Heart Shaped
Smallest spinal canal
Smallest spinal canal
Body of thoracic spine
Costovertebral articulations with rib heads.
Costotransvers articulations with rib tubercles.
Joints subject to degenerative processes.
Costotransvers articulations with rib tubercles.
Joints subject to degenerative processes.
Costal Facets of Thoracic Spine
Project posterior in the sagittal plane.
Significance for the AP Film = Present/Absent, density
Significance for the Lateral Film = IVF
Significance for the AP Film = Present/Absent, density
Significance for the Lateral Film = IVF
Pedicles of thoracic spine
Pedicle/Lamina junction
Directed obliquely posterolaterally
Costal facets (except T11 & T12)
Directed obliquely posterolaterally
Costal facets (except T11 & T12)
Transverse processes of thoracic spine
Superior facet – Posterior/Lateral
Inferior facet – Anterior/Medial
Facet spaces seen on the lateral film.
(Cross reference with A-P)
Inferior facet – Anterior/Medial
Facet spaces seen on the lateral film.
(Cross reference with A-P)
Articular processes of thoracic spine
Short, broad, and thick
Overlap subjacent vertebrae
Overlap subjacent vertebrae
Laminae of thoracic spine
T1 is longest = 30-40% of population VP.
T5-8 imbricate
Look for the thoracic spinous on the vertebrae below.
T5-8 imbricate
Look for the thoracic spinous on the vertebrae below.
Spinouses of thoracic spine
Facets
What limits Flexion/Extenion in thoracic spine
Ribs
What limits lateral flexion in thoracic spine (lateral bending)
Rotation
What is less restricted in thoracic spine
A-P
Lateral
Lateral
What are the standard thoracic films
Anatomy/Alignment:
1. Identify all bony landmarks T1-T12.
2. Identify any scoliotic curvatures.
– Cobb method of scoliosis evaluation (preferred)
– Risser-Ferguson method
1. Identify all bony landmarks T1-T12.
2. Identify any scoliotic curvatures.
– Cobb method of scoliosis evaluation (preferred)
