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Vertebral Column
| Question | Answer |
|---|---|
| Functions of the vertebral column | Encloses and protects the spinal cord Supports the trunk Supports the skull Provides attachment muscles of back and ribs. |
| The vertebral column is held together by: | ligaments |
| In childhood the vertebral column consists of how many bones | 33 Cervical Thoracic Lumbar Sacrum (separated/5 sacral segments) Coccyx (separated/ 3-5 segments usually 4) |
| True or movable vertebrae consist of: | Cervical Thoracic lumbar |
| False or fixed vertebrae: | Sacrum coccyx |
| anterior/posterior curves of the spine: | Lordotic - Cervical & Lumbar – convexed anteriorly Kyphotic – thoracic and pelvic – concaved anteriorly |
| Lumbosacral angle: | Obtuse angle formed by the junction of the lumbar and pelvic curves Steeper curve for females |
| Primary curves: | Present at birth Thoracic and Pelvic |
| Secondary or compensatory curves: | Develop after birth Cervical and Lumbar |
| Cervical curve develops at what stage of life: | Usually 3 to 4 months old Infant begins to hold head up |
| Lumbar curve develops at what stage of life: | 1 to 1 ½ years of age When child begins to walk |
| A slight lateral curvature is sometimes present in the thoracic region and is considered normal: which way will it curve? | To the right in a right handed person To the left in a left handed person |
| Two main parts of a Typical vertebra | Body – anterior mass Vertebral arch – ring-like portion enclosing the vertebral foramen |
| Vertebral canal | Formed by the stacked vertebral foramina of the vertebral arches |
| Intervertebral disks: | Separates the vertebral bodies and form ¼ of the length of the spine |
| Nucleus Pulposis | Central mass of the intervertebral disks |
| Anulus fibrosus | Fibrocartilaginous disk that surrounds the nucleus pulposis |
| The vertebral arch of the typical vertebra is formed by: | 2 pedicles 2 laminae 2 transverse processes 1 spinous process |
| Pedicles | Short, thick processes that project posteriorly from the superior and lateral parts of the posterior surface of the vertebral body. Vertebral notches |
| Vertebral notches | Concaved Notches in the superior and inferior surfaces of the pedicles |
| Intervertebral foramen | Opening for the transmission of spinal nerves and blood vessels. Formed by the vertebral notches (superior of one and inferior of another) |
| Lamina | Flat, broad projections extending posteriorly and medially from the pedicles |
| Transverse Processes | Processes that project laterally at the junction of the laminae and the pedicles |
| Spinous process | Process that projects posteriorly and inferiorly from the junction of the laminae Posterior midline |
| Articular Processes | 2 superior and 2 inferior process arising from the junction of the pedicles and laminae |
| Superior articular process | Superior portion of the articular process Has an articular facet on the posterior surface for articulation of the inferior articular process of the vertebra above |
| Inferior articular process | Inferior portion of the articular process Has articular facet on the anterior surface for articulation with the superior articular process of the vertebrae below |
| Zygapophyseal joints | Joint formed by the superior and inferior articular processes of adjacent vertebra |
| Which vertebra are considered typical cervical vertebra? | C3-C6 C& has the typical structures with the exception of the vertebral prominens |
| What is the Atlas? | C1 |
| What is the Axis? | C2 |
| Describe the Atlas | Ringlike short spinous process Anterior arch Posterior arch 2 lateral masses2 transverse processes |
| How do the transverse processes of the atlas differ from the rest of the cervical vertebra? | Longer than the others. They projects laterally and slightly inferiorly from the lateral masses |
| Where are the articular processes of C1? | On the lateral masses. Superior is horizontal, large and concaved to receive the occipital condyles Inferior articulates with the superior articular process of C2 |
| What is the atlantal ligament? | Extends across the ring of the atlas dividing into anterior and posterior portions. Holds dens anteriorly |
