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Bontrager Ch 8

Cervical and thoracic spine

Define LORDOSIS exaggerated concavity of lumbar spine (p293)
Define KYPHOSIS abnormal convexity of thoracic spine curvature
Define SCOLIOSIS abnormal or exaggerated lateral curvature of the upper thoracic spine
How many vertebra are there? 33 vertebra in small child reduce to 26 in adult: 7 cervical, 12 thoracic, 5 lumbar, sacrum (5 fused) and coccyx (4 fused)
Name the primary spinal curvatures. THORACIC (convex posteriorly) and SACRAL (convex posteriorly)
Which vertebra are the strongest? LUMBAR
Name the secondary spinal curvatures. CERVICAL (concave posteriorly) and LUMBAR (concave posteriorly)
When do the primary curvatures develop? soon after birth
When do the secondary curvatures develop? Cervical develops as child learns to raise it's head and sit up, the lumbar curvature develops as the child learns to walk.
What is the common name for exaggerated lumbar curvature? Swayback (increased concavity)
What are the two main parts of a vertebra? The body and the arch
What is the name of the opening in an individual vertebra? What is the name of the contiguous opening in a stack of vertebra? vertebral foramen and vertebral canal
Define pedicle the bone that extends from the body of the vertebra to the transverse process.
define lamina (laminae) the bone that extends from the transverse process and unites in the midline. This bone is somewhat flat and completes the vertebral arch (encloses the vertebral foramen)
Define transverse process. The bone that extends laterally from the junction of each pedicle and lamina. there is one on each side of the vertebra.
Define spinous process The bone that extends posteriorly from the midline junction of the two laminae. It can often be palpated.
Define superior articular process Bone extensions on the right and left that articulate with the superior vertebra in the spinal column.
Define inferior articular process Bone extension on the right and left that articulate with the inferior vertebra in the spinal column
name the parts of a vertebra 2 pedicles and 2 laminae that form the vertebral foramen, 2 transverse processes, 1 spinous process and 4 articular processes that allow for important joints of the spinal column
Name the vertebral joints intervertebral joints, zygapohyseal joints, costal joints
Describe intervertebral joints amphiarthrodial joints found between vertebral bodies, cushioned by intervertebral disks
Describe zygapophyseal joints the joints created between vertebra at the articular processes
Describe facet in relation to the vertebra The articulating surface of the articular process. The entire joint is referred to as the zygapophyseal joint. Can also refer to the costal articulating surfaces for the ribs
Describe costal joints The articulation of the spinal column with the 24 thoracic ribs (12 per side).
Name the opening, or passageway, for the spinal cord. vertebral canal
List the number of bones found in each division of the adult vertebral column. cervical 7, thoracic 12, lumbar 5, sacral 1, coccyx 1
Which part of the spine demonstrates a posterior convex curvature? Thoracic and sacral
Which part of the spine demonstrates a posterior concave curvature? Cervical and lumbar
an abnormal lateral curvature seen in the thoracolumbar spine is called? scoliosis
The spinal cord begins with ________________ in the brain. The medulla oblongata
The spinal cord ends with a tapered ending called the ________. conus medullaris
Where does the spinal cord exit the vertebral column? lower border of L5
What structures pass through the intervertebral foramina? spinal nerves and blood vessels
name the cervical landmarks 1" below EAM (external acoustic meatus) C1 Mastoid tip (C1) head neutral gonion (jaw) (C3) thyroid cartilage prominent (C5) but can be C4-C6 vertebra prominens (C7 or T1)
Why should the shoulders be depressed during imaging of the cervical spine? to reduce or eliminate superimposition of the C7 by the shoulders
Name the atypical cervical vertebrae Atlas (C1) and Axis (C2) and vertebra prominens (C7)
List the characteristics of cervical vertebrae transverse foramina, bifid spinous process tips, overlapping vertebral bodies
describe the transverse processes of the cervical vertebrae they are small and have small openings called transverse foramen that allow vertebral arteries, veins and certain nerves to pass through
What is the articular pillar? It is the bone that forms the superior and inferior articular processes on each side of the vertebra. In C1, it is also called the lateral mass.
