Vertebral Column

• 5 groups of vertebra

  • Cervical - 7
  • Thoracic - 12
  • Lumbar - 5
  • Sacrum - 5
  • Coccyx - 3 to 5

  
• Vertebral curves


  • Viewed from the side - 4 curves (cervical, thoracic, lumbar and pelvic)
  • Cervical and lumbar - lordotic
  • Thoracic and pelvic - kyphotic

  
• Abnormal curvatures


  • Abnormal posterior convexity of thoracic - kyphosis
  • Abnormal posterior concavity of lumbar - lordosis
  • Abnormal lateral curvature of the spine - scoliosis

  
• Vertebral body


  • Anterior part of vertebra
  • Cylindrical shape
  • Posterior surface - flat
  • Anterior and lateral surface - concave
  • Superior and inferior surface - flat and covered by cartilage

  
• Vertebral arch


  Posterior part of vertebra

  
• Vertebral foramen


  Space enclosed by body and arch, passage of spinal cord and meninges

  
• Main parts of vertebra

  • Vertebral body
  • Vertebral arch
  • 2 pedicles
  • 2 laminae
  • 2 transverse processes
  • 1 spinal process

  
• Basic radiographic projections


  • AP Axial
  • Lateral
  • AP Open mouth (C1-C2)
• Additional radiographic projections


  • Lateral (hyperflexion & hyperextension)
  • Lateral cervicothoracic (swimmer's view)
  • AP axial oblique
• Major types of cervical injuries

  • Flexion and flexion-rotation
  • Hyperextension and extension-rotation
  • Vertical compression
• Other common cervical injuries

  • Hangman's fracture
  • Tear drop fracture
  • Anterior dislocation of C5-6 with tear of interspinal ligaments and posterior fibres of the intervertebral disc
• Osteophytes compress spinal cord, causing hemorrhage and edema, leading to quadriplegia
• Vertebral body burst with characteristic vertical fracture
• Bilateral fracture traversing the par interarticularis of C2
• Subaxial fracture caused by forced extension of the neck with resulting avulsion of the anteroinferior corner of the vertebral body
• Fracture continues sagittally through the vertebral body, and is associated with deformity of the body and subluxation or dislocation of the facet joints at the injured level
• Tech Factors for AP Axial cervical spine

  • Exposure factor 65 - 75 kVp, 16- 18 mAs
  • Film-18 cm x 24 cm
  • FFD-100cm
  • Shielding-Yes

  
• Patient position for AP Axial cervical spine

  • Erect (or supine), MSP centered to midline
  • Arms along the side of trunk; both shoulders lie in the same horizontal plane

  
• Part position for AP Axial cervical spine


  Raise chin slightly if necessary so that the CR angle above the mentum of the lower jaw over the base of the skull (in order to prevent that the lower jaw overlaps more than C1-C2)
• Central ray for AP Axial cervical spine

  • Center beam at 15-20 degrees cranial to MSP at level of C4 (slightly below most prominent point of thyroid cartilage) with suspended respiration
  • Cassette centered to the central ray
  • Beam angle - to compensate lordotic curve of the cervical region

  
• Radiographic criteria for AP Axial cervical spine

  • Contrast and density are adequate to demonstrate the surrounding soft tissue, air filled trachea, and bony structure of the cervical
  • Penetration is enough to visualized the bony trabecular pattern and cortical outline of the vertebral bodies, and spinous processes
  • The spinous processes are aligned with the midline of the cervical bodies
  • The articular pillar and pedicles are symmetrically visualized lateral to the cervical bodies
  • The intervertebral disk are open, the vertebral bodies are demonstrated without distortion, and each spinous process is visualized at the level of its inferior intervertebral disk space
  • The whole of C3 can be visualized and posterior occiput and mandibular mentum are superimposed
  • Long axis of the cervical column is aligned with the long axis of the collimated field

  
• Tech Factors for lateral cervical and upper thoracic spine


  • Grid-Yes; E.F- 65-75 kVp,16-18 mAs
  • Film-18 cm x 24 cm
  • FFD-150cm
  • Shielding-Yes

  
• Patient position for lateral cervical and upper thoracic spine

  • Patient in lateral position, one side of the body closed to erect bucky
  • Center coronal plane that passes thru the mastoid tip to midline if film
  • Patient close to film until one shoulder touching the bucky with both depressed shoulders lie in same horizontal plane
  • Head's MSP parallel to film
  • Elevate chin to prevent superimposition of the mandibular rami with the spine
  • Ask patient to focus to one spot to help maintain the position of the head

  
• Central ray for lateral cervical and upper thoracic spine


  • Horizontal beam centered at plane passing through mastoid at level of C4
  • Expose on arrested expiration (help to depress the shoulder. Apply equal weight to patient's hand - help depress shoulder - immediately before exposure
• Radiographic criteria for lateral cervical and upper thoracic spine

