertebral joint: between head of ribs with
    bodies of vertebrae are a synovial gliding joint
   Costotransverse joint: between tubercles of ribs
    and transverse processes of T.spine are synovial
    gliding joints
                 Lumbar Spine – 5 v
   AP
       14 x 17 (collimated to 10 x 17), portrait, marked on
        lateral side (inside collimation), respiration
        suspended, 40” Bucky
       Respiration: expiration
       Patient positioning: Upright when possible to
        eliminate curvature of spine
       Position of part: MSP centered to grid
       CR: Perpendicular 1 ½” above iliac crest (L3) at MSP
            (Some center at iliac crest, L4, for lumbosacral spine)
       Evaluation criteria:
              Lumbar Spine – 5 v
   AP Obliques for zygapophyseal joints (RPO,LPO)
       14 x 17 (collimated to 11 x 17), portrait, marked
        laterally on side down
       Respiration: expiration
       Patient position: supine or upright
       Position of part: 45 degree oblique to demonstrate
        joint closest to IR with long axis of patient parallel to
        long axis of table
       CR: 2” medial to elevated ASIS at the level of 1 ½”
        above the iliac crest
       Structures shown: Zygapophyseal joints of side
        closest to IR
              Lumbar Spine – 5 v

   AP Obliques for zygapophyseal joints
       Evaluation criteria:

          Pedicle anterior on vertebral body: Not enough
          Pedicle posterior on vertebral body: Too much
              Lumbar Spine – 5 v
   Lateral
       14 x 17 (collimated to 10 x 17), portrait,
        marked on anterior side 40” Bucky
       Respiration: suspended on expiration
       Patient position: Recumbent, but can be
       CR: Perpendicular to IR 1 ½” above iliac
        crest (L3) with midcoronal plane centered to
       Evaluation criteria:
              Lumbar Spine – 5 v
   L5-S1
       10 x 12, portrait, marked on anterior side, 40” Bucky
       Respiration: Suspended
       Patient position: Vertebral column parallel to IR,
        arms at right angles to body, sponge above iliac crest
        to keep spine horizontal with knees superimposed
        (pillow between knees to prevent rotation forward)
       CR: Coronal plane 2” posterior to elevated ASIS and
        at the level of 1 ½” inferior to iliac crest
       Evaluation criteria:
                 Sacroiliac Joints
   AP
       10 x 12, landscape, marked on lateral side 40” Bucky
       Respiration: suspended
       Patient position: supine
       Position of part: supine with MSP centered to IR, legs
        extended, no rotation to pelvis
       CR: 30-35 degrees cephalic with CR entering 1 ½”
        above symphysis pubis
       Evaluation criteria:
                 Sacroiliac Joints
   AP Obliques (RPO, LPO)
       10 x 12, portrait, marked “side up”, 40” Bucky
          LPO demonstrates right SI joint
          RPO demonstrates left SI joint

       Respiration: suspended
       Shield: when possible
       CR: Perpendicular to IR entering 1” medial to
        elevated ASIS, patient obliqued 25-30 degrees
       Evaluation criteria:
                   Sacrum & Coccyx
   AP
       10 x 12 for sacrum, 8 x 10 for coccyx, portrait,
        marked on lateral side, 40” Bucky
       Respiration: suspended
       Position of part: patient supine with MSP of body
        centered to IR, ASIS equidistant to IR, support under
       CR:
            Sacrum: 15 degrees cephalic, 2” superior to symphysis
            Coccyx: 10 degrees caudal, 2” superior to symphysis
              Sacrum & Coccyx
   AP
       Shield
          Women
          Men

       Evaluation criteria:
                Sacrum & Coccyx
   Lateral
       10 x 12, portrait, marked on lateral side, 40” Bucky
       Respiration: suspended
       Patient positioning: recumbent, knees & hips flexed
       Position of part: arms at right angles to body, knees
        superimposed with support, sponge above crest
       Use lead blocker behind patient to absorb scatter (Do
        not use blocker with CR)
                Sacrum & Coccyx

   Lateral
       CR:
          Sacrum: perpendicular to ASIS, 3 ½” posterior
          Coccyx: perpendicular, 2” inferior to ASIS & 3 ½”

       Shielding: when possible
       Evaluation criteria:
                 Scoliosis Series

   Scoliosis: abnormal lateral curvature of
    vertebral column caused by disease,
    trauma, or surgery; usually detected in

       Frequently is idiopathic
                  Scoliosis Series

   PA & Lateral view:
       14 x 36 folded film

          Cassette uses compensating filters
          Demonstrates amount and degree of curvature

          Evaluates fixation devices such as Harrington rods
                 Scoliosis Series

   Bending studies & Ferguson method:
    differentiates primary curve from
    compensatory curve
       Primary curves will not change with patient
       Secondary curves will
                Scoliosis Series

   Ferguson method: uses 2 images to
    include 1” iliac crest

       1st exposure: Normal upright position with CR
        at iliac crest
       2nd exposure: Elevate foot/hip of convex side
        3-4” (Do not support patient)
                 Scoliosis Series

   Bending studies:

       Demonstrate mobility of intervertebral joints

       Shows limitation of movement at the site of a
        disc problem

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