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125 Week 11 Cervical Spine

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125 Week 11 Cervical Spine

  1. 1. <ul><li>RT 1125 </li></ul><ul><li>RADIOGRAPHIC PROCEDURES </li></ul><ul><li>Cervical Spine </li></ul>NEW YORK CITY COLLEGE OF TECHNOLOGY http://www.med-ed.virginia.edu/courses/rad/cspine/index.html http://www.radiographicceu.com/article29.html
  2. 2. Objective Conditions: Lecture and discussion on the anatomy and positioning of the cervical spine.   Performance: The student will:   1. Define terms related to anatomical structures and positioning. 2. Identify the bony anatomy of the cervical spine. 3. Describe the AP, AP open mouth, lateral and oblique positions of the cervical spine.
  3. 3. Agenda Cervical Spine A. Projections/Positioning of the Cervical Spine 1. Anteroposterior (AP) 2. Open Mouth 3. Anteroposterior / Obliques Posterioanterior 4. Lateral (Lat) B. Anatomy 1. 7 cervical spine 2. Related Articulations
  4. 4. The Vertebral Column <ul><li>Forms central axis of skeleton </li></ul><ul><li>Protects/encloses spinal cord ( the spinal cord extends to the Fourth sacral vertebrae, however the spinal cord proper usually ends around the 2 nd Lumbar vertebrae ) </li></ul><ul><li>Supports trunk and skull </li></ul><ul><li>Attachments of muscles & ribs </li></ul><ul><li>Made of segments (vertebrae) </li></ul><ul><li>Curved making it flexible and strong </li></ul>
  5. 5. Breakdown of Vertebrae 7 12 5 5 FUSED http://www.anatomyatlases.org/bonebox/spine.shtml
  6. 6. Curvature <ul><li>Four Curves </li></ul><ul><li>Convex or Concave </li></ul><ul><li>Aka Lordotic/Kyphotic </li></ul><ul><li>Primary – thoracic/pelvic </li></ul><ul><li>Secondary (compensatory) – cervical/lumbar </li></ul>
  7. 7. Flexability <ul><li>The greatest amount of flexibility is permited in the Cervical region. The least is in the Sacral region </li></ul>
  8. 8. Kyphosis-Lordosis-Scoliosis <ul><li>Kyphosis – increased curve of thoracic </li></ul><ul><li>Lordosis – increased curve of lumbar </li></ul><ul><li>Scoliosis – an abnormal lateral curvature (Ant. View) </li></ul>
  9. 9. Kyphosis Scoliosis brace
  10. 10. Scoliosis
  11. 11. Vertebra Anatomy <ul><li>Body & vertebral arch create the vertebral foramen </li></ul><ul><li>¼ of column are intervertebral disks </li></ul><ul><ul><li>Nucleus pulpous can rupture </li></ul></ul><ul><ul><li>HNP </li></ul></ul><ul><li>1 st two cervical vertebrae are not typical for articulation with the skull </li></ul>
  12. 12. Bone View
  13. 13. Lumbar-Thoracic Rad
  14. 14. Cervical Vertebrae C1 <ul><li>The atlas (C1) ring </li></ul><ul><ul><li>Small spinous process </li></ul></ul><ul><ul><li>2 arches (Ant./Post.) </li></ul></ul><ul><ul><li>2 lateral masses </li></ul></ul><ul><ul><ul><li>Bear superior and inferior articular processes </li></ul></ul></ul><ul><ul><li>2 transverse processes </li></ul></ul><ul><ul><ul><li>Longer than other vertebrae </li></ul></ul></ul><ul><li>Ant. Ring portion receives dens (odontoid) from C2 ( Axis ) </li></ul><ul><li>Post Ring portion receives spinal cord </li></ul>
  15. 15. Cervical Vertebrae C2 <ul><li>The Axis (C2) has strong process dens or odontoid process </li></ul><ul><ul><li>Acts as pivot for atlas </li></ul></ul><ul><li>Superior articular processes adapted to join with the atlas </li></ul><ul><li>Inferior are similar to other vertebrae </li></ul><ul><li>Laminae are broad and thick </li></ul><ul><li>Horizontal spinous process </li></ul>C7 has a prominent spinous process
  16. 16. Typical Cervical Vertebrae <ul><li>C3 – C6 – C7 </li></ul><ul><ul><li>Small oblong bodies </li></ul></ul><ul><li>Short wide transverse processes contain foramen </li></ul><ul><ul><ul><li>Vertebral artery & vein </li></ul></ul></ul><ul><li>Pedicles project laterally & posteriorly </li></ul><ul><li>Laminae narrow and thin </li></ul><ul><li>Spinous processes are short </li></ul>C7 has longer spinous process called the prominens
  17. 17. C2 Vert. Axial Cross Section (inferior view) BODY Transverse Foramen Inferior Articular Facet Lamina Transverse Process Vertebral Canal Spinous Process
