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L-SpineSacrumCoccyx
| Question | Answer |
|---|---|
| Number of lumbar vertebrae and sacral vertebrae | 5 lumbar, 5 sacral |
| body and vertebral arch | - body (anterior) - vertebral arch (posterior) - formed by 2 pedicles and 2 laminae |
| pedicles project from where? | posterior aspect of the body |
| laminae project from where? | posteriorly and medially from pedicles |
| spinous processes project from where? | posteriorly from junction of lamine |
| transverse process project from where? | laterally from junction of laminae and pedicles |
| pedicle is concave to form what? | vertebral notches |
| articulation of vertebral notches forms what? | intervertebral foramina? |
| how many articular processes arise from junction of pedicles and laminae? | two superior, two inferior |
| zygapophyseal joints are from vertebrae articulating where? | above and below |
| vertebral disks composed of | annulus fibrosus - outer, fibrocartilaginous disk nucleus pulposus - central, soft mass |
| vertebral column sections and curves | cervical - lordosis (convex anteriorly) thoracic - kyphosis (concave anteriorly) lumbar - lordosis sacral - kyphosis |
| what is the pars interarticularis? | part of lamina between articular processes |
| sacrum articulations with hip bones are called | sacroiliac joints |
| sacrum is formed by | fusion of five segments into curved, triangular bone |
| anatomical features of sacrum | promontory - articular surface with lumbar 5 foramina - just be able to locate cornu - two small, horn-like bony projections extending downward from the posterior surface of the sacrum |
| pars articularis is visible where? | in posterior |
| coccyx is formed by | fusion of 3-5 rudimentary vertebrae |
| coccyx curves... | inferiorly and anteriorly from articulation with sacrum |
| cornu of coccyx | a horn-like bony projection located on the first segment of the coccyx (tailbone) |
| transverse process of coccyx | small, rudimentary bony projections extending from the lateral sides of the coccygeal vertebrae |
| for L-spine, oblique views show what joints, and lateral views show what joints? | oblique - zygapophyseal lateral - intervertebral |
| joints of the vertebral column 1 of 2: intervertebral - tissue, type, movement | tissue - cartilaginous type - symphysis movement - slightly movable |
| joints of the vertebral column 2 of 2: zygapophyseal - tissue, type, movement | tissue - synovial type - gliding movement - freely movable |
| intervertabral joints are between | two vertebral bodies |
| zygapophyseal joints are between | articular processes of the vertebral arches |
| xiphoid tip location (re: lumbar spine topographic landmarks) | T9-10 |
| lower costal margin location (re: lumbar spine topographic landmarks) | L2-3 |
| iliac crest location (re: lumbar spine topographic landmarks) | L4-5 |
| ASIS location (re: lumbar spine topographic landmarks) | S1-2 |
| AP lumbar spine | - supine - legs flexed to reduce lumbar lordosis - CR centered to iliac crest (L4-L5) - Include T-12-S1 - demonstrates lumbar vertebral bodies, disc spaces, transverse processes |
| for lumbrosacral exams, the CR enters at iliac crests (L4), but for lumbar only, the CR enters where? | 1.5" above iliac crests (L3) |
| evaluation criteria for AP or PA L-spine | - T12-S1 included - no rotation - spinous processes centered to the bodies - SI joints equidistant from vertebral columns - collimation includes SI joints - psoas muscles |
| Lateral L-spine | - knees flexed, arms forward - use sponge under waist to support spine - CR centered to L3 (level of lower costal margin) - include T-12-S1 |
| lateral L-spine demonstrates what? | intervertebral foramina |
| For lateral L-spine, if the spine is not horizontal, then do what? | angle 5-8 degrees |
| evaluation criteria for lateral L spine | - lower thoracic spine to coccyx - intervertebral joint spaces open - intervertebral foramina open - superimposed crests - spinous processes visible in profile |
| L5-S1 spot view | - patient in true lateral - shoulders and pelvis in same vertical plane - use sponge under waist to support spine - 5-8 degree caudad angle - centered 1-2 inches posterior to ASIS |
| Lateral L5-S1 CR | When spine is horizontal, CR is perpendicular to a coronal plane, 2 inches posterior to ASIS and 1½ inches inferior to iliac crest If not, angle 5 degrees caudad for males, 8 degrees caudad for females |