| What is the Dens | Odontoid Process Strong Conical process extending superiorly into the anterior portion of the of the atlas Serves as body or pivot of atlas |
| Superior articular process of C2 | On each side of the dens Articulate with the inferior articular processes of the Atlas |
| Vertebral Prominens | 7th cervical vertebra Similar to typical cervical vertebra except it has a long prominent spinous process the projects almost horizontally. Palpable land mark Level with C7/T1 Interspace |
| Which vertebra are considered typical cervical vertebra? | C3 thru C6 |
| Transverse processes of typical cervical vertebra | Arise from the body and arch Short/wide Have transverse foramina for arties and veins |
| The spinous processes of the typical cervical vertebra | Short Double pointed (Bifid) Directed posteriorly and slightly inferiorly Tip is at the level of the interspace below from the body they arise from |
| Articular Pillars | Short thick columns formed by the junction of the superior and inferior articular process where the pedicles and laminae unite |
| Zygapophyseal Joints of C2-C7 | Articulation of superior and inferior process Between the articular pillars Lie at right angles to the midsagittal plane Demonstrated on a lateral projection |
| Intervertebral foramen | Formed by the superior and inferior notches Directed anteriorly at a 45 degree angle from the MSP and 15 degrees inferiorly Demonstrated on AP or PA Oblique Projection of the cervical spine. |
| Thoracic Vertebral Bodies | Increase in size from 1 to 12 Superior resemble cervical bodies Inferior resemble lumbar bodies |
| Typical thoracic vertebra | T3-T9 Bodies are triangular and deeper posteriorly than anteriorly Posterior bodies have concaved surface Have costal facets for head of ribs (costovertebral joints) |
| Transverse processes of thoracic vertebrae | Project obliquely, laterally, posteriorly Has facet for articulation with rib tubercle (not 11/12) – costotransverse joints |
| Thoracic spinous processes | 5 to 9 project inferiorly sharply and overlap (Less vertical above and below 5-9) 5th-9th spinous process corresponds in position to the interspace below the vertebrae from origination |
| Zygapophyseal joints of Thoracic vertebrae: | (not T12/L1) Angle anteriorly 15 to 20 degrees and form angle of 70-75 degrees to the MSP Demonstrated on AP/PA oblique |
| Thoracic Intervertebral Foramen | Perpendicular to the MSP Demonstrated on Lateral Projection |
| Why do the arms need to be raise to right angles from the body for lateral projection | To elevate the ribs above the intervertebral foramen |
| Lumbar vertebral bodies | Bean-shaped Increase in size form 1st to 5th |
| Spinous processes of lumbar vertebra | Large, thick, blunt and directed posteriorly at almost horizontal plane Tips align with interspace below from which it arises |
| Mammillary process | Smooth rounded projection on the back of each superior articular process on Lumbar vertebra |
| Accessory process | Process at the back of the root of the transverse process on lumbar vertebra |
| Pars Interarticularis | Part of the lamina of the lumbar vertebrae between the superior and inferior articular processes |
| Zygapophyseal Joints of the Lumbar Vertebra | Form an angle of 30 to 60 degrees to the MSP Angle increases from L1-L5 Average 45 degrees |
| Demonstrating lumbar zygapophyseal joints radiographically | 45 degree AP Oblique projection demonstrates most average patients 25% L1-2 seen on AP Some L4/5 seen on lateral |
| Intervertebral Foramen of the lumbar spine | Situated at right angles to the MSP (except for 5th, turns anteriorly) Demonstrated on lateral projection |
| How does the first sacral segment differ from the others? | Resembles lumbar vertebra Contains sacral base and sacral promontory Has superior articular process to form zygapophyseal joint with L5 |
| Atlantooccipital Joint | Ellipsoidal/freely movable Junction of atlas and occipital condyles |
| Antlantoaxial Joint | Dens and atlas- pivot/freely movable Lateral masses of C1 and Axis – gliding/freely movable |
| Intervertebral Joints | Cartilaginous/symphysis/slightly movable |
| Zygapophyseal Joints | Gliding/freely movable |
