Spinal Anatomy Overview

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Questions and Answers

Which of the following statements accurately describes the primary and secondary curves of the spine?

Kyphosis is a secondary curve located in the thoracic spine.

Lordosis is a primary curve found in the sacral spine.

Kyphosis refers to curves in the cervical and lumbar regions.

Lordosis is a secondary curve located in the cervical and lumbar spine. (correct)

What anatomical feature distinguishes the cervical vertebrae from other vertebrae?

Presence of rib facets.

Transverse foramen that transmits the vertebral artery. (correct)

Bifid spinous process exclusive to lumbar vertebrae.

Large size of the vertebral body.

Which of the following statements about the atlas (C1) is correct?

C1 has an odontoid process (dens) extending superiorly.

C1 connects directly to the thoracic vertebrae.

C1 contains superior articular facets that articulate with the occipital condyles. (correct)

C1 has a large vertebral body and spinous process.

Which of the following structures is part of the vertebral anatomy located posteriorly?

Vertebral arch. Signup and view all the answers

What is the primary function of the sacral foramina?

To allow passage of nerves. Signup and view all the answers

Which type of joint is the atlantoaxial joint primarily composed of?

Synovial joint. Signup and view all the answers

Which characteristic is typical of lumbar vertebrae compared to thoracic vertebrae?

Large vertebral bodies and small vertebral foramen. Signup and view all the answers

What is the significance of the sacral promontory?

It marks the border between abdominal and pelvic cavities. Signup and view all the answers

Which projection is NOT typically included in a C-spine series?

Lateral (standing) Signup and view all the answers

What is the primary distinction in imaging requested by chiropractors compared to routine spinal imaging?

Every imaging must be performed erect. Signup and view all the answers

During patient preparation, what misconception might patients have regarding X-ray projections?

They will only have one X-ray for the whole spine. Signup and view all the answers

Which of the following is a feature of the T-spine series?

AP, Lateral Signup and view all the answers

What is included in the collimation for an AP/PA lumbar spine view requested by chiropractors?

Acetabulum and greater trochanters Signup and view all the answers

What might widening of the pedicles indicate during an examination?

A burst fracture Signup and view all the answers

Which of the following is NOT recommended to be removed from the patient before an L-spine radiograph?

Loose clothing Signup and view all the answers

What is the correct arm position for a recumbent patient during this procedure?

Arms raised, elbows flexed, and hands in front of the face Signup and view all the answers

In which position should the patient’s shoulders and hips be during the procedure?

Not rotated at all Signup and view all the answers

When assessing lateral views of the spine, which factor is NOT considered important?

Condition of soft tissues Signup and view all the answers

In patient preparation for the SC-spine examination, which of the following is NOT necessary?

Checking the patient's medical history Signup and view all the answers

What is the correct body orientation for an erect patient?

Standing sideways with shoulder touching the vertical bucky Signup and view all the answers

How should the central ray be aligned during this procedure?

Aligned perpendicular to the midsagittal plane Signup and view all the answers

Which of the following structures would NOT typically be visible in an AP sacroiliac joint radiograph?

Transverse processes Signup and view all the answers

When ensuring the pelvis is lateral, which statement is accurate?

Pelvis should not be directed in any way Signup and view all the answers

What is a key requirement when a patient is in the erect position?

Patient's shoulder must touch the vertical bucky Signup and view all the answers

What might happen if the patient is tilted during the procedure?

It could affect the accuracy of the image Signup and view all the answers

In the erect position, how should the arms be positioned?

Raised with elbows flexed and placed on the head Signup and view all the answers

Which item should be removed from a patient prior to a C-spine radiograph?

Bracelet Signup and view all the answers

What is the center point for an AP C-spine radiograph?

C4 Signup and view all the answers

Why should clothing with buttons or zippers be removed before a T-spine radiograph?

They can create artifacts on the image. Signup and view all the answers

Which projection is specifically used to visualize C1 and C2?

AP open mouth Signup and view all the answers

What is the appropriate tube angulation for a lateral C-spine radiograph?

0 degrees Signup and view all the answers

What is the primary purpose of a gown in T-spine preparations?

To provide a clear imaging field. Signup and view all the answers

Which respiratory pattern is recommended for obtaining C-spine images?

Suspended respiration on inspiration Signup and view all the answers

In a lateral C-spine view, what does the intervertebral disc space appearance indicate?

Correct alignment Signup and view all the answers

What is a potential issue that occurs if there is no motion artifact in the exposure time?

