Chapter 8 Cervical and Thoracic Spine
1. How many bones make up the cervical spine?
2. How many bones make up the thoracic spine?
3. How many bones make up the lumbar spine?
4. How many bones make up the sacrum?
5. How many bones make up the coccyx?
6. What is the total number of bones in the adult vertebral column?
7. List the two primary or posterior convex curves seen in the vertebral column?
Thoracic and Sacral
8. Indicate which two portions of the vertebral column are classified as secondary or compensatory curves?
Cervical and Lumbar
9. Convex curve (with respect to posterior) is associated with what aspect(s) of the vertebral column?
Thoracic spine and Sacrum
10. Concave curve ( with respect to posterior) is associated with what aspect(s) of the vertebral column?
Cervical spine and Lumbar spine
11. Secondary curve is associated with what aspect of the vertebral column?
Cervical spine and Lumbar spine
12. Primary curve is associated with what aspect of the vertebral column?
Thoracic spine and Sacrum
13. What aspect of the vertebral column develops as a child learns to hold head erect?
14. An abnormal, or exaggerated "sway back" lumbar curvature is called?
15. An abnormal lateral curvature seen in the thoracolumbar spine is called?
16. The two main parts of a typical vertebra are?
Body and vertebral arch
17. The _________ are two bony aspects of the vertebral arch that extend posteriorly from each pedicle to join at the midline.
18.The ______ foramina are created by two small notches on the superior and inferior aspects of the pedicles
19. The opening, or passageway, for the spinal cord is the?
20. The spinal cord begins with the _______ of the brain and extends down to the __________ vertebra, where is tapers and ends. This tapered ending is called the _________?
Lower border L1
21. Which structures pass through the intervertebral foramina?
Spinal nerves & blood vessels
22. What is found between the superior and inferior articular processes?
23. True or False: Only T1, T11, and T12 have full facets for articulation with ribs.
24. True or False: The zygapophyseal joints of all cervical vertebrae are visualized only in a true lateral position?
25. Outer and inner aspects of the intervertebral disk
Annulus fibrous and inner aspect nucleus pulposus
26. The condition involving a "slipped disk" is correctly referred to as?
herniated nucleus pulposus
27. Alternate name for C1
28. Alternate name for C2
29. Alternate name for C7
30. Three features that make the cervical vertebrae unique
1. Transverse foramina
2. Bifid spinous process
3. Overlapping vertebral bodies
31. A short column of bone found between the superior and articular processes in a typical cervical vertebra is called
32. What is the term for the Articular pillar for the C1 vertebra?
33. The zygapophyseal joints for the second through seventh cervical vertebrae are a _____ degree angle to the midsagittal plane; the thoracic vertebrae are at _______ degree to the midsagittal plane?
34. What is the name of the joint found between the superior articular processes of C1 and the occipital condyles of the skull?
35. The modified body of C2 is called the ________ or __________?
Dens or Odontoid process
36. A lack of symmetry of the zygapophyseal joints between C1 and C2 may be caused by injury or may be associated with
rotation of the skull
37. What is the unique feature of all thoracic vertebrae that distinguishes them from other vertebrae
Presence of the facets for articulation with ribs
38. The upper portion of the sternum
39. Superior margin of the manubrium
40. Center portion of the sternum
41. Most inferior aspect of the sternum
42. Gonion is at what vertebral level
43. Xiphoid process is at what vertebral level
44. Thyroid cartilage is at what vertebral level
45. Jugular notch is at what vertebral level
46. Sternal angle is at what vertebral level
47. Mastoid tip is at what vertebral level
48. Vertebra prominens is at what vertebral level
49. 30 to 4 inches below jugular notch is at what vertebral level
50. In addition to the gonads, which other radiosensitive organs are of greatest concern during cervical and thoracic spine radiography
Thyroid, parathyroid glands and breasts
51. Two advantages of using higher kV exposure factors for spine radiography, especially on an AP thoracic spine radiograph.
