Wk 1- Cervical and Thoracic Spine

• The spinal canal houses and protects the spinal cord
• The spinal cord extends from the medulla oblongata to the conus medullaris (L1)
• How many vertebrae:

  • Cervical: 7
  • Thoracic: 12
  • Lumbar: 5
  • Sacrum: 4 fused into 1
  • Coccyx: 4 fused into 1
  • 26 total in adults
• Vertebral curvatures:

  • Cervical: concave (1st compensatory curve)
  • Thoracic: convex (1st primary curve)
  • Lumbar: concave (2nd compensatory curve)
  • Sacral: convex (2nd primary curve)
• Kyphosis: exaggerated thoracic curvature; increased convexity
• Lordosis: exaggerated lumbar curvature; increased concavity
• Scoliosis: abnormal lateral curvature of the spine; best seen in a AP view
• HNP: Herniated nucleus pulpous; a condition where the jelly-like nucleus pulposus is forced to leak out
• Annulus Fibrous: Outer fibrous portion of intervertebral disk

  Nucleus Pulposus: Inner jelly-like portion of intervertebral disk
• Zygapophyseal joints are present bilaterally in cervical through lumbar areas
• Costal joints are the joints between the ribs and the vertebrae; present only in the thoracic area
• C1 (aka Atlas):

  • doesn't have a body
  • articulates with the condyles of the occipital bone (this is an ellipsoidal joint type)
• C2 (aka Axis):

  • Has a dens/odontoid
  • Articulates with C1 to form a pivot joint
• C3-C6(typical cervical vertebrae):

  • Have bifid tips
  • Small transverse process (what size?)
  • Their bodies overlap
• C7:

  • No bifid tips
  • Long vertebral prominence
• C-SPine Articulations:

  • Zygagopophyseal joints are at 90 degrees to MSP (seen laterally)
  • Intervertebral foramina are at 45 degrees to MSP and a 15 degree inferior angle
• C-Spine obliques and intervertebral foramen in profile:

  • LAO: Left IVF
  • RAO: Right IVF
  • LPO: Right IVF
  • RPO: Left IVF
• C-Spine Landmarks:

  • EAM: Top of C1 (?)
  • Mastoid tip: C1
  • Gonion: C3
  • Thyroid cartilage: C4 to C6
  • Vertebra prominens: C7-T1
• T-Spine distinctive feature:

  • Rib articulations (facets and demifacets)
  • Caudally pointed spinous processes
  • T1-T4: smaller and resemble cervical vertebrae
  • T5-T8: typical thoracic vertebrae
  • T9-T12: larger and resemble lumbar vertebrae
  • T11-T12: Dont have facets for costotransverse joints (because of floating ribs?)
• T-Spine Articulations:

  • Costovertebral: The head of the rib articulates with the facet on the vertebral body
  • Costotransverse: The tubercle of the rib articulates with the facet on the transverse process
• T-Spine Joints:

  • Zygapophyseal: at a 70 to 75 degree angle from MSP (seen on a 70 degree oblique)
  • Intervertebral: at 90 degrees from MSP (seen in a lateral)
• T-Spine obliques and Z-Joint seen in profile:

  • LAO: Left ZJ
  • RAO: Right ZJ
  • LPO: Right ZJ
  • RPO:Left ZJ
• Jefferson Fx: Commuted fracture of C1 on both sides
• Compression Fx: Too much pressure on the vertebral body that causes a small break or crack in it.
• Odontoid Fx's:

  • Type 1: At the upper part of the odontoid peg; is rare and potentially unstable
  • Type 2: At the base of odontoid; unstable and high risk of non-union
  • Type 3: Through the odontoid and into the lateral mass; best prognosis for healing
• HNP: Herniated Nucleus Pulpous; the nucleus pulposus is pushed out of the intervertebral foramen and results in back pain and nerve root irritation
• Osteoarthritis/Spondylosis: Wear and tear in the cervical spinal disks
• Osteoporosis: the bones become brittle and fragile from loss of tissue
• Ankylosing Spondylitis: A chronic inflammatory disease that causes the vertebrae to fuse together, causing a hunchback
• Spina bifida: Spinal canal doesn't close and spinal cord is exposed; seen in newborns
• Spondylolisthesis: Forward displacement of the vertebrae; best seen in a lateral image
• Scoliosis: Abnormal lateral curvature of the spine.
• Spondylolysis: A stress fracture through the PARS interarticularis of the L-spine
• C-Spine Routine:

  • Lateral
  • AP Axial
  • AP Open Mouth
  • Bilateral Obliques
• C-Spine Special Views:

  • Flexion and extension
  • Trauma lateral
  • Fuch's
  • Judd
  • Swimmer's lateral
• AP axial c-spine:

  • 15-20 cephalic angle
  • 40" SID
  • The lower margin of upper incisors and mastoid tip is perpendicular to IR
  • CR to C4 (thyroid cartilage)
• Lateral c-spine:

  • 72" SID
  • AML parallel to floor
  • CR to C4 (top light to top of ear)
• AP open mouth:

  • SID 40"
  • CR to center of mouth
  • Upper incisors and base of skull should be superimposed
• C-Spine obliques:

  • 15 angle (Posterior- Cephalad; Anterior- Caudad )
  • MSP rotated 45 degrees
  • CR to C4 (top light at top of ear)
  • 40" SID
• Trauma lateral c-spine:

  • Do not move neck or head !!
  • CR to C4 (top of light at top of ear)
  • Done crosswise on table
  • 60 to 72" SID