What is the lateral mass? In C1, it is the bone that forms the superior and inferior articular processes on each side of the vertebra. It is also called the articular pillar. It supports the weight of the skull and therefore is bulky and very solid.
Describe the cervical intervertebral foramina The intervertebral foramina are situated at a 45' angle to the MSP. (for imaging oblique is 45') they are also 15' inferiorly angled. (for imaging use a 15' cephalad angle)
What angle should you use to image the Cervical intervertebral foramina? 45' oblique and 15' cephalad
describe the atlas. C1 - anteriorly, no body, instead anterior arch including anterior tubercle. posteriorly, arch with small posterior tubercle midline, small transverse processes with foramina, articular pillars (lateral masses) Most bulky/solid support weight of head
Function of C1 articulates skull with vertebral column - 2 superior articular processes end in superior articular surface articulates w/occipital condyles. (atlantoccipital joints)
Describe the axis. C2 - demonstrates conical process (dens or odontoid process) that extends superiorly to articulate with C1 . blunt spinous bifid process
Function of C2 articulates with C1 to allow pivoting of the head via the Dens and the Superior articular processes. Dens is held in place by the transverse atlantal ligament.
What is the transverse atlantal ligament? holds the odontoid process of C2 in place inside C1
What is the atlantoaxial joint? 2 joints between C1 and C2 lateral (odontoid process with anterior arch) - plane joint, synovial, diarthrodial medial (between lateral masses and superior facets) - trochoid joint, synovial, diarthrodial
What is the atlantoccipital joint? an ellipsoid (condyloid) joint between the skull and C1, it's synovial and diarthrodial
What is the intervertebral joint? between C2-T12 they are cartilaginous (symphysis) and amphiarthrodial (slightly moveable)
What is zygapophyseal joint? between C2-T12 plane joints(gliding) that are synovial and diarthrodial between each vertebra
What is a costovertebral joint? between ribs and T1-T12 these are plane (gliding) joints that are synovial and diarthrodial
What are costotransverse joints? between rib tubercles and T1-T10 these are plane (gliding) joints that are synovial and diarthrodial
What is a key distinguishing feature of thoracic vertebrae? facets for articulation with ribs
What is a demifacet? a partial facet that articulates with a rib or rib tubercle, the other part of the facet is on the next vertebra
What is a costotransverse facet? located on T1-T10 articulates with the tubercles of ribs 1-10 via the costotransverse joints
What angle should you use to image the thoracic zygapophyseal joints? 70' - 75' oblique position and perpendicular beam
What angle should you use to image the thoracic intervertebral foramina? true lateral
What are the distinquishing features of the cervical vertebrae? Three foramina each; more dominant articular pillars
What are the distinquishing features of the C1 (atlas)? No body, but anterior and posterior arches; no spinous process but has a posterior tubercle with bifid tip; lateral masses (articular pillars); superior facets for occipitoatlantal articulations
What are the distinquishing features of the C2 (axis)? contains odontoid process (dens)
What are the distinquishing features of the C2-C6? short spinous processes with bifid tips
What are the distinquishing features of the thoracic vertebrae? Contain facets for rib articulations (facets, demifacets)
What are the distinquishing features of the T1-T10? Contain facets on transverse processes for rib articulations
What are the distinquishing features of the T1-T9? contain demifacets for rib articulation
What are the distinquishing features of the T10-T12? contain single facet for rib articulation
The joints between the ribs and vertebrae at the pedicle is called ______ . costovertebral joints (head of rib articulates with vertebra)
The joints between the ribs and vertebrae at the inferior articular facet are called _____ . Costotransverse joint (tubercle of rib articulates with vertebra)
Name the parts of the intervertebral disk. outer - annulus fibrosus inner - nucleus pulposus
What is the outer layer of the intervertebral disk called? What is it made of? annulus fibrosus it is made from a tough, fibrous cartilage
What is the inner layer of the intervertebral disk called? What is it made of? nucleus pulposus It is made from soft, semi-gelatinous cartilage.