| Costovertebral Joints | Gliding/freely movable Head of the rib and facets of the vertebral bodies |
| Costotransverse Joints | Gliding/Freely movable Facets on transverse processes and tubercles of ribs 1-10 |
| Ankylosing spondylitis | Rheumatoid arthritis variant involving the sacroiliac joints and spine |
| Clay Shoveler's Fracture | Avulsion fracture of the spinous process in the lower cervical and upper thoracic region |
| Compression Fracture | Fracture that causes compaction of bone and a decrease in length or width |
| Hangman's Fracture | Fracture of the anterior arch of C2 owing to hyperextension |
| Jefferson Fracture | Comminuted fracture of the ring of C1 |
| Herniated nucleus pulposus | Rupture or prolapse of the nucleus pulposus into the spinal canal |
| Kyphosis | Abnormally increased convexity in the thoracic curvature |
| Lordosis | Abnormally increased concavity of the cervical and lumbar spine |
| Scheuermann Disease | Adolescent kyphosis Kyphosis with onset in adolescence |
| Spina Bifida | Failure of the posterior encasement of the spinal cord to close |
| Spondylolisthesis | Forward displacement of a vertebra over a lower vertebra, usually L5-S1 |
| Spondylolysis | Breaking down of the vertebra at the pars interaticularis leading to spondylothisthesis |
| The vertebral column articulates with the hip bone at the: | sacroiliac joint |
| How many vertebrae make up the vertebral column? | 33 In adults Usually 26 vertebra In early life it consists of @33 small bones divided into 5 groups Cervical (superior) – 7 (disks in between) Thoracic – 12 (disks – in between) Lumbar – 5 (wide) (disk in between) Sacral - 5 (fused) |
| How many vertebrae are there in the sacrum? | 5 |
| When viewed from the side, the vertebral column presents how many curves? | 4 |
| Which of the following vertebral areas have a lordotic curve? 1) cervical 2) thoracic 3) lumbar | 1 and 3 |
| An abnormal increase in the curve of the thoracic spine is termed: | kyphosis |
| An abnormally increased curve of the lumbar spine is termed: | lordosis |
| An abnormal lateral curvature of the spine is termed: | scoliosis |
| The articulations between the articular processes of the vertebral arches are called the: | zygapophyseal joints |
| The short, thick processes that project posteriorly on each side of a vertebral body are called the: | pedicles |
| Spinal nerves and blood vessels exit the spinal column through the: | intervertebral foramina |
| Which vertebral process projects posteriorly from the junction of the laminae? | Spinous process |
| The condition in which an intervertebral disk "slips" and protrudes into the vertebral canal is called: | herniated nucleus pulposus (HNP) |
| The first cervical vertebra is called the: | atlas |
| The "vertebra prominens" is the name given to the: | 7th cervical vertebra |
| The openings in the cervical vertebrae for the transmission of the vertebral artery and vein are called the: | transverse foramen |
| The intervertebral foramina of the cervical spine open: | 45º anteriorly and 15º inferiorly |
| The zygapophyseal joints of the cervical spine are clearly demonstrated on which projection? | lateral |
| How many thoracic vertebrae have a small concave facet on the transverse process, for articulation with the tubercle of a rib? | 10 |
| The zygapophyseal joints of the thoracic spine form an angle of how many degrees with the midsagittal plane | 70º-75º |
| How much is the body rotated from the lateral position to demonstrate the zygapophyseal joints of the thoracic region? | 15º-20º |
| The intervertebral foramina of the thoracic spine are clearly demonstrated on which projection? | lateral |
| The condition of the lumbar spine in which there is anterior displacement of one vertebra over another is termed: | spondylolisthesis |
| Where should the center of the IR be positioned for the "open mouth" AP projection of the atlas and axis | second cervical vertebra |
| Which of the following lines must be perpendicular to the IR for the AP "open mouth" atlas and axis? | a line drawn from the lower edge of the upper incisors to the tip of the mastoid process (Occlusal Plane |
| For which projection is the patient instructed to softly phonate "ah" during the exposure? | AP "open mouth" atlas and axis This will place the tongue in the floor of the mouth so that it is not superimposing the atlas and axis |