  18. 18. C2 Vert. Axial Cross Section (superior view) Superior Articular Facet Dens/Odontoid Transverse Process Lamina Verterbral Column Spinous Process
  19. 19. CT/MR Cervical Spine
  20. 20. Zygapophyseal facet joints C2-C7 <ul><li>Lie at right angles to the midsagittal plane and are seen in the lateral projection </li></ul>
  21. 21. AP Projection <ul><li>8x10 </li></ul><ul><li>Upright or Supine </li></ul><ul><li>Prevent rotation by adjusting shoulders </li></ul><ul><li>Midsagittal plane Cntr to bucky </li></ul><ul><li>Extend chin preventing superimposition </li></ul><ul><li>Center IR to C4 </li></ul><ul><li>Adjust head </li></ul><ul><li>Shield </li></ul><ul><li>Suspend respiration </li></ul><ul><li>CR – 15 – 20 degree cephalad </li></ul>
  22. 22. AP Projection
  23. 23. Cervical Spine AP EVAL <ul><li>Covers C3 – T2 </li></ul><ul><li>Mandible and occipital bones superimposed </li></ul><ul><li>Open intervertebral disk spaces </li></ul><ul><li>Spinous processes equidistant to pedicles </li></ul><ul><li>Mandibular angles equidistant to vertebrae </li></ul>
  24. 24. AP Open Mouth <ul><li>8x10 </li></ul><ul><li>Supine </li></ul><ul><li>Midsagittal plane centered </li></ul><ul><li>Exposure factors set </li></ul><ul><li>Open mouth wide </li></ul><ul><li>Shield </li></ul><ul><li>Ah to keep the tongue down </li></ul><ul><li>CR Perp to the IR @ midpoint of open mouth </li></ul><ul><li>40 inch SID </li></ul>
  25. 25. AP Open Mouth EVAL <ul><li>AP view of atlas & Axis, Dens, and articulation btwn C1,2 </li></ul><ul><li>Articular surface of atlas and axis (lateral displacement) </li></ul><ul><li>Occlusal plane superimposed </li></ul><ul><li>Wide open mouth </li></ul><ul><li>No tongue shadow </li></ul><ul><li>Rami equidistant from dens </li></ul>
  26. 26. Lateral C-spine <ul><li>GOAL: C7 </li></ul><ul><li>10x12 (not in Merrills) </li></ul><ul><li>72 inch SID (reduces inherent OID) </li></ul><ul><li>Long axis of vertebrae parallel to IR </li></ul><ul><li>Standing or sitting </li></ul><ul><li>Coronal plane centered to mid IR </li></ul><ul><li>Bring pt as close as possible to IR </li></ul><ul><li>Depress shoulders & bring chin up </li></ul><ul><li>Shield </li></ul><ul><li>Suspend respiration at end of expiration </li></ul>CR – Perp to C4 Sandbags are utilized to help bring shoulders down
  27. 27. Lateral CS EVAL <ul><li>Goal to visualize all seven vertebrae and part of T1 </li></ul><ul><li>Neck extended to avoid Mandibular Rami superimposition </li></ul><ul><li>Superimposed Rami </li></ul><ul><li>No rotation, superimposed open zygapophyseal joints </li></ul><ul><li>C4 alignment to mid IR </li></ul><ul><li>Bone and soft tissue </li></ul>zygapophyseal joints Rami
  28. 28. Lateral View
  29. 29. Lateral Anatomy
  30. 30. AP Axial Oblique (RPO/LPO) <ul><li>10x12 </li></ul><ul><li>Upright is best to get 72 inch SID </li></ul><ul><li>Adjust to 45 degree angle </li></ul><ul><li>Cntr cervical spine to mid IR </li></ul><ul><li>Center to 3 rd cervical body about 1 inch superior to thyroid </li></ul><ul><li>Adjust mandible </li></ul><ul><li>Do not turn chin </li></ul>CR 15-20 degree cephalad Can be done semi supine, not recommended
  31. 31. AP Axial OBL EVAL <ul><li>Goal : Open intervertebral foramina (C2-C7) Farthest from IR </li></ul><ul><li>Open intervertebral disk space </li></ul><ul><li>Uniform size of foramina </li></ul><ul><li>Elevated chin (avoid superimposition) & Occipital bone </li></ul>Markers
  32. 32. PA Axial Obl RAO/LAO <ul><li>10x12 </li></ul><ul><li>72 SID </li></ul><ul><li>Standing Vs. Sitting </li></ul><ul><li>Body @ 45 degree </li></ul><ul><li>Head tilted for alignment </li></ul><ul><li>Elevate chin </li></ul><ul><li>Shield </li></ul><ul><li>Suspend respiration </li></ul><ul><li>shield </li></ul>CR- 15-20 degrees caudad
  33. 33. PA Axial OBL RAO/LAO <ul><li>Intervertebral Foramina and pedicles closes the IR </li></ul><ul><li>Open intervertebral disk spaces </li></ul><ul><li>Elevated chin Mandible overlap of C1/2 </li></ul><ul><li>No superimposition of the occipital bone </li></ul><ul><li>All 7 vertebrae </li></ul>
  34. 34. Oblique
  35. 35. Pos. chart
  36. 36. Practice Diagrams
  37. 37. Comparison
  38. 38. Fractures