What is it called when the soft inner portion of the intervertebral disk protrudes through the annulus fibrosus and puts pressure on the spinal cord? (HNP) herniated nucleus pulposus - most often occurs in L4/L5 area but can occur in the cervical spine as well
What is the purpose of the intervertebral disks? They are tightly bound to the vertebrae for stability, but allow for flexibility and movement of the entire vertebral column.
Which of the following is found between the superior surface and inferior articular processes? A. intervertebral joints B. Articular joints C. Zygapophyseal joints D. Intervertebral facets C. zygapophseal joints
True/False Only T11 and T12 have full facets for articulation with ribs. FALSE T1, T10 to T12 have full facets
True/False The zygapophyseal joints of all cervical vertebrae are visualized only in a true lateral position. FALSE Between C1 and C2 visualized on a frontal or AP projection
What characteristics make the cervical vertebrae unique? transverse foramina (total of 3 foramina) bifid spinous processes overlapping vertebral bodies (joints of Luschka)
A short column of bone found between the superior and articular processes in a typical cervical vertebra is called ______ . articular pillar
What is the term for the short column of bone found between the superior and articular processes in C1? lateral mass
The zygapophyseal joints for the 2nd - 7th vertebrae are at a _____ angle to the mid-sagittal plane. 90'
The zygapophyseal joints for the thoracic vertebrae are at a _____ angle to the mid-sagittal plane. 70 - 75'
What is the name of the joint found between the superior articular processes of C1 and the occipital condyles of the skull? atlanto-occipital articulation
The modified body of C2 is called _____ or _____. odontoid process dens
What positioning error creates a lack of symmetry of the zygapophyseal joints between C1 and C2? What else can cause this lack of symmetry? rotation of the skull injury
What unique feature of all thoracic vertebrae distiguishes them from other vertebrae? facets/demifacets that allow articulation with ribs
Which vertebrae are typical thoracic vertebrae? T5 - T8
For the central ray to pass through and open the intervertebral spaces on a 45' posterior oblique projection of the cervical vertebrae, what CR angle (if any) is needed? 15' cephalad
What is the gonion? a cephalometric positioning landmark located at the lowest, posterior, and lateral point on the angle. This site is at the apex of the maximum curvature of the mandible, where the ascending ramus becomes the body of the mandible.
What level is the gonion? C3
What level is the xiphoid process? T9-T10
What level is the thyroid cartilage? C4-C6
What level is the jugular notch? T2-T3
What level is the sternal angle? T4-T5
What level is the mastoid tip? C1
What is the mastoid tip? a positioning landmark on the skull located posterior and inferior to the EAM.
What is the level of the vertebra prominens? C7 - T1
What is 3 - 4 inches below the jugular notch? T7
What are the major radiosensitive organs of greatest concern during cervical and thoracic spine radiography? Gonads, Thyroid, parathyroid and mammary glands
True/False When using digital imaging for spine radiography, it is important to use close collimation, grids, and lead masking. True
To ensure that the intervertebral joint spaces are open for lateral thoracic spine projections, it is important to: A. keep the vertebral column parallel to IR B. Use a small focal spot C. Use a breathing technique D. Angle the central ray caudad A. Keep the vertebral column parallel to IR
For lateral and oblique projections of cervical spine, need to minimize magnification/maximize detail. How? A. keeping vertebral column parallel to IR B. Using small focal spot C. Increasing SID D. Using breathing technique B. Using small focal spot C. Increasing SID
Which aspect of the vertebrae visualize well in lateral cervical spine image? zyagapophyseal joints
Which aspect of the vertebrae visualize well in oblique cervical spine image? intervertebral foramina
What is visualized with CR 15' cephalad - upside cervical spine? LPO - right foramina RPO - left foramina
