Chapter 8 Cervical and Thoracic Spine

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1

1. How many bones make up the cervical spine?

7

2

2. How many bones make up the thoracic spine?

12

3

3. How many bones make up the lumbar spine?

5

4

4. How many bones make up the sacrum?

1

5

5. How many bones make up the coccyx?

1

6

6. What is the total number of bones in the adult vertebral column?

26

7

7. List the two primary or posterior convex curves seen in the vertebral column?

Thoracic and Sacral

8

8. Indicate which two portions of the vertebral column are classified as secondary or compensatory curves?

Cervical and Lumbar

9

9. Convex curve (with respect to posterior) is associated with what aspect(s) of the vertebral column?

Thoracic spine and Sacrum

10

10. Concave curve ( with respect to posterior) is associated with what aspect(s) of the vertebral column?

Cervical spine and Lumbar spine

11

11. Secondary curve is associated with what aspect of the vertebral column?

Cervical spine and Lumbar spine

12

12. Primary curve is associated with what aspect of the vertebral column?

Thoracic spine and Sacrum

13

13. What aspect of the vertebral column develops as a child learns to hold head erect?

Cervical Spine

14

14. An abnormal, or exaggerated "sway back" lumbar curvature is called?

lordosis

15

15. An abnormal lateral curvature seen in the thoracolumbar spine is called?

scoliosis

16

16. The two main parts of a typical vertebra are?

Body and vertebral arch

17

17. The _________ are two bony aspects of the vertebral arch that extend posteriorly from each pedicle to join at the midline.

Lamina

18

18.The ______ foramina are created by two small notches on the superior and inferior aspects of the pedicles

Intervertebral

19

19. The opening, or passageway, for the spinal cord is the?

vertebral canal

20

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 _________?

Medulla oblongata

Lower border L1

Conus medullaris

21

21. Which structures pass through the intervertebral foramina?

Spinal nerves & blood vessels

22

22. What is found between the superior and inferior articular processes?

Zygapophyseal joints

23

23. True or False: Only T1, T11, and T12 have full facets for articulation with ribs.

True

24

24. True or False: The zygapophyseal joints of all cervical vertebrae are visualized only in a true lateral position?

False

25

25. Outer and inner aspects of the intervertebral disk

Annulus fibrous and inner aspect nucleus pulposus

26

26. The condition involving a "slipped disk" is correctly referred to as?

herniated nucleus pulposus

27

27. Alternate name for C1

atlast

28

28. Alternate name for C2

Axis

29

29. Alternate name for C7

Vertebra prominence

30

30. Three features that make the cervical vertebrae unique

1. Transverse foramina

2. Bifid spinous process

3. Overlapping vertebral bodies

31

31. A short column of bone found between the superior and articular processes in a typical cervical vertebra is called

Articular pillar

32

32. What is the term for the Articular pillar for the C1 vertebra?

Lateral mass

33

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?

90

70-75

34

34. What is the name of the joint found between the superior articular processes of C1 and the occipital condyles of the skull?

occipitoaltantal articulation

35

35. The modified body of C2 is called the ________ or __________?

Dens or Odontoid process

36

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

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

38. The upper portion of the sternum

Manubrium

39

39. Superior margin of the manubrium

jugular notch

40

40. Center portion of the sternum

body

41

41. Most inferior aspect of the sternum

xiphoid process

42

42. Gonion is at what vertebral level

C3

43

43. Xiphoid process is at what vertebral level

T9-T10

44

44. Thyroid cartilage is at what vertebral level

C4-C6

45

45. Jugular notch is at what vertebral level

T2-T3

46

46. Sternal angle is at what vertebral level

T4-T5

47

47. Mastoid tip is at what vertebral level

C1

48

48. Vertebra prominens is at what vertebral level

C7-T1

49

49. 30 to 4 inches below jugular notch is at what vertebral level

T7

50

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

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

52. True or False: When using digital imaging for spine radiography, it is important to use close collimation, grids, and lead masking.

True

53

53. True or False: If close collimation is used during conventional radiography of the spine, the use of lead masking is generally not required.

False

54

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.