| Where is the CR directed for an "open mouth" AP projection of the atlas and axis? | perpendicular through the open mouth |
| Which of the following methods is used to demonstrate the dens within the foramen magnum? | fuchs |
| Where is the center of the IR positioned for the AP projection of the dens, Fuchs method? | tip of the mastoid process |
| What is the CR angulation for the AP projection of the dens, Fuchs method? | 0º |
| What line is placed perpendicular to the tabletop for the AP axial cervical vertebrae? | a line drawn from the lower edge of the upper incisors to the tip of the mastoid process |
| Where is the IR centered for an AP axial cervical spine? | fourth cervical vertebra |
| The CR angle for an AP axial cervical vertebrae is: | 15º-20º cephalad |
| The SID for a lateral cervical spine must be a minimum of how many inches? | 60-72 inches |
| The respiration phase for a lateral cervical spine is: | Suspended on full expiration |
| The Grandy method is _______projection of the ______: | lateral projection of the cervical vertebrae |
| Where is the CR centered for a hyperflexion or hyperextension lateral cervical spine? | fourth cervical vertebra |
| The intervertebral foramina of the cervical spine are demonstrated on which of the following projections? | AP Axial Oblique (RPO and LPO Or the PA Axial Oblique (RAO and LAO) |
| What is the CR angle for the AP axial oblique projection of the cervical intervertebral foramina? | 15º-20º cephalad |
| Which intervertebral foramina are demonstrated on an AP axial oblique projection of the cervical spine | those farthest from the IR |
| What is the recommended SID for the AP axial oblique projection of the cervical spine? | 60-72 inches |
| How much is the body rotated for a PA axial oblique projection of the cervical intervertebral foramina? | 45º |
| What is the name of the most anterior portion of a thoracic vertebra? | body |
| The brain and the spinal cord make up which part of the nervous system? | central |
| The natural curvature of the lumbar spine is classified as what type? | Concave (posteriorly) |
| Which vertebrae have demifacets for the articulation of ribs? | Thoracic The thoracic vertebrae articulate with the ribs at the facets |
| What is another name for the first cervical vertebrae? | atlas |
| Which position/projection is necessary to demonstrate the intervertebral foramina of the cervical spine? | 45 degree oblique with a 15 degree tube angle (Cephalic for RPO/LPO & Caudal for RAO /LAO |
| Which vertebrae has no body? | First cervical Remember: the dens or odontoid process of c2 sits in the ring of C1. The ring-like structure of C1 has no body. |
| What is the purpose of having the patient flex his knees for an AP projection of the lumbar spine? | Better visualization of disk spaces |
| How much should the patient be obliqued from the lateral position in order to demonstrate the zygapophyseal joints of the thoracic spine? | 20 degrees |
| What is the posterior, bony ring of a typical vertebrae called? | Vertebral arch |
| Which of the following positions/projections would be required to demonstrate the mobility of the cervical spine? | Lateral Projection in Flexion and extension laterals |
| What is the forward slipping of a vertebrae called? | Spondylolisthesis |
| Spina bifida is caused by: | Posterior laminae not fusing |
| What is the recommended SID for the AP/PA Axial Oblique projections of the C-spine? | 72” |
| Which of the following projections will best demonstrate the transverse processes of the lumbar vertebrae? | AP |
| The manubrial notch is at approximately the same level as the: | T2-T3 interspace T5 is at the sternal angle L3 is at the costal margin |
| The pars interarticularis is represented by what part of the “scotty dog” seen in a correctly positioned oblique lumbar spine? | neck |
| What position/projection best demonstrates the intervertebral foramina of the lumbar spine? | lateral |
| The apophyseal articulations of the thoracic spine are demonstrated with the : | Coronal plane 70 degrees to the IR |
| Which position/projectionswill provide an AP projection of the L5-S1 interspace? | Patient AP with 30-35 degree angle cephalad |