Increase in exposure latitude
Decrease in patient does.
52. True or False: When using digital imaging for spine radiography, it is important to use close collimation, grids, and lead masking.
53. True or False: If close collimation is used during conventional radiography of the spine, the use of lead masking is generally not required.
54. True or False: To a certain degree, MRI and CT are replacing myelography as the imaging modalities of choice for the diagnosis of a ruptured inverted disk.
55. Nuclear medicine is often performed to diagnose bone tumors of the spine.
56. To ensure the intervertebral joint spaces are open for lateral thoracic spine projection, it is important to
Keep the vertebral column parallel to the IR
57. For lateral and oblique projections of the cervical spine, it is important to minimize magnification and maximize detail by
Using a small focal spot and increasing source image receptor distance
58. Fracture through the pedicles and anterior arch of C2 with forward displacement upon C3
59. Inflammation of the vertebrae
60. Abnormal or exaggerated convex curvature of the thoracic spine
61. Comminuted fracture of the vertebral body with posterior fragments displaced into the spinal canal
Teardrop burst fracture
62. Avulsion fracture of the spinous process at C7
Clay shoveler's fracture
63. Abnormal lateral curvature of the spine
64. A form of rheumatoid arthritis
65. Impact fracture from axial loading of the anterior and posterior arch C1
66. Mild form of scoliosis and kyphosis developing during adolescence
67. Produces the "bow tie" sign
68. Conventional radiographic examination and or projections for Scoliosis
Erect (AP/PA) & lateral spine including bending laterals
69. Conventional radiographic examination and or projections for Teardrop burst fracture
70. Conventional radiographic examination and or projections for Jefferson fracture
AP, Open mouth C1, C2 Tomography for lateral
71. Conventional radiographic examination and or projections for Scheuermann disease?
72. Conventional radiographic examination and or projections for unilateral subluxation of cervical spine
lateral cervical spine
73. Conventional radiographic examination and or projections for HNP
Lateral of affected side
74. What are major differences between spondylosis and spondylitis
Spondylitis is an inflammatory process of vertebrae and spondylosis is a condition of the spine characterized by rigidity of vertebral joint.
75. True or False: Many geriatric patients have a fear of following off the radiography table.
76. What is the name of the radiographic procedure that requires the injection of contrast media into the subarachnoid space.
77. This fracture is, which results from hyperflexion of the neck, results in avulsion fractures on the spinous process of C6-T1. This fracture is best demonstrated on a lateral cervical spine radiograph.
Clay shoveler's fracture
78. Frequently associated with osteoporosis, a compression fracture often involves collapse of a vertebral body, which results from flexion or axial loading most often in the thoracic or lumbar regions. It also can result from severe kyphosis caused by other diseases. The anterior edge collapses, changing the shape of the vertebral body into a wedge instead of a block. This increases kyphosis and may compromise respiratory and cardiac function; it also frequently results in injury to the spinal cord. Theses fractures are best demonstrated on a lateral projection of the affected region of the spine.
79. This fracture extends through the pedicles of C2, with or without subluxation of C2 on C3. This cervical fracture occurs when the neck is subjected to extreme hyperextension. The patient, if alive is not stable because the inact dens is pressed posteriorly against the brainstem. A lateral projection of the cervical spine will demonstrate the anterior displacement of C2.
80. This comminuted fracture occurs as a result of axial loading, such as that produced by landing on one's head or abruptly on one's feet. The anterior and posterior arches of C1 are fractured as the skull slams onto the ring. The AP open mouth projection and lateral cervical spine projections will demonstrate this fracture.
81. This fracture involves the dens and can extend into the lateral masses or arches of C1. An AP open mouth projection will demonstrate any disruption of the arches of C1.
