Five lumbar vertebrae
How many lumbar vertebrae are there?
Lumbar
Which vertebrae are considered the strongest?
L5
Which lumbar vertebrae is the largest?
The load of body weight increases toward the end of the vertebral column especially at the lumbar region
Why are the disks between the inferior lumbar vertebrae common sites for injury and pathologic processes?
Only one foramina
How many foramina do the lumbar vertebrae have?
Superior vertebral notch and the inferior vertebral notch
Intervertebral Foramina are formed by the ________ and the _______.
They are where nerves and blood vessels pass
What is the purpose of the intervertebral foramina?
Lateral projection
What projection best demonstrates the intervertebral foramina on the lumbar spine?
Superior articular process and the inferior articular process
The ________ and the _______ make up the zygapophyseal joint space.
90 degrees
The intervertebral foramina of the lumbar spine are situated ____ relative to the midsagittal plane.
30 degrees to 50 degrees
The zygapophyseal joints form an angle open from ___ to ___ to the midsagittal plane.
Upper/proximal
The ______ lumbar vertebrae are nearer the 50 degree angle.
Lower/distal
The _____ lumbar vertebrae are nearer the 30 degree angle.
45 degrees
How much should you angle a patient to demonstrate the zygapophyseal joints of the lumbar spine?
Form a bridge between the transverse processes, lateral masses, and spinous process
Laminae
The portion of each lamina between the superior and inferior articular processes
Pars Interarticularis
Obliques of the lumbar spine
What projections best demonstrate the Pars Interarticularis?
Pars Interarticularis
What is a common site of fracture in the lumbar spine?
To demonstrate the spinous processes and transverse processes
Why do we preform AP or PA projections of the lumbar spine?
Inferiorly
The sacrum is located _____ to the lumbar vertebrae.
Five; adulthood
The original ____ segments of the sacrum fuse into a single bone in ______.
Shovel; inferior my and anteriorly
The sacrum is shaped like a _____ and the apex points _____ and ______.
Four sets of foramina similar to those of the spine that transmit nerves and blood vessels.
Pelvic (anterior) Sacral Foramina
Wings; large masses lateral to the first sacral segment
Alae of the Sacrum
Two; form the zygapophyseal joints with the inferior articular processes of the fifth lumbar vertebrae
Superior Articular Processes of the Sacrum
Convex
The sacrum has a ______ curvature.
The anterior ridge of the first sacral segment; helps form the posterior wall of the inlet of the true pelvis
Promontory
Lateral
The promontory is best demonstrated by a ______ projection.
A continuation of the vertebral canal that contains sacral nerves and is located posterior to the body of the first sacral segment
Sacral Canal
Formed by fused spinous processes of the sacral vertebrae
Median Sacral Crest
Where the sacrum articulates with the ilium of the pelvis; forms the SI joint
Auricular Surface
Small tubercles that represent the inferior articular processes projecting inferiorly for each side of the fifth sacral segment
Sacral Horns
Cornua
What is another name for the sacral horns or the horns of the coccyx?
To articulate with the horns of the coccyx
Why do the sacral horns project inferiorly and posteriorly?
Obliquely posteriorly at an angle of 30 degrees
Each SI joint opens _________________.
Coccyx
The most distal portion of the vertebral column is the _____.
Tailbone
The coccyx is sometimes referred to as the ______.
Three to five
How many coccygeal segments do humans start out with?
Largest and broadest
The most superior segment of the coccyx is the _____ and ______.
Transverse processes
The most superior segment of the coccyx has two ______ ______.
Distal pointed tip
Apex of the Coccyx
Broad, superior portion
Base of the Coccyx
Larger
The long axis of the sacrum (projects posteriorly) is _____ in females than males.
Smaller
The long axis of the coccyx (projects anteriorly) is _____ in females than in males.
Birth canal; impede the birth process
The coccyx projects into the ____ ____ of females and can ___________________.
More likely; coccyx
Females are _____ _____ to fracture their ____ than males.