| In the posterior oblique of the cervical spine, the intervertebral foramina that are best seen are those: | Furthest from the IR |
| To demonstrate the first two cervical vertebrae in the AP Projection, the patient is positioned so that: | A line between the maxillary occlusal plane and the mastoid tip is vertical and the CR isperpendicular through the open mouth |
| Which of the following will demonstrate the lumbosacral apophyseal articulation? | AP Oblique Projection: 30 degree RPO and LPO |
| Which method utilizes a "chewing motion" of the mandible to demonstrate the cervical spine in an AP projection? | Ottonello |
| What is the CR angulation for the lateral projection of the cervicothoracic region (Swimmers method) when the shoulder can be depressed? | 0 degrees |
| The CR angulation for the lateral projection of the cervicothoracic region when the shoulders cannot be separated: | 3º-5º caudad |
| Ideally, the cathode end of an x-ray tube should be positioned to take advantage of the "heel effect" of the tube. Where should the cathode be placed for an AP thoracic spine? | toward the feet |
| Where should the arms be placed for a lateral projection of the thoracic spine? | at right angles to the long axis of the body This will aid in elevating the ribs to clear the intervertebral foramina |
| If support is not placed under the lower thoracic vertebrae for a lateral projection, the central ray may have to be angled. What is the degree of angulation that would be required? | 10º-15º cephalad |
| If a lead rubber sheet is not placed on the table when performing a lateral projection of the thoracic spine, the image may be: | Underexposed |
| Which respiration phase should be used for the lateral projection of the thoracic spine? | Breathing Technique or Suspended at expiration |
| The phase of respiration for an AP projection of the lumbar spine is: | expiration |
| Where is the CR directed for an AP lumbosacral spine? | iliac crests |
| Which plane is placed perpendicular to the tabletop and centered to the midline of the grid for a lateral lumbar spine? | midcoronal plane |
| If the lumbar spine cannot be adjusted so it is horizontal for the lateral projection, the central ray should be angled: | 5º-8º-caudad |
| Where should CR location be for Lateral L5/S1? | 2 inches posterior to the ASIS and 1½ inches below the iliac crest |
| What is the CR centering point for an AP oblique lumbar spine? | 2 inches medial to the elevated ASIS and 1½ inches above the iliac crest |
| How does the first sacral segment differ from the others? | Resembles lumbar vertebra Contains sacral base and sacral promontory Has superior articular process to form zygapophyseal joint with L5 |
| Pelvic Sacral Foramina | Four pairs of openings throughout the sacrum for transmission of nerves and blood vessels |
| Ala of the Sacrum | Wing-like masses of the sacrum |
| Auricular surface of sacrum | Superoanterior surface for articulation with the pelvis |
| Sacral Apex | Inferior portion of the sacrum |
| Sacral cornu | 2 processes that project inferiorly from posterolateral aspect of the last sacral segment to join coccygeal cornu |
| How are the legs positioned for the AP Axial (sacrum, coccyx, and SI joints) | Patient is supine with legs EXTENDED |
| CR angle and location for AP Axial Sacrum | 15 degrees cephalic 2” superior to the pubic symphysis |
| CR angle and location for AP Axial coccyx? | 10 degrees cadual 2” superior to the Pubic Symphysis |
| CR angle and location for AP Axial L5/S1 (Ferguson Method) | 30 (male) to 35 (female) degrees cephalic 1 ½” superior to the pubic symphysis |
| How can the spine be supported to lateral when the patient has a smaller waist than hips? | Place radiolucent support under the waist when in lateral position |
| What can be done to limit the amount of scatter that reaches the IR when performing the lateral sacrum and coccyx (other than the grid) | Lead masking posteriorly on the table |
| CR location for the lateral sacrum? | 3 ½” posterior to ASIS |
| CR location for lateral coccyx? | 3 1/2” Posterior to ASIS and 2” inferior to ASIS |
| IR size and direction for lateral Sacrum? | 10x12 LW |
Created by:
rcervantes3