82. The mechanism of injury is compression with hyperextension in the cervical region. The vertebral body is comminuted, with triangular fragments avulsed from the anteroinferior border and fragments from the posterior vertebral body displaced into the spinal canal. Neurological damage (usually quadriplegia) is a high probability. Based on the extent of the fracture and possible spinal cord involvement, CT scanning usually is indicated once a baseline lateral and AP projections of the cervical spine have been taken.
Teardrop burst fracture
83. Zygapophyseal joints in the cervical region can be disrupted during trauma. If the patients injury involves flexion, distraction, and rotation, only one zygapophyseal joint may be out of alignment. Radiographically, the vertebral body will be rotated on its axis, creating a bowtie artifact on the lateral cervical spine image. If the patient's injury involves extreme flexion and distraction, both right and left zygapophyseal joints on the same level can be disrupted, creating bilateral locked facets. Radiographically, the vertebral body will appear to have jumped over the vertebral body immediately inferior to it. In either case, the spine is not stable because the spinal cord is distressed by this manipulation. Following the AP and lateral projections of the cervical spine, CT scanning of the spine generally is indicated.
Facets- unilateral subluxation and bilateral locks
84. If the soft inner part (nucleus pulposus) of an intervertebral disk protrudes through the fibrous cartilage outer layer (annulus) into the spinal canal, it may press on the spinal cord or spinal nerves, causing severe pain and possible numbness that radiate into the extremities. This condition sometimes is called slipped disk. This is well demonstrated by MRI of the cervical spine region. This condition can affect cervical spine however, it more frequently involves levels L4 through L5.
Herniated Nucleus Pulposus (HNP)
85. An abnormal or exaggerated convex curvature of the thoracic spine that results in stooped posture and reduced height. May be caused by compression fractures of the anterior edges of the vertebral bodies in osteoporotic patients, particularly postmenopausal women. It also may be caused by poor posture, ricketts, or other diseases involving the spine. A lateral projection of the spine will best demonstrates this fracture.
86. Although many individuals normally have some slight lateral curvature of the thoracic spine, an abnormal or exaggerated lateral curvature of the spine. It is most common in children between the ages of 10 and 14 years and is more common in girls. It may require the use of a back brace for a time, until the condition of vertebral stability improves. This deformity, if severe enough, may complicate cardiac and respiratory function. The effect may be more obvious if it occurs in the lower vertebral column, where it may create tilting of the pelvis with a resultant effect on the lower ribs, producing a limp, or uneven walk.
87. This type of arthritis is characterized by degeneration of one or many joints. In the spine, changes may include bony sclerosis, degeneration of cartilage, and formation of osteophytes.
88. This condition is characterized by loss of bone mass. Bone loss increases with age, immobilization, long-term steroid therapy, and menopause. The condition predisposes individuals to vertebral and hip fractures. Bone densitometry has become the gold standard for measuring the degree.
89. A relatively common disease of unknown origin that generally begins during adolescence. It results in the abnormal spinal curvature of kyphosis and scoliosis. It is more common in boys than girls. Most cases are mild and continue for several years, after which symptoms disappear but some spinal curvature remains.
90. Inflammation of the vertebrae
91. The systemic illness of unknown origin involves the spine and larger joints. It predominantly affects men from 20 to 40 and results in pain and stiffness that results from inflammation of the sacroiliac, intervertebral, and costovertebral joints, as well as paraspinal calcification, with ossification. It may cause complete rigidity of the spine and thorax, which usually is seen first in the sacroiliac joints.
92. The characteristics of this condition is neck stiffness due to age-related degeneration of intervertebral disks. The condition can contribute to arthritic changes that may affect the zygapophyseal joints and intervertebral foramen.
93. An incidental finding that occurs when the vertebra takes on a characteristic of the adjacent region of the spine. A transitional vertebra occurs most often in the lumbosacral region in which the vertebrae possess enlarged transverse processes. Another example involves the cervical and lumbar ribs. A cervical rib is a rudimentary rib that projects laterally from C7 but does not reach the sternum. A lumbar rib occurs as an outgrowth of bone extending from the transverse processes of L1.