A direct blow to the lower vertebral column when a person is in a sitting position; results from falling backward onto rear end
What is the most common injury associated with the coccyx?
Scottie dogs
An oblique of the lumbar spine should result in the appearance of ______ ____.
Superior articular process (ear), transverse process (nose), pedicle (eye), pars Interarticularis (neck), inferior articular process (front leg), zygapophyseal joint (curve of the back)
Describe what anatomy makes up the Scottie dog in oblique lumbar projections.
Synovial, diarthrodial (freely movable), plane (gliding)
Zygapophyseal joints are classified as ____ and are _______ with a ______ type of movement.
Cartilaginous, amphiarthrodial (slightly movable), symphysis subclass
Intervertebral joints are classified as ________ and are ________ of the _______ subclass.
True lateral projection
What projection of the lumbar spine best demonstrates the intervertebral foramina?
Oblique projections
What projection of the lumbar spine best demonstrates the zygapophyseal joints?
Right side is demonstrated
Which side is demonstrated on an RPO of the lumbar spine?
Left side is demonstrated
Which side is demonstrated on an RAO of the lumbar spine?
Down
The posterior obliques of the lumbar spine demonstrate the ____ side.
Up
The anterior obliques of the lumbar spine demonstrate the ___ side.
Less weight on spine, easier to maintain
Why are anterior obliques considered easier for most patients?
Natural lumbar curvature, divergence
Anterior obliques allow the ______________ of the lumbar spine to converge with the _______ of the x-ray beam.
45 degrees
A _____ oblique angle is typically used to demonstrate an oblique lumbar spine.
50 degrees
To better view the L1 and L2 area on an oblique lumbar spine, you should oblique the patient to ___.
30 degrees
To better view the L5 and S1 area on an oblique lumbar spine, you should oblique the patient to ___.
Right zygapophyseal joints
An RPO Os the lumbar spine will demonstrate _________________.
Left zygapophyseal joints
An LPO will best demonstrate _________________.
Left zygapophyseal joints
An RAO will best demonstrate _________________.
Right zygapophyseal joints
A LAO will best demonstrate _________________.
Midcoccyx
The ______ is approximately at the level of the phobic symphysis or the greater trochanter (which is 1 inch superior to the pubic symphysis)
S1 or S2
The ASIS is approximately the same level as the ______.
Junction of L4 and L5
The most superior portion of the iliac crest corresponds with the ____________________.
L2 or L3
The lower costal margin (lower ribs) is at the approximate level of _____.
T9 or T10
The xiphoid tip is approximately at the level of _____.
Flexing the knees reduces the lumbar curvature bringing the lumbar spine more parallel to the IR; more comfortable for patient
Why do we ask patients to flex their knees up during AP lumbar exams?
False, extending the legs will cause OID.
True or false: it is okay for a patient to extend their legs during AP lumbar exams.
PA places the lumbar spine with its natural curvature in such a way that the intervertebral disk spaces are nearer parallel to the divergent x-ray beam; lower female ovarian dose
Why is a PA lumbar spine projection better than an AP?
OID
What is a disadvantage of PA lumbar projections?
Close collimation and the use of a lead mat behind the patient for lateral lumbar spine projections
What are two ways to reduce scatter reaching the IR?
The superior and inferior surfaces of the vertebral body are driven together, producing a wedge-shaped vertebra
Compression Fractures
The soft nucleus pulposus protrudes through the fibrous outer layer, pressing on the spinal cord and nerves; occurs most often in L4 and L5 causing sciatica
Herniated Nucleus Pulposus (HNP)
Lateral curvature of the spine
Scoliosis
Dissolution of a vertebra such as from separation of the pars Interarticularis of the vertebra, causing the neck of the Scottie dog in oblique positions to appear broken
Spondylolysis
AP or PA, both obliques, lateral, and lateral L5-S1 (spot)
What are the basic projections for the lumbar spine?
AP axial L5-S1
What is a special projection for the lumbar spine?
PA or AP erect or recumbent and an erect lateral
What are the basic projections for a scoliosis series?