Inadequate exposure Signup and view all the answers

When demonstrating C3 to T2 in an AP C-spine view, which anatomy should be visualized?

C3-T2 vertebrae Signup and view all the answers

What is the ideal SID for C-spine imaging?

110 cm Signup and view all the answers

Which physical representation is encouraged to maintain during an oblique C-spine view?

45-degree rotation Signup and view all the answers

In the AP open mouth projection, what should be visible for a proper image?

Odontoid process Signup and view all the answers

What is the guideline for hair accessories during a T-spine radiograph?

They should be removed. Signup and view all the answers

Study Notes

Spinal Anatomy

Kyphosis: A primary spinal curve, present in the thoracic and sacral regions.
Lordosis: A secondary spinal curve, present in the cervical and lumbar regions.
The spine consists of 33 vertebrae: 7 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 4 coccygeal.

Cervical Vertebrae

Transverse Foramen: Present in the transverse processes of all cervical vertebrae except C7. It transmits the vertebral artery, vein, and nerves.
Spinous Process: Small and bifid.

Atypical Cervical Vertebrae

C1 (Atlas): Lacks a body and spinous process. It has two lateral masses and two arches. Articulates with the occipital condyles superiorly and C2 inferiorly.
C2 (Axis): Features an odontoid process (dens) that extends superiorly. Has two lateral masses.

Thoracic Vertebrae

Articular Facets: Long and sloping downward for rib articulation.
Spinous Process: Long and slopes downward.

Lumbar Vertebrae

Vertebral Bodies: Large and robust.
Vertebral Foramen: Relatively small.

Sacrum

Formed by the fusion of 5 segments after puberty.
Sacral Canal: Continuation of the vertebral canal.
Sacral Foramina: Located within the lateral masses and allow passage of nerves.
Auricular Surfaces: On the lateral aspect, they articulate with the ilium to form the sacroiliac joint (SIJ).
Sacral Promontory: A prominent ridge on the anterior aspect of the S1 segment. It marks the boundary between the abdominal and pelvic cavities.

Coccyx

Formed by the fusion of 4 vertebrae into a triangular bone.
It forms part of the pelvic floor.

Spinal Joints

Atlanto-occipital joint: Located between the occipital condyles and the superior articular surface of the atlas.
Atlantoaxial Joint: Consists of three joints:
- A synovial joint between the anterior surface of the dens and the posterior aspect of the anterior arch of the atlas.
- Two synovial joints between each lateral mass of the atlas and axis.
Facet Joints: Located between the articular processes of the vertebral arches.
Sacroiliac Joint: Located between the auricular surface of the sacrum and ilium.

C-Spine Patient Preparation

Remove all jewelry, clothing, and accessories that may show on radiographs.
Patients should be instructed to remove any objects in their mouth, like retainers, plates, and tongue studs.

T-Spine Patient Preparation

Remove all jewelry, clothing and accessories that may show on radiographs.
Patients should be instructed to remove bras with underwires and clasps.
Provide a gown for patients and assist them with putting it on if necessary.

C-Spine Radiographs

Clinical indications for a c-spine x-ray include trauma, upper extremity paraesthesia, persistent headaches, osteoarthritis, and rheumatoid arthritis.
Projections include AP, AP Open Mouth, Oblique, Lateral, and Cervicothoracic Lateral (Swimmers).

AP C-Spine

Collimation: C1-T2, Neck Skin margins
Landmarks: EAM, Mastoid Process, Sternal Notch
Centre Point: C4.
Tube Angulation: 15-20 degrees cephalic.
Exposure Factors: kVP: 70-85; mAs: SNR is low if mottle is present, high if too high; Burnout: Loss of contrast in low-attenuating areas.
Technical Factors: SID: 110 cm, Grid use: Scatter may be problematic for larger patients, AEC Use: C-spine over the central chamber.
Respiration: Suspended Respiration (inspiration and hold).

AP Open Mouth C1-2

Collimation: C1-C2
Landmarks: Base of Skull, Upper Central Incisors, Mastoid Tips
Centre Point: C2, middle of the open mouth.
Exposure Factors: kV: 70-85; mAs: Too low mottle is present, too high dose will be excessive.

Posterior Obliques

Collimation: Cervical vertebrae, skin margins.
Landmarks: EAM, Mastoid process, Sternal Notch.
Centre Point: C4, lower margin of thyroid cartilage at C5.
Tube Angle: 15-20 degrees cephalic.
Exposure Factors: kV: 70-85, adequate penetration; mAs: Too low mottle will be present, too high dose will be excessive.