94. Which imaging modality is ideal for detecting early signs of osteomyelitis?
95. Which two landmarks must be aligned for an AP open mouth projection?
Lower margin of the upper incisors and base of the skull
96. True or False: The tip of the odontoid process does not have to be demonstrated on the AP "open mouth" projection because it is best seen on the lateral projection.
97. What is the purpose of the 15 to 20 degree angle for the AP axial projection of the cervical spine?
To open up the intervertebral disk spaces.
98. For an AP axial of the cervical spine, a plane through the tip of the mandible and the ________ should be parallel to the angled CR.
Base of the skull
99. True or False: Less CR angle is required for the AP axial projection of the cervical spine if the examination is performed supine rather than erect.
100. What are two important benefits of an SID longer than 40 to 44 inches for the lateral cervical spine?
compensates for Increased OID and less divergence of x-ray beam to reduce shoulder superimposition of C7
101. What CR angulation must be used with a posterior oblique projection of the cervical spine?
15 Degree Cephalad
102. Which foramina are demonstrated with a left posterior oblique position of the cervical spine?
Right intervertebral foramina (upside)
103. Which foramina are demonstrated with a left anterior position of the cervical spine?
Left intervertebral foramina (downside)
104. In addition to extending the chin, which additional positioning technique can be performed to ensure that the mandible is not superimposed over the upper vertebrae for oblique projections?
Rotate the skull into a near lateral position
105. What is the recommended SID for a lateral projection of the cervical spine?
72 inches or 60
106. The lateral projection of the cervical spine should be taken during expiration why?
for maximum shoulder depression
107. Which specific projection must be taken first if trauma to the cervical spine is suspected and the patient is in a supine position on a backboard?
Lateral, horizontal beam projection
108. The proper name of the method for performing the cervicothoracic lateral swimmers position is the?
109. Where should the CR be placed for a cervicothoracic lateral swimmers position?
To T1. 1 inch above the jugular notch anteriorly or level of vertebral prominence posteriorly.
110. What region of the spine must be demonstrated with a cervicothoracic lateral swimmers position?
C2 to T3
111. Which projections is considered a functional study of the cervical spine?
Hyperextension and hyperflexion lateral position
112. When should the judds or fuchs method be performed?
If unable to demonstrate the upper portion of the dens.
113. Which AP projection of the cervical spine demonstrates the entire upper cervical spine with one single projection?
AP wagging jaw ottonello method
114. Which two things can be done to produce equal density along the entire thoracic spine for the AP projection?
Correct use of anode heel effect, use of compensating filters
115. What is the purpose of using an orthostatic (breathing) technique for a lateral projection of the thoracic spine?
To blurr out rib and lung markings that obscure detail of the thoracic vertebrae.
116. Which zygapophyseal joints are demonstrated in a right anterior oblique projection of the thoracic spine?
117. Which projection delivers the greatest skin dose to the patient?
Cervicothoracic lateral position
118. Which structure is best demonstrated with an AP axial vertebral arch projection of the cervical spine?
Articular pillars of cervical spine
119. What central ray angle must be used with the AP axial - vertebral arch projection?
20 degrees to 30 degrees caudad
120. What ancillary device should be placed behind the patient on the tabletop for a recumbent lateral projection of the thoracic spine?
lead mat or masking
121. Which skull positioning line is aligned for perpendicular to the IR for a PA (judd) projection for the odontoid process?
Mentomeatal line (MML)
122. Which zygapophyseal joints are best demonstrated with an LPO position of the thoracic spine
123. How much rotation of the body is required for an oblique position of the thoracic spine from a true lateral position?