AP (Ferguson method) and AP or PA right and left bending
What are the special projections for a scoliosis series?
AP or PA right and left bending, lateral hyper extension, and lateral hyper flexion
What are the basic projections for a spinal fusion series?
AP axial sacrum and lateral
What are the basic projections for the sacrum?
AP axial coccyx and lateral
What are the basic projections for the coccyx?
AP axial and posterior obliques
What are the basic projections for sacroiliac joints?
To the level of the iliac crest (L4-L5 interspace)
Where do you center for an AP lumbar spine if you use a 14 x 17 IR?
Center to level of L3 which is 1 1/2 inches above the iliac crest
How does the centering change if you use a 11 x 14 IR for an AP lumbar spine instead of a 14 x 17?
Expiration
On all projections of the lumbar spine you should suspend breathing on _______.
It helps to straighten the spine and open intervertebral disk spaces
Why do we ask patients to flex knees during AP lumbar spine projections?
The natural weight bearing stance of the spine
Erect projections of the lumbar spine are useful in demonstrating _______________________.
Place the intervertebral spaces more closely parallel to the diverging rays
AP lumbar spine projections may be done PA in order to _____________________.
Lumbar vertebral bodies, intervertebral joints, spinous and transverse processes, SI joints, and sacrum
What should be included on an AP or PA lumbar spine?
Pars Interarticularis (spondylolysis)
Oblique projections of the lumbar spine demonstrate defects of the ____ _________.
Posterior or anterior
Obliques of the lumbar spine must either be both ______ or _____ for comparison.
RPO and LPO
Semi supine obliques of the lumbar spine are ___ and ___.
RAO and LAO
Semi prone obliques of the lumbar spine are ___ and ___.
45 degrees
How much do you generally rotate a patient for oblique projections of the lumbar spine?
Center to L3 at the level of the costal margin (1 1/2 inches) above the iliac crest and 2 inches medial to the upside ASIS
Where do you center for obliques of the lumbar spine?
50 degrees
How much do you rotate the patient for oblique projections of the lumbar spine when L1 and L2 are most important?
30 degrees
How much do you rotate a patient for oblique projections of the lumbar spine when L5 and S1 are the most important?
Zygapophyseal
Obliques of e lumbar spine demonstrate ________ joints.
Pedicle (eye)
Correct 45 degree rotation of oblique projections of the lumbar spine results in the _____ of the Scottie dog to be near the center of the vertebral body.
Overrotated
If the pedicle on the Scottie dog is more posterior, your patient is ______.
Under rotated
Is the pedicle of the Scottie dog is more anterior, your patient is ______.
Center to the level of the iliac crest
Where do you center for a lateral projection of the lumbar spine when using a 14 x 17 IR?
Center to L3 at the level of the lower costal margin (1 1/2 inches) above the iliac crest
Where do you center for a lateral projection of the lumbar spine when using a 11 x 14 IR?
5 to 8 degrees caudad
The average patient requires no tube angulation for a lateral lumbar spine, however you should angle _____ for some patients when necessary.
5 to 8 degrees caudad
You should angle the tube _____ for lateral projections of the L5-S1 region (spot).
Add a sponge underneath the patients waist to raise them up
What is another option to bring the spine parallel on lateral lumbar spines other than tube angulation?
30 degrees cephalad for males and 35 degrees cephalad for females
How much do you angle for an AP axial L5-S1 projection of the lumbar spine?
Center to the level of the ASIS and the midline of the body
Where do you center for AP axial L5-S1 projections of the lumbar spine?
Prone, caudal, OID
The AP axial L5-S1 projection of the lumbar spine may be performed ____ with a _____ angle, but his will increase ___.
Lateral L5-S1 (spot)
What projection will provide more information than the AP axial L5-S1 projection of the lumbar spine?
Iliac crest
The lower margin of the IR should be a minimum of 1 to 3 inches below the _____ ____ for projections in scoliosis series.
Expiration
Patients for scoliosis series exams should be asked to suspend breathing on _______.
The PA projection reduces the dose to the thyroid gland and to female breast tissue.