What is visualized with CR 15' cephalad - downside cervical spine? LAO - left foramina RAO - right foramina
What is visualized with CR 90' lateral cervical spine? zygapophyseal joints
What is necessary to visualize zygapophyseal joints for thoracic spine? 70' oblique
Name the topographic landmarks for cervical spine imaging. mastoid process or tip (C1) 1' inferior to EAM (C1) Gonion - (C3) (head must be neutral position) Thyroid cartilage - (C4 - C6) Vertebra prominens - (C7/T1)
Name the topographic landmarks for thoracic spinal imaging T1 - vertebra prominens T2/T3 - Jugular notch (suprasternal) T4/T5 - Sternal angle (2" below notch) T7 - inferior angle of scapula or 3-4" below notch) T9 /T10 - xiphoid process (xiphoid tip, ensiform process)
Why do Cervical Spine imaging erect versus recumbent? better demonstrates alignment/ligament stability permits natural curvature of spine and easier to depress shoulders and use 72" SID
Avulsion fracture of the spinous process of C7 Clay shoveler's fracture
Inflammation of the vertebrae Spondylitis
Abnormal or exaggerated convex curvature of the thoracic spine Kyphosis
Abnormal lateral curvature of the spine scoliosis
What is a subluxation? partial dislocation
What is unilateral subluxation? Only one zygapophyseal joint is out of alignment - radiographically visible as "bowtie"
impact fracture from axial loading of the anterior and posterior arch of C1 Jefferson fracture
comminuted fracture of the vertebral body w/posterior fragments displaced into the spinal canal Teardrop burst fracture
Fracture through pedicles and anterior arch of C2 with forward displacement on C3 Hangman's fracture
A form of rheumatoid arthritis Ankylosing spondylitis
Mild form of scoliosis and kyphosis developing during adolescence Scheuermann Disease
Which two landmarks must be aligned for an AP "open mouth" projection? The lower margin of the upper incisors and the base of the skull
What is the purpose of the 15 - 20' cephalad angle for AP axial cervical spine? To open the intervertebral joint spaces
What are two important benefits of using an SID 60 - 72" for the lateral cervical spine projection? compensates for increased OID, reduces magnification and less divergence of x-ray beam reduces shoulder superimposition of C7
True/False The tip of the odontoid process does not have to be demonstrated on the AP "open mouth" projection because it is best seen on the lateral projection. FALSE
What CR angulation must be used (amount and direction) must be used with a posterior oblique projection of the cervical spine? 15-20' cephalad to C4
True/False Less CR angle is required for the AP axial projection of the cervical spine if the examination is performed supine rather than erect. TRUE
Which foramina are demonstrated with a LPO position of the cervical spine? right intervertebral foramina
Which foramina are demonstrated with a LAO position of the cervical spine? left intervertebral foramina
In addition to extending the chin, what additional positioning techniques can be performed to ensure that the mandible is not superimposed over the upper cervical vertebrae for oblique projections? rotate the skull into a near lateral position
The lateral cervical spine projection should be taken during _____ (inspiration, expiration, suspended respiration) and why? expiration to allow maximum depression of the shoulders
What is the technical term for the swimmer's position? cervicothoracic lateral position
Where should the CR be placed for a cervicothoracic lateral position? T1, 1" above the jugular notch
Which specific projection must be taken first if trauma to the cervical spine is suspected and the patient is in a supine position on a backboard? lateral - horizontal beam projection
Which region of the spine must be demonstrated with a cervicothoracic lateral position? C5 - T3
Which of the following projections is considered a functional study of the cervical spine? A) AP "wagging jaw" projection B) AP "open mouth" projection C) Fuchs/Judd methods D) Hyperextension/hyperflexion lateral position D) Hyperextension/hyperflexion lateral position
When do you perform a Fuchs or Judd method? When you don't clearly visualize the entire dens (especially the tip) in the AP "open mouth" projection.
