Transcript L spine and etc…

L spine and etc… No running
with Keys!
Ouch!
X-table lateral
Skull
Routine films L-S spine
AP
 AP axial
 RPO & LPO
 Lateral
 Lateral sacrum/coccyx
 **Cone down view of L5-S1 **May not need
to do if space is open on lateral films

AP L-Spine
Arrows
demonstrating
spina bifida
Structures shown:
 AP
of T-12 and all five lumbar to Sacrum
Good Film:
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Cone to the lateral margins of psoas muscles
Rotation? –
- The SI jnts should be equal distance from the
vertebral column
-Spinous processes in the center of spine
No artifacts elastic in pants, bra, belly rings
Good exposure do you see bony detail and
tissue(can you see the psoas muscle?)
Open intervertebral joints
Are they on the film?5 lumbar bodies, intervertebral disk
space, spinous and transverse processes
AP AXIAL
(Ferguson Method)
Structures Shown
 Lumbosacral
junction open and both SI jnts
Good film
 The
lumbosacral junction and sacrum should
be seen without rotation
 Both SI jnts free from superimpositions from
the pubis (did you angle enough?)
 Open intervertebral space between L5-S1
 *** check protocols at clinical site to see if
they do this view
Oblique
RPO
L-S Spine
Scotty
**
6.
**
1.Superior articular process.
2. Pedicle
3. Inferior articular process
4. Pars interarticularis
5.Transverse process
6. Lamina ( Scotty's body)
**Zygapophyseal joint is between one of Scotty’s feet and
another Scotty’s ear they are also called facet joints or apophyseal
joints
RPO/LPO:
Shows the (Superior/Inferior) articular
processes and the zygapophyseal joints of
the side closest to IR :So in the RPO position
the right side is down . It will demonstrate the
right zygapophyseal joint (the one closest to
the IR) and the right articular processes open
 Always do both obliques for comparison of
both sides

Structures shown
 All
five lumbar and the zygapophyseal joints
closest to the IR open
Good Film:
All 5 lumbar and top of sacrum on the image
 The zygapophyseal joints closest to the IRopen
 When the joint is not well demonstrated and
the pedicle is anterior on the vertebral body,
the patient is not rotated enough, and when
the pedicle is posterior on the vertebral body,
the patient is rotated too much
 Check site protocols:*** SI joint on ? ,3-5
lumbar on, all five on no SI jnts on….

RPO/LPO
for the zygapophyseal joints or the interarticular processes
LPO
RPO
Rotation: Roll up more or less?
the pedicle (eye) is anterior on the vertebral body, the patient is not
rotated enough
Posterior
*
Posterior
Anterior
LPO
Rotation: Roll up more or less?
Pedicle is posterior on the vertebral body, the patient is rotated too
much.
Posterior
*
LPO
L
L
Lateral
Structure Shown:
 All
5 lumbar bodies and the their interspaces,
the spinous processes, the lumbosacral
junction
Good Film:
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All 5 lumbar and top of sacrum in the lateral
projection
Open intervertebral disk spaces and intervertebral
foramina
The posterior margins of each vertebral body
should be superimposed
Spine down center of the film
Iliac crests superimposed
Spinous processes in profile and on the film
What?
Rotation
Left Lateral L-S Spine
Tube angle or build patient up
Lateral Sacrum (we go over this
later with sacrum/coccyx)
Coned Down
Lateral L5-S1
Angle? B, The interiliac (IL) line is perpendicular, and the central ray (CR) is
perpendicular. C, Typical lumbar spine curvature if pts has big hips. Angle the CR
caudal and parallel to the IL. D, Typical lumbar spine position in a patient with big
shoulders. The IL demonstrates that the CR must be angled cephalic to open the joint
space
C
Structures shown:
 All
of 5th lumbar vertebrae, and the upper
sacrum with a open lumbosacral joint.
Good Film:
The lumbosacral joint should open and in the
center of the film
 Coned well- all of the 5th lumbar on and the
top of the sacrum on the image
 Iliac crest superimposed (rotation) (postion)

Open?
Big hips angle
down
Routine Views:
Sacrum/Coccyx
 AP axial
 Lateral

AP Axial Sacrum
Structures Shown
 The
entire sacrum free of superimposition
Good film:
The pubic bones should not overlap the
sacrum
 No foreshortening (angle 15 degrees up)
 Good even contrast
 No rotation
 Sacrum centered to film
 Good collimation
 Fecal material should not overlap the sacrum

AP Axial coccyx
Here is a list of some of physical traumas that
tailbone sufferers have experienced and reported
from Tailbone.com:
Auto Accident, rear-end collision
Auto Accident, vertical fall from a cliff
Child birth (vaginal) delivery
Dead-lifting of heavy weights or barbells
Fall on the buttocks down the stairs or ladders
Fall on the buttocks during Cheerleading Stunts (Throw & catch or Pyramids)
Fall on the buttocks during gymnastics on a balance beam
Fall on the buttocks during ice skating
Fall on the buttocks during roller blading or in-line skating
Fall on the buttocks during roller skating
Fall on the buttocks during skiing
Fall on the buttocks during snow boarding
Fall on the buttocks from a swing
Fall on the buttocks in a bath tub
Fall on the buttocks in a bathroom
Fall on the buttocks on a frozen sidewalk
Fall on the buttocks on a oily or greased floor
Fall on the buttocks while skate boarding
Horseback riding or falling from a horse
Martial Art accidental contact with buttocks
Prolonged sitting
Sexual intercourse
Sitting during Pregnancy
Sitting on a bicycle seat with gel padding
Sitting on a broken car seat or office chair
Sitting on a thinly padded bicycle seat
Sitting on hard surfaces such as stadium bleachers
Slip and fall on a hard slippery/wet tile floor
Sports injury, accidental kick in the buttocks
Straddle injury on a fence top or tree limb
Water slide drops and jumps
Structures Shown

The whole coccyx and distal sacrum free of
superimposition
Good Film
The coccygeal segments should not be
superimposed by pubic bones (angle)
 Good even contrast
 Coccyx should be centered to film and seen
in its entirety
 No rotation
 Good collimation
 Do they need to use the
restroom?

Lat. Sacrum/coccyx
Structures Shown

The lateral aspect of the entire sacrum and
entire coccyx (**for L-S spine it is okay to clip
coccyx)
Good Film:
The sacrum and coccyx should be seen
clearly with even contrast
 Good collimation
 Superimposed iliac crest

SI joints
AP Axial (same as “up shot” on L-S spine)
 RPO/LPO

AP Axial SI joints
Same as AP axial for L-S spine Junction
RPO/LPO SI joints
R
L
LPO
RPO
Structures shown:
 Shows
the sacroiliac joint farthest from the IR
and an oblique projection of the adjacent
structures
**Always do both obliques for comparison
Good Film:
Open SI joint space with minimal overlapping
of the ilium and sacrum
 Joint centered on the film
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Final Tuesday Dec 7th 2011
7:30-9:30