Why is a PA projection preferred over the AP for scoliosis series?
The thoracic and lumbar spine in their entirety.
What should be included in projections for scoliosis?
To demonstrate possible spondylolisthesis, degree of kyphosis, or lordosis.
Why do we perform an erect lateral for scoliosis series?
40 to 60 inch SID
What SID is used for scoliosis series?
Assists in differentiating deforming (primary) curve from compensatory curve
What is the purpose of the Ferguson method for scoliosis series (PA/AP projection)?
Two images are taken: one standard erect PA/AP and one erect with the foot or hip on the convex side of the curve elevated
Describe the projections taken for the ferguson method for scoliosis series.
Unassisted
Patients should perform the positions for the ferguson method for scoliosis series ___________.
1 inch; iliac crest
A minimum of _______ of the ____ ______ should be included on images in a scoliosis study.
To demonstrate the range of motion of the vertebral column
Why do we perform a AP/PA projection right and left bending for scoliosis?
Supine or erect
The AP/PA projection right and left bending for scoliosis studies may be taken either _____ or ____.
1 to 2 inches below the iliac crest
For an AP/PA projection right and left bending for scoliosis studies, the IR should be placed ____________________.
Fulcrum
The pelvis acts as a ______ for right and left bending projections for scoliosis studies.
They are used to assess mobility at the spinal fusion site
Why do we perform hyper extension and hyper flexion lateral projections for spinal fusion series?
Right and left bending
The ____ and _____ _______ positions for scoliosis series are also used for spinal fusion series and are set up the same way.
The fetal position; bend forward and draw the legs up as far as possible
Hyper flexion
Move the torso and legs posteriorly as far as possible
Hyper extension
Site of fusion
You should center to the _____ ___ ______ if it is known for spinal fusion projections.
15 degrees cephalad to enter 2 inches superior to the pubic symphysis
How do you angle the CR for an AP axial projection of the sacrum?
Shorter and wider
The female sacrum is generally ____ and ____ than the male sacrum.
5 degrees
You should increase the CR angle by ____ for patients with an apparent posterior curvature or tilt of the sacrum, coccyx, and pelvis.
No foreshortening
The AP axial sacrum projection should result in ___ ______ of the sacrum.
Void and take an enema
For exams of the sacrum and coccyx, the patient should ____ and take an _____ if possible before the exam.
10 degrees caudad to enter 2 inches superior to the pubic symphysis
How do you angle the CR for an AP axial coccyx projection?
3 to 4 inches posterior to the ASIS
Where do you center the CR for a lateral sacrum projection?
3 to 4 inches posterior to the ASIS and 2 inches distal to the ASIS
Where do you center the CR for a lateral projection of the coccyx?
Coccyx
The lateral sacrum and coccyx may be taken as one image, but when separate the ____ requires a lower kV and less mAs.
30 to 35 degrees cephalad (Males: 30 and Females: 35)
How do you angle for an AP axial projection for the sacroiliac joints?
A midpoint about 2 inches below the level of the ASIS
Where do you center the CR for an AP axial projection for the sacroiliac joints?
30 to 35 degrees caudad centered to the level f L4 or slightly above the iliac crest
The AP axial projection for the sacroiliac joints may be performed PA. What is the angulation and Centering point for the PA version?
Posterior obliques: RPO and LPO
Which obliques are used for projections of the sacroiliac joints?
Farthest; up
Posterior obliques of the sacroiliac joints demonstrate the joint ______ from the IR or the side ____.
25 to 30 degree oblique with the side of interest elevated
How much should you oblique the patient for a posterior oblique of the sacroiliac joints?
Right
The LPO projection will demonstrate the _____ sacroiliac joint.
Left
The RPO projection will demonstrate the _____ sacroiliac joint.
1 inch medial to the upside ASIS
Where do you center the CR for a posterior oblique for the sacroiliac joints?
15 to 20 degrees cephalad
To demonstrate the inferior part of the sacroiliac joint on a posterior oblique more clearly, the CR may be angled _________.