| evaluation criteria for Lateral L5-S1 | - L5 and S1 demonstrated and centered - L5-S1 intervertebral space open - ilia superimposing |
| oblique lumbar spine | - projections - RPO / LPO, RAO / LAO - patient rotated 45 degrees, shoulders and pelvis rotated together - MSP obliqued to show zygapophyseal joints - include T-12 through S1 |
| Evaluation Criteria: Posterior Oblique L-Spine (RPO/LPO) | L1 to S1 demonstrated Z-joints visualized closest to the IR pedicle near center of vertebral body |
| re: Posterior Oblique L-Spine (RPO/LPO): When the joint is not well seen, and the pedicle is anterior on the vertebral body, the patient is ... | not rotated enough |
| re: Posterior Oblique L-Spine (RPO/LPO): When the joint is not well seen, and the pedicle is posterior on the vertebral body, the patient... | rotated too much |
| the "scottie dog" is visible in which view | AP oblique L-spine |
| ferguson method | - AP axial L5-S1 - patient prone with pelvis not rotated - CR 30-35 degree caudad, centered to level of ASIS |
| Evaluation Criteria: AP Axial L5-S1 | - lumbosacral junction and sacrum - open intervertebral disk space between L5 and S1 - both sacroiliac joints |
| AP Axial SI joints vs. Ferguson | AP Axial demonstrates both sacroiliac joints Ferguson demonstrates the L5-S1 intervertebral disk space |
| AP Axial SI joints shot | - patient supine on table - IR placed lengthwise - 30-35 degree cephalad, centered to the level of the ASIS - include SI joints, sacrum, ilia |
| AP oblique SI joints | - supine, then rotated to an oblique position - patient rotated 25-30 degrees into a posterior oblique - CR centered 1 inch medial to the ASIS of the elevated side |
| Posterior Oblique SI joints | - elevate affected side 25 - 30 degrees - CR perpendicular to 1" medial to upside ASIS |
| Evaluation Criteria: Posterior Oblique SI Joints | - Sacroiliac joint of interest open - Ala of ilium not overlapped over sacrum |
| AP Axial sacrum | - 15 degree cephalad, centered 2" above pubic symphysis |
| evaluation criteria: AP Axial sacrum | - sacrum not foreshortened - sacral foramina visualized |
| AP axial coccyx | - 10 degree caudad angle, centered 2" above pubic symphysis |
| Evaluation Criteria: AP Axial Coccyx | coccyx free of superimposition coccyx free of gas and feces |
| lateral sacrum and coccyx | - use sponge under waist to support pelvis - IR centered to sacrum and coccyx - CR centered 3-4 inches posterior to ASIS - use a lead blocker |
| ferguson method: scoliosis series | - 2 IRs used - elevate convex side |
| Evaluation Criteria: Scoliosis Ferguson Method | - Thoracolumbar spine demonstrated - 1" iliac crest centered |
| Lumbar spine - AP right and left bending | maximum lateral flexion spinal fusion |
| LATERAL SPINAL FUSION SERIES: HYPERFLEXION AND HYPEREXTENSION | Pelvis as fulcrum |
| S p o n d y l o l y s i s | acquired bony defect occuring in the pars articularis (neck on scottie dog) |
| S p o n d y l o l i s t h e s i s – B i l a t e ra l S p o n d y l o l y s i s | anterior displacement of one vertebrae over another, generally the fifth lumbar over the sacrum |
| if you see pars articularis / scottie dog, think... | pars form the NECK of the scottie dog |
| if you see SI joints closest to IR | AP obliques demonstrate downside joint |
| scotty dog "broken neck," equals | pars defect (spondylolysis) |
| RPO/LPO shows ... | side closest to IR |
| RAO / LAO shows... | side farthest from IR |
| lower costal margin is at the level of | L3 |
| waist support opens... | disk spaces |
| end expiration reduces ... | motion and patient thickness |
| lateral L spine must show... | T12-S1 |
| if L5-S1 is closed on lateral... | do a spot |
| spot view indicates the CR is... | parallel to disk, ~5-8 caudad |
| Ferguson method equals .... | PA axial L5-S1 |
| 30-35 caudad + ASIS equals | Ferguson method |
| same angle as AP axial SI -- what direction? | opposite direction |
| Si joints slope in what direction | posteriorly |
| 30-35 degree cephalad opens both SI joints | just repeat the question to memorize it |
| unilateral SI joint means what shot? | oblique |
| AP oblique shows side | closest to IR |
| sacrum is shot at what angle? | 15 degrees cephalad |
| coccys is shot at what angle? | 10 degrees caudad |
| a PA shot for sacrum coccyx means you do what to the angle? | reverse it |
| 30-35 degree caudad, think... | ferguson |
| 30-35 degree cephalad, think... | AP axial SI |
| ASIS mentioned, think... | SI joints or L5-S1 |
| pars / scottie dog mentioned, think... | lumbar obliques |
Created by:
user-1998695