  • Contrast and density are adequate to demonstrate the surrounding soft tissue, air filled trachea, and bony structure of cervical prevertebral fat stripe
  • Penetration is sufficient to visualize the bony trabecular patterns and cortical outlines of the vertebral bodies, zygapophyseal joints, spinous process, mandibular rami
  • The vertebral bodies are demonstrated without pillar superimposition
  • The posterior arc of C1 and spinous process of C2 are shown in profile without posterior occiput superimposition and their bodies are not superimposed with mandible
  • The intervertebral disk, zygapophyseal joints and spinous process of C2 through C7 should be clearly demonstrated

  
• Tech Factors for AP open mouth (C1-C2)

  • Film-18 cm x 24 cm
  • FFD-102-113cm
  • Shielding- Yes
  • E.F- 65-75 kVp,16-18 mAs
  • Grid -Yes
• Patient position for AP open mouth (C1-C2)


  • Patient in supine position
  • Center the MSP of body to the midline of grid
  • Arms along the side of trunk; both shoulders lie in the same horizontal plane
  • Straighten the head without opening the mouth -the biting surface of the upper incisors (joining the lips)to align with the base of the skull (mastoid tips)
  • Centre IR on CR
  • As a last step before taking the picture, open the mouth wide without moving the head (final check of head alignment)
  • Ask patient to keep the mouth wide open and to softly phonate "ah" during the exposure (This will affix the tongue in the floor of the mouth so that its shadow will not be projected on that atlas and axis and will prevent movement of the mandible)
• Central ray for AP open mouth (C1-C2)

  Vertical beam is directed to the midpoint of the mouth
• Radiographic criteria for AP open mouth (C1-C2)

  • AP projection of the atlas and axis through the open mouth
  • Contrast and density are adequate to demonstrate the bony structure of the atlas and axis
  • Penetration is sufficient to visualized the bony trabecular patterns and cortical outlines of the atlas lateral masses and the transverse processes and the transverse processes and the axis's den, spinous process and the body
  • Atlas and axis demonstrate a true AP projection. Atlas is symmetrically seated on the axis, with the atlas's lateral masses at equal distance from the dens. Spinous process of the axis is aligned with the midline of the axis body, and mandibular rami are demonstrated at equal distance from the lateral masses
  • Upper incisors and posterior occiput inferior edge are demonstrated superior to the dens and the atlantoaxial joint
  • Dens is centered within the collimated field
  • Altanto-axial and atlanto-occipital joints, the atlas lateral masses and transverse process, and the axis's dens and body are included within the field
  • Shadow of the tongue not projected over the atlas and axis
• Additional radiographic projections


  • Oblique
  • Fractures
  • Compression
  • Burst
  • Flexion-distraction
  • Fracture-dislocation
  • Scoliosis/ kyphosis
  • Tumour
  • Congenital abnormality
• Diagnosed by lateral view of thoracic spine. Showing as a decrease in vertebral body height of at least 20% (or 4mm reduction) from baseline height

  
• Burst fracture result in disruption of a vertebral body endplate and the posterior vertebral body cortex
• The fracture lines are found to propagate from the spinous process posteriorly through the lamina , pedicles and vertebral body anteriorly
• The presence of 1 or more lateral curvatures of the spine in the coronal plane

  
• Lateral view of spine x-ray shows a curvature of the spine measuring 50 degrees or greater

  
• Tech Factors for lateral thoracic spine

  Grid-Yes; E.F- 80/32 Film-35x43cm. FFD - 100cm

  
• Patient position for lateral thoracic spine

  • Patient lie supine on the x-ray table
  • The head rest on a thin sheet to avoid accentuating the dorsal kyphosis
  • Center MSP of body to midline of grid
  • Arms by the side and shoulder plane is horizontal
  • Flex hips and knees to place the back in contact with table (this will reduce the dorsal kyphosis)
  • Superior cassette is at the level of 4-5cm above shoulders
• Central ray for lateral thoracic spine


  • Direct vertical beam at MSP at the level of T7 approximately 8-10 cm inferior to the jugular notch
  • The top of the IR should be at approximately 1.5 to 2 in above the top of the shoulder
  • Respiration: full arrested expiration OR shallow breathing during exposure to blur out the lung anatomy
• Radiographic criteria for lateral thoracic spine

  • Should included C7 through to L1
  • Contrast and density are adequate to demonstrate the surrounding mediastinum soft tissue and the bony structure of the thoracic vertebra and connecting posterior ribs
  • Penetration is sufficient to visualize the bony trabecular patterns and cortical outline of the vertebral bodies, pedicles, spinous process, posterior ribs and transverse process
  • The spinous process are aligned with the midline of the vertebral bodies
  • The distance from the vertebral column to the medial end of the clavicle are equal
  • The distance from the pedicles to the spinous process are equal on the two sides
  • Long axis of the spine aligns with the long axis of the collimated field. Intervertebral disc are open
  • C7 is centered within the collimated field. C7-L1 are in the collimated field. 5cm of posterior ribs and mediastinum on each side of the spine are included

  
• Tech Factors for lateral scoliosis

  Grid - Yes, EF 90/45 FFD - 100cm. Shielding - Yes