Chapter 9: Image Analysis of the Lumbar Vertebrae, Sacrum, and Coccyx (PDF)

Chapter 9 Image Analysis of the Lumbar Vertebrae, Sacrum, and Coccyx  Outline  Lumbar vertebrae: AP projection  Lumbar vertebrae: AP oblique projection (right and left posterior oblique positions)  Lumbar vertebrae: Lateral projection  L5-S1 lumbosacral junction:...

Chapter 9 Image Analysis of the Lumbar Vertebrae, Sacrum, and Coccyx  Outline  Lumbar vertebrae: AP projection  Lumbar vertebrae: AP oblique projection (right and left posterior oblique positions)  Lumbar vertebrae: Lateral projection  L5-S1 lumbosacral junction: Lateral projection  Sacrum: AP axial projection  Sacrum: Lateral projection  Coccyx: AP axial projection  Coccyx: Lateral projection Lumbar Vertebrae Anteroposterior Projection  Lumbar Vertebrae: Anteroposterior Projection AP Lumbar Analysis Practice Analysis The distance from the left pedicles to the spinous process is narrower than the same distance from the right pedicles to the spinous process.  The patient was rotated toward the right side (RPO rotation). Correction Rotate the patient toward the left side until the midcoronal plane is aligned parallel with the IR. Lumbar Vertebrae AP Oblique Projection (Right and Left Posterior Oblique Positions)  Lumbar Vertebrae: AP Oblique Projection (Right and Left Posterior Oblique Positions) AP Oblique Lumbar Analysis Practice Analysis The superior and inferior articular processes are not in profile, the corresponding zygapophyseal joints are closed, and the pedicles are demonstrated closer to the vertebral body midline.  The patient was rotated more than 45 degrees. Correction Decrease the degree of rotation until the midcoronal plane is at a 45-degree angle with the IR. Lumbar Vertebrae Lateral Projection Lumbar Vertebrae: Lateral Projection Lateral Lumbar Vertebrae Analysis Practice Analysis The posterior surfaces of the vertebral bodies are not superimposed.  The right side of the patient was rotated anteriorly. Correction Rotate the right side of the patient posteriorly until the midcoronal plane is aligned perpendicular with the IR. L5-S1 Lumbosacral Junction Lateral Projection L5-S1 Lumbosacral Junction: Lateral Projection Lateral L5-S1 Analysis Practice Analysis The L5-S1 intervertebral disk space is closed. The L5 vertebral body is distorted.  The lumbar vertebral column was sagging toward the table. Correction Place a radiolucent sponge between the patient’s lateral body surface and the table to align the vertebral column parallel with the table, or angle the CR caudally until it parallels the interiliac line. Sacrum AP Axial Projection Sacrum: AP Axial Projection AP Sacrum Analysis Practice Analysis The patient was rotated toward the right side (RPO rotation). The cephalic CR angulation was excessive. Correction Rotate the patient toward the left side until the midcoronal plane is parallel with the IR. Slightly decrease the degree of cephalic CR angulation. Sacrum Lateral Projection Sacrum: Lateral Projection Lateral Sacrum Analysis Practice Analysis The L5-S1 intervertebral disk space is closed. The L5 vertebral body and sacrum are distorted. The lumbar vertebral column was sagging toward the table. Correction Place a radiolucent sponge between the patient’s lateral body surface and the table to align the vertebral column parallel with the table, or angle the CR caudally until it parallels the interiliac line. Coccyx AP Axial Projection Coccyx: AP Axial Projection AP Coccyx Analysis Practice Analysis The patient was rotated toward the right side (RPO rotation). The caudal CR angulation was slightly insufficient. Correction Rotate the patient toward the left side until the midcoronal plane is parallel with the IR. Slightly increase the degree of caudal CR angulation. Coccyx Lateral Projection Coccyx: Lateral Projection