– Risser-Ferguson method
In AP Thoracic x-ray, what is the A in the ABC’s of reading x-rays
Bone
1. Increase or decrease in bone density
2. Change in contour or evidence of deformity of a bone (Example: Hemivertebra, butterfly vertebra, nuclear impression).
3. Change in trabecular patterns within the bone.
4. Disruption of cortical margins. (Example: Schmorl’s nodes).
1. Increase or decrease in bone density
2. Change in contour or evidence of deformity of a bone (Example: Hemivertebra, butterfly vertebra, nuclear impression).
3. Change in trabecular patterns within the bone.
4. Disruption of cortical margins. (Example: Schmorl’s nodes).
In AP Thoracic x-ray, what is the B in the ABC’s of reading x-rays
Cartilage
1. Disc spaces and margine – narrowing, sclerosis, osteophytes, erosions, fusion.
2. Facet joints – evidence of sclerosis
3. Costovertebral joints – narrowing, hypertrophy/sclerosis, erosions, fusions.
4. Costotransverse joints – evidence of sclerosis, erosions, fusion.
5. Costochondral calcification
1. Disc spaces and margine – narrowing, sclerosis, osteophytes, erosions, fusion.
2. Facet joints – evidence of sclerosis
3. Costovertebral joints – narrowing, hypertrophy/sclerosis, erosions, fusions.
4. Costotransverse joints – evidence of sclerosis, erosions, fusion.
5. Costochondral calcification
In AP Thoracic x-ray, what is the C in the ABC’s of reading x-rays
Soft Tissue
1. Paravertebral fat stripe.
2. Descending thoracic aorta.
3. Aortic arch (knob.)
4. Soft tissue calcifications (example: Aorta, costal cartilage).
5. Lung masses
6. Abnormal cardiac contour.
7. Calcification below the diaphragm.
8. Abnormal gas shadows below the diaphragm.
1. Paravertebral fat stripe.
2. Descending thoracic aorta.
3. Aortic arch (knob.)
4. Soft tissue calcifications (example: Aorta, costal cartilage).
5. Lung masses
6. Abnormal cardiac contour.
7. Calcification below the diaphragm.
8. Abnormal gas shadows below the diaphragm.
In AP Thoracic x-ray, what is the S in the ABC’s of reading x-rays
Alignment
1. Identify all anatomical parts.
2. Evaluate the thoracic kyphosis.
3. Evaluate posterior body alignment.
1. Identify all anatomical parts.
2. Evaluate the thoracic kyphosis.
3. Evaluate posterior body alignment.
In Lateral Thoracic x-ray, what is the A in the ABC’s of reading x-rays
Bone
1. Increase or decrease in density
2. Change in contour or evidence of deformity (compression fracture).
3. Change in trabecular patterns (telescoping).
4. Disruption of cortical margins (Schmorl’s Nodes).
1. Increase or decrease in density
2. Change in contour or evidence of deformity (compression fracture).
3. Change in trabecular patterns (telescoping).
4. Disruption of cortical margins (Schmorl’s Nodes).
In Lateral Thoracic x-ray, what is the B in the ABC’s of reading x-rays
Cartilage
1. Disc space narrowing, subchondral sclereosis, osteophytes.
2. Facet space narrowing, sclerosis
3. Bony fusion or erosion.
1. Disc space narrowing, subchondral sclereosis, osteophytes.
2. Facet space narrowing, sclerosis
3. Bony fusion or erosion.
In Lateral Thoracic x-ray, what is the C in the ABC’s of reading x-rays
Soft Tissue
1. Calcified Aorta
2. Abnormal lung shadow
3. Costochondral calcification
1. Calcified Aorta
2. Abnormal lung shadow
3. Costochondral calcification
In Lateral Thoracic x-ray, what is the S in the ABC’s of reading x-rays
Lines through superior end plate of T1, and inferior end plate of T12. Perpendiculars droppped, angles measured.
Lateral film.
Normal: varies by Age and Gender.
Significance: Increase seen in:
– Old age
– Osteoporosis
– Scheuermann’s Disease (injury to ring of pophysis)
– Congenital anomalies
– Muscular paralysis
Lateral film.
Normal: varies by Age and Gender.
Significance: Increase seen in:
– Old age
– Osteoporosis
– Scheuermann’s Disease (injury to ring of pophysis)
– Congenital anomalies
– Muscular paralysis
Thoracic spine Kyphosis Measurements
A-P films
Line through the superior endplate of the most superior vertebra of the curve. Line through the inferior endplate of the most inferior vertebra of the curve. Drop perpendiculars and measure the angle.
Significance: Curves less than 20⁰ require no bracing or surgery.
Patient between 10-15 years old = monitor for progression of more than 5⁰ within 3 months time.
Line through the superior endplate of the most superior vertebra of the curve. Line through the inferior endplate of the most inferior vertebra of the curve. Drop perpendiculars and measure the angle.
Significance: Curves less than 20⁰ require no bracing or surgery.
Patient between 10-15 years old = monitor for progression of more than 5⁰ within 3 months time.
Cobb method of scoliosis evaluation
A-P Films
The two end vertebrae and the apical vertebra of the curve. Locate vertebral body centers. Connect the three dots with two lines. Measure the angles.
Results in measurements about 25% (10⁰) less than the Cobb angle method, and therefore this is less useful for smaller curves.
The two end vertebrae and the apical vertebra of the curve. Locate vertebral body centers. Connect the three dots with two lines. Measure the angles.
Results in measurements about 25% (10⁰) less than the Cobb angle method, and therefore this is less useful for smaller curves.
Risser-Ferguson method of scoliosis evaluation
Cobb method
What is the preferred method for evaluating scoliosis
A-P films
Lateral full spine films
Others are:
– Lateral bending to evaluate flexibility
– Lateral hand and wrist to evaluate skeletal age (in pt younger than 20 yrs old)
– AP view of the pelvis to identify Risser’s sign.
Lateral full spine films
Others are:
– Lateral bending to evaluate flexibility
– Lateral hand and wrist to evaluate skeletal age (in pt younger than 20 yrs old)
– AP view of the pelvis to identify Risser’s sign.
When evaluating scoliosis, what are the minimum number of films to be taken
Describe the grading scale to evaluate pedicle rotation on the convex side of the curve for scoliosis
Lateral bending – evaluate flexibility
Lateral hand/wrist – evaluate skeletal age (in patients under 20)
A-P view of the pelvis – to identify Risser’s sign
Lateral hand/wrist – evaluate skeletal age (in patients under 20)
A-P view of the pelvis – to identify Risser’s sign
Other than the A-P and Lateral full spine x-rays to evaluate scoliosis, what other three films may help to evaluate scoliosis
