Cervical and Thoracic Spine Lab Notes

• Laboratory notes on the Cervical and Thoracic Spine

AP Open Mouth - C1 to C2

• Radiographic projection to visualize C1 and C2 vertebrae.
• Key visible structures include the odontoid process, upper incisor, lateral mass (C1), atlantoaxial joint (C1-C2), and body (C2).

AP Axial - 15° Cephalad Angle

• Radiographic projection with a 15° to 20° cephalad angle.
• Central ray (CR) is set at a 15° angle, parallel to the plane of intervertebral disk spaces, centered to C4.
• Key visible structures include the vertebral bodies of C3 and C4, the spinous process of C5, the pedicle of C7, and the intervertebral disk space (C6-C7).

Erect Left Lateral Cervical Spine

• Radiographic projection with the patient erect.
• Key visualized structures include the odontoid process (C2), posterior arch (C1), spinous process (C2), zygapophyseal joint (C4-5), intervertebral joint (C6-7), and articular pillar (C7).

Left Lateral Cervical Spine - Horizontal Beam

• Radiographic projection with a horizontal beam.
• Key structures include the odontoid process-dens (C2), intervertebral joint space (C6-C7), body of C7, zygapophyseal joint (C4-C5), and vertebra prominens (C7).

AP Thoracic Spine

• Radiographic projection of the thoracic spine.
• Key visible structures include the 1st rib, left clavicle, bodies of T8 and T12, and the posterior rib (T9).

Left Lateral Thoracic Spine

• Radiographic projection with proper waist support.
• Key visible structures include the intervertebral joints and foramina (R and L), and the thoracic vertebral bodies.

AP Lumbar Projection

• A PA projection is an alternate view.
• Key visible structures include the transverse process (L1), spinous process (L2), intervertebral joint (L3-4), right sacroiliac joint, and ala (wing) of the sacrum.
• The projection uses a 35 x 43-cm IR, that is centered.

Left Lateral Lumbar Spine

• The central ray (CR) is perpendicular to the Image Receptor (IR).
• Key visible structures include the pedicles (L2), intervertebral foramina (L2-L3), intervertebral joint (L3-L4), body (L4), articular processes (L5-S1), sacrum, and greater sciatic notches.

Left Lateral L5-S1

• Radiographic projection with sufficient support at 0°.
• Key visible structures include the body (L5), lumbosacral joint (L5-S1), promontory of sacrum and greater sciatic notches.

Lateral Sternum

• Key visible structures include the manubrium, sternal angle, body, and xiphoid process.

Jefferson Fracture

• This is a comminuted fracture typically caused by axial loading.
• The anterior and posterior arches of C1 are fractured as the skull slams onto the ring.
• Can be diagnosed with AP open-mouth and lateral cervical spine projections.

Herniated Nucleus Pulposus (HNP)

• This occurs when the inner part (nucleus pulposus) of an intervertebral disc protrudes.
• The protrusion goes through the fibrous cartilage outer layer (annulus) and into the spinal canal.
• The protrusion may press on the spinal cord or spinal nerves, leading to severe pain and possible numbness into the extremities
• It can be visualized via a T2-weighted imaging (T2-WI) right paramedian sagittal image, plain lateral X-ray, or a three-dimensional CT scan.

Hangman's Fracture

• This fracture extends through the pedicles of C2, with or without subluxation of C2 on C3.
• It happens when the neck undergoes extreme hyperextension.
• The patient, if alive, is not stable because the intact odontoid process is pressed posteriorly against the brainstem.

Facets - Unilateral Subluxation and Bilateral Locks

• Zygapophyseal joints in the cervical region are disrupted during trauma.
• Only one zygapophyseal joint may be out of alignment in flexion, distraction, and rotation injuries.
• This results in unilateral subluxation.

Compression Fracture

• Frequently associated with osteoporosis.
• Involves collapse of a vertebral body.
• Occurs with flexion or axial loading most often in the thoracic or lumbar regions.
• Results from severe kyphosis caused by other diseases.

Ankylosing Spondylitis

• A systemic illness of unknown origin that involves the spine and larger joints.
• Predominantly impacts men aged 20 to 40.
• It results in pain and stiffness from inflammation of the sacroiliac, intervertebral, and costovertebral joints.
• Causes paraspinal calcification, with ossification and ankylosis (union of bones) of the spinal joints.

Clay Shoveler's Fracture

• Results from hyperflexion of the neck.
• Avulsion fractures occur on the spinous processes of C6 through T1.