20 degrees from lateral position
124. A radiograph of an AP open mouth projection of the cervical spine reveals that the base of the skull is superimposed over the upper odontoid process. What positioning error is present in the radiograph
excessive rotation of the skull
125. A radiograph of an AP axial projection of the cervical spine reveals that the intervertebral disk spaces are not open. The following positioning factors were used. Extension of the skull, central ray angles 10 degrees cephalad, central ray centered to the thyroid cartilage, and no rotation or tilt of the spine. Which factor must be modified to produce a more diagnostic image?
Increase CR angulation to 15 degrees cephalad
126. A radiograph of a RPO cervical spine projection reveals that the lower intervertebral foramina are NOT open. The upper intervertebral foramina are well visualized. What positioning error most likely led to this radiographic outcome.
When the lower intervertebral foramina are narrowed while the upper foramina are well demonstrated, often over rotation of the upper body occured.
127. A radiograph on a lateral projection of the cervical spine reveals that C7 is not clearly demonstrated. The following factors were used: erect position, 44 inch SID, arms down by the patients side, and exposure made during inspiration. Which of these factors should be changed to produce a more diagnostic image during the repeat exposure?
Initiate exposure during suspended expiration and increase SID to 72 inches
128. A radiograph of an AP wagging jaw projection was taken at 75 kV, and 20 mAs, and 0.5 seconds demonstrates that part of the image of the mandible is still visible and obscuring the upper cervical spine. Which modification needs to be made to produce a more diagnostic image during the repeat exposure
Reduce mAs and increase exposure time to produce more blurring of the mandible
129. A radiograph of an AP projection of the thoracic spine reveals that lung markings and ribs make it difficult to visualize the vertebral bodies. The following factors were used: recumbent position, 40 inch SID, short exposure time, and exposure made during full expiration. Which one of these factors must be modified to produce a more diagnostic image during the repeate exposure?
Use of an orthostatic (breathing) technique to blurr lung markings and ribs more effectively.
130. A radiograph of an AP projection of the thoracic spine reveals that the upper thoracic spine is greatly overexposed but the lower vertebrae are well visualized. The head of the patient was placed at the anode end of the table. What can be modified during the repeat exposure to produce a more diagnostic image?
Use a compensating filter with thicker part of filter placed over the upper thoracic spine to equalize the density along the T-spine.
131. A radiograph of cervicothoracic lateral position demonstrates superimpositions of the humeral head over the upper thoracic spine. Because of an arthritic condition, that patient is unable to rotate the shoulders any further apart. What can the technologist do to further separate the shoulders during the repeat exposure?
Angle CR 3 to 5 degrees caudad.
132. A patient with a possible cervical spine injury enters the emergency room. The patient is on a backboard. Which projection of the cervical spine should be taken first
Horizontal beam lateral projection
133. A patient comes to the radiology department for a cervical spine series. An AP open mouth projection indicates that the base of the skull and lower edge of the front incisors are superimposed, but the top of the dens is not clearly demonstrated. what should the technologist do to demonstrate the upper portion of the dens? (A horizontal beam lateral projection has ruled out a c-spine fracture or subluxation)
Perform either a AP Fuchs or PA Judd method.
134. A patient comes to the radiology department for a routine cervical spine series. The lateral projection demonstrates only the C1 to C6 region. The radiologist wants to see C7- T1. What additional projection can be taken to demonstrate this region of the spine?
cervicothoracic swimmers lateral
135. A patient enters the ER with a possible cervical spine fracture, but the initial projections do not demonstrate any gross fractures or subluxation. After reviewing the initial radiographs, the ER physician suspects either a congenital defect or fracture of the articular pillars of C4. He wants an additional projection taken to better see this aspect of the vertebrae. What additional projection can be taken to demonstrate the articular pillars of C4?
AP axial - vertebral arch (pillar) projection
136. A patient comes to the ER with a possible Jefferson fracture. Other than a lateral projection or a CT scan, what specific radiographic projection will best demonstrate this type of fracture?
AP openmouth projection (carefully)
137. A patient comes to the radiology department with a clinical history of Scheuermann disease. Which radiographic procedure is often performed for this condition?