Which Z joints are demonstrated in a RAO t-spine image? right (downside)
Which Z joints are best demonstrated in LPO t-spine image? Right side
How much rotation of the body is required for an oblique position of the thoracic spine from a true lateral? 20' from lateral, 70' from plane of IR
At which vertebral level does the solid spinal cord terminate? lower border of L1 (conus medullaris terminates, beginning of cauda equina)
how many segments make up the sacrum in the neonate? 5
Which of the following divisions of the spine is described as possessing a primary curve? A. Thoracic B. Cervical C. Lumbar D. Sacral A. Thoracic D. Sacral
True/False The lumbar possesses a concave posterior spinal curvature. TRUE
An abnormal or exaggerated thoracic spinal curvature with increased convexity is called _____. Kyphosis
An abnormal or exaggerated lateral spinal curvature is called _____. scoliosis
What is the correct term for condition involving a "slipped disk"? HNP - Herniated nucleus pulposus
The superiro and inferiro vertebral notches create which foramina? intervertebral foramina
Which joints are found between the superior and articular processes? zygapophyseal joints
Which of the following structures make up the inner aspect of the intervertebral disk? A. Annulus fibrosus B. Nucleus pulposus C. annulus pulposus D. Nucleus fibrosus B. Nucleus pulposus
True/False The carotid artery and certeain nerves pass through the cervical transverse foramina. FALSE (vertebral artery and vein)
True/False The thoracic spine possesses facets for rib articulations and bifid spinous processes. FALSE (C-spine possesses bifid spinous processes)
The intervertebral foramina for the cervical spine lie at a _____ degree angle to the MSP. 45'
Which ligament holds the dens against the anterior arch of C1? transverse atlantal ligament
The large joint space between C1 and C2 is called the _____. atlantoaxial joint
Two partial facets found on the thoracic vertebrae are called _____. demifacets
Which of the following thoracic vertebrae do not possess a facet for the costotransverse joint? A. T1 B. T7 C. T11 D T12 C. T11 D T12
What are 3 distinctive features of all cervical vertebrae? transverse foramina overlapping vertebral bodies bifid spinous processes
What is the one feature of thoracic vertebrae that makes them different from all other vertebrae? facets and demifacets for rib articulation
Which position of the lateral spine best demonstrates the intervertebral foramina? lateral
Which position or projection of C-Spine best demonstrates the Z joints between C3-C7? lateral c-spine
Which specific joint spaces are visualized with a LAO projection of the thoracic spine? Left z-joints (downside)
Which of the following imaging modalities is NOT normally performed to rule out HNP? A. Computed tomography (CT) B. Myelography C. Magnetic Resonance Imaging (MRI) D. nuclear medicine D. nuclear medicine
An avulsion fracture of the spinous processes of C6 - T1 is called? Clay shoveler's fracture
Scheuermann's disease is a form of _____. Scoliosis and/or kyphosis (adolescents)
True/False HNP most frequently develops at the L2/L3 vertebral level. FALSE (most common L4/L5)
Which two things can be done to minimize the effects of scatter radiation on lateral projections of the thoracic and lumbar spine? Lead masking grids
Which position or projection best demonstrates the Z joints between C1 and C2? AP Open Mouth
How much and which direction (caudad or cephalad) should CR be angled for AP axial C-spine? erect 20' cephalad, supine 15' cephalad
How much and which direction (caudad or cephalad) should CR be angled for anterior oblique C-spine? 15-20' caudad (less thyroid dose)
How much and which direction (caudad or cephalad) should CR be angled for posterior oblique C-spine? 15-20' cephalad
Which of the following positions best demonstrates the left cervical intervertebral foramen? A) LPO B) LAO C) Lateral projection D) RAO B. LAO
In addition to using a long SID, list two positioning techniques you can use to lower the shoulders to visualize C7-T1 for a lateral projection of the C-spine? suspend respiration on full expiration patient hold 5-10lb sandbags tell patient to take 2 deep breaths and relax
Which position or projection demonstrates the lower cervical and upper thoracic spine (C4 - T3) in a lateral perspective? (no trauma) cervicothoracic lateral (swimmer's)
List two projections that will project the dens in the center of the foramen magnum. AP Fuchs and PA Judd
Which of the following technical factors is most important in producing high quality CR image? A. Decrease SID whenever possible B. Minimize the use of grids C. Decrease kV as much as possible D. Collimate as closely as possible D. Collimate as closely as possible
Which of the following imaging modalities is recommended for a teardrop burst fracture? A. CT B. MRI C. Nuclear medicine D. sonography A. CT
Created by: Larobbins