True

55

55. Nuclear medicine is often performed to diagnose bone tumors of the spine.

True

56

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

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

58. Fracture through the pedicles and anterior arch of C2 with forward displacement upon C3

Hangman's fracture

59

59. Inflammation of the vertebrae

Spondylititis

60

60. Abnormal or exaggerated convex curvature of the thoracic spine

Kyphosis

61

61. Comminuted fracture of the vertebral body with posterior fragments displaced into the spinal canal

Teardrop burst fracture

62

62. Avulsion fracture of the spinous process at C7

Clay shoveler's fracture

63

63. Abnormal lateral curvature of the spine

Scoliosis

64

64. A form of rheumatoid arthritis

Ankylosing spondylitis

65

65. Impact fracture from axial loading of the anterior and posterior arch C1

Jefferson fracture

66

66. Mild form of scoliosis and kyphosis developing during adolescence

Scheuermann disease

67

67. Produces the "bow tie" sign

Unilateral subluxation

68

68. Conventional radiographic examination and or projections for Scoliosis

Erect (AP/PA) & lateral spine including bending laterals

69

69. Conventional radiographic examination and or projections for Teardrop burst fracture

lateral cervical

70

70. Conventional radiographic examination and or projections for Jefferson fracture

AP, Open mouth C1, C2 Tomography for lateral

71

71. Conventional radiographic examination and or projections for Scheuermann disease?

Scoliosis series

72

72. Conventional radiographic examination and or projections for unilateral subluxation of cervical spine

lateral cervical spine

73

73. Conventional radiographic examination and or projections for HNP

Lateral of affected side

74

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

75. True or False: Many geriatric patients have a fear of following off the radiography table.

True

76

76. What is the name of the radiographic procedure that requires the injection of contrast media into the subarachnoid space.

Myelography

77

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

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.

Compression fractures

79

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.

Hangman's fracture

80

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.

Jefferson fracture

81

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.

Odontoid fracture

82

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

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

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

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.

Kyphosis

86

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.

Scoliosis

87

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.

Osteoarthritis

88

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.

Osteoporosis

89

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.

Scheuermann's Disease

90

90. Inflammation of the vertebrae

Spondylitis

91

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.

Ankylosing spondylities

92

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.

Spondylosis

93

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.

Transitional vertebra

94

94. Which imaging modality is ideal for detecting early signs of osteomyelitis?

Nuclear medicine

95

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

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.

False

97

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

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

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.

True

100

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

101. What CR angulation must be used with a posterior oblique projection of the cervical spine?

15 Degree Cephalad

102

102. Which foramina are demonstrated with a left posterior oblique position of the cervical spine?

Right intervertebral foramina (upside)

103

103. Which foramina are demonstrated with a left anterior position of the cervical spine?

Left intervertebral foramina (downside)

104

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

105. What is the recommended SID for a lateral projection of the cervical spine?

72 inches or 60

106

106. The lateral projection of the cervical spine should be taken during expiration why?

for maximum shoulder depression

107

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

108. The proper name of the method for performing the cervicothoracic lateral swimmers position is the?

Twinning method

109

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

110. What region of the spine must be demonstrated with a cervicothoracic lateral swimmers position?

C2 to T3

111

111. Which projections is considered a functional study of the cervical spine?

Hyperextension and hyperflexion lateral position

112

112. When should the judds or fuchs method be performed?

If unable to demonstrate the upper portion of the dens.

113

113. Which AP projection of the cervical spine demonstrates the entire upper cervical spine with one single projection?

AP wagging jaw ottonello method

114

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

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

116. Which zygapophyseal joints are demonstrated in a right anterior oblique projection of the thoracic spine?

RIght (downside)

117

117. Which projection delivers the greatest skin dose to the patient?

Cervicothoracic lateral position

118

118. Which structure is best demonstrated with an AP axial vertebral arch projection of the cervical spine?

Articular pillars of cervical spine

119

119. What central ray angle must be used with the AP axial - vertebral arch projection?

20 degrees to 30 degrees caudad

120

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

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

122. Which zygapophyseal joints are best demonstrated with an LPO position of the thoracic spine

Right

123

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

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

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

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

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

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

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

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

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

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

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

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

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

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

137. A patient comes to the radiology department with a clinical history of Scheuermann disease. Which radiographic procedure is often performed for this condition?

Scoliosis series