Anterior Obliques

Collimation: Cervical Vertabrae, skin margins
Landmarks: EAM, Mastoid process, Sternal Notch.
Centre Point: C4, Lower margin of thyroid cartilage at C5.
Tube Angle: 15-20 degrees Caudal
Exposure Factors: kV: 70-85, adequate penetration; mAs: Too low mottle will be present, too high dose will be excessive.

Lateral C-Spine

Collimation: C1-T1 vertebrae, skin margins.
Landmarks: EAM, Mastoid process, C7 Spinous process, Sternal notch.
Centre Point: C4, upper margin of the thyroid cartilage.
Exposure Factors: kV: 70-85.
Technical Factors: SID: 150-180 cm, AEC: Spine over the central chamber, Respiration: Suspended (inspiration).

Swimmers Lateral C-Spine

Collimation: C5-T3 intervertebral disc spaces
Landmarks: Sternal Notch, C7 Spinous process
Centre Point: T1, 4 cm above sternal notch.
Exposure Factors: kV: 75-95
Technical Factors: SID: 150-180 cm, AEC: C-spine over the central chamber, Respiration: Suspended (inspiration).

Patient Positioning - Lateral Spine

Ensure the pelvis is lateral.
Erect: Patient stands with their side against the bucky, shoulder touching for stability to minimize OID.
Arms:
- Recumbent: Arms raised, elbows flexed, and hands in front of the face.
- Erect: Arms raised, elbows flexed, with hands on top of the head.
Ensure the patient is not rotated through the shoulders or hips, with the central ray traveling along the coronal plane.
Ensure the patient is not tilted or leaning toward or away from the bucky/table. Central ray should be aligned perpendicular to the midsagittal plane. Look for localised bulging.
Check for widening of the pedicles- could indicate a burst fracture.
Check for fractures of the transverse processes.

Lateral Spine - Additional Considerations

Check alignment.
Check for loss of height of the vertebral bodies.
Check the disc spaces.
Look for bony fragments.

L-Spine Patient Preparation

Consider what area of the spine is being radiographed.
Remove:
- Jewelry
- Navel piercings
- Clothing that will show up on radiographs (e.g., buttons, studs, zippers, prints, embellishments).
- Bras with underwires and clasps (metal or thick plastic).
- Belts.
- Items from pockets.
- Hair/hair accessories from the spine.
Provide:
- Gown.
- Explain how to put the gown on if necessary.
- Assist the patient if required.
- Ensure the patient is changed after the examination.

SC- Spine Patient Preparation

Consider what area of the spine is being radiographed.
Remove:
- Clothing that will show up on radiographs (e.g., buttons, studs, zippers, prints, embellishments).
- Belts.
- Items from pockets.
Provide:
- Gown.
- Explain how to put the gown on if necessary.
- Assist the patient if required.
- Ensure the patient is changed after the examination.

Lumbar and Sacrococcygeal Spine Anatomy

Lateral Spot L5/6 radiographic anatomy.
Oblique Lumbar Spine radiographic anatomy.
AP Sacrococcygeal Spine radiographic anatomy.
Lateral Sacrococcygeal Spine radiographic anatomy.

Sacroiliac Joints Radiographic Anatomy

AP Sacroiliac Joints radiographic anatomy
Oblique Sacroiliac Joint radiographic anatomy.

Chiropractic Spine Considerations

Learning outcomes:
- X-ray projections.
- Patient preparation.
- Routine erect spinal imaging vs chiropractic imaging.

X-Ray Projections

C-spine series:
- AP, AP open mouth, Obliques, Lateral (neutral), Flexion/extension laterals, Swimmers lateral.
T-spine Series:
- AP, Lateral.
L-Spine series:
- AP/PA to include AP pelvis, obliques, lateral (neutral), L5/S1 spot lateral, flexion/extension laterals.

Patient Preparation - Chiropractic Spine

All imaging requested by chiropractors is to be performed erect using the same erect positioning instructions in the cervical, thoracic and lumbar spine lectures.
Only 2 main differences so that alignment can be assessed:
- AP open mouth view: open lateral collimation to include both mastoid tips.
- AP/PA lumber spine: open lateral collimation to include both iliac crests, acetabulum and greater trochanters.

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Description

This quiz covers the basics of spinal anatomy, including the types of spinal curves like kyphosis and lordosis, as well as details about cervical, thoracic, and lumbar vertebrae. Test your knowledge on the unique features of atypical cervical vertebrae, including the Atlas and Axis.