1
LUMBAR SPINE
SACRUM COCCYX
SI JOINTS
SCOLIOSIS
RT 124 2008-10
WEEK 7
2
LUMBAR SPINE
AP,
AP AXIAL (HIBBS)
BOTH OBLIQUES
LAT,
L5-S1 SPOT
3
4
5
6
7
LUMBAR SPINE SERIES
SEQUENCE
AP
AP AXIAL (HIBBS)
BOTH OBLIQUES
LAT,
L5-S1 SPOT
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AP
9
10
11
12
13
14
15
AP NO FLEX
LEGS FLEX
PA
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17
collimation
18
AP AXIAL HIBBS
19
“HIBBS” METHOD
20
21
22
Flex
legs
shield
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CRITIQUE
•
•
The positioning error suggested is
insufficient CR angulation
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OBLIQUES
RPO & LPO
25
26
27
28
29
30
31
32
•
•
•
•
•
•
•
•
A body
E transverse process
D pedicle
O superior articular
facet, left
P pars
interarticularis, left
R inferior articular
facet, left
I apophyseal
(interfacetal) joint, left
V disk space
33
34
35
36
30 – 50 degrees
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L5 –S1
30 degrees
•38The AP and PA oblique
projections are helpful in
demonstrating spondylolysis.
What is the definition of this
condition?
• Spondylolysis is defined as the
breaking down of the vertebra,
usually at the pars
interarticularis of the lumbar
vertebrae. It is an acquired bony
defect that may affect one or both
sides of the lamina between the
articular processes of the
vertebrae.
39
• Critique?
• The positioning error
suggested is overobliquity or excessive
rotation of the patient.
40
• Zygapophyseal
joints and
pedicles are
posterior to the
vertebral body
and indicate
over-obliquity
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• AP OBIQUE – CRITIQUE
• The positioning error
suggested is
insufficient obliquity or
rotation of the patient
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LUMBAR SPINE
LAT
43
44
45
46
47
48
More on this at the
end of the slides
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50
51
52
LUMBAR SPINE
L5-S1 SPOT
53
54
55
56
57
58
59
Oblique vs Lat
60
61
SPINA BIFIDA
62
ankylosing spondylitis
• Ankylosing spondylitis is
a rheumatoid arthritis
involving the SI joints and
spine,
• It is characterized
radiographically by
ossification of the outer
portion of the annulus
fibrosus and osteophyte
formation between the
vertebrae (bone
spurring).
63
Facets distroyed
“BAMBOO SPINE”
64
65
spurring
66
• What are the major differences
between spondylolysis and
spondylolisthesis?
• Spondylolisthesis is the forward
displacement of one vertebra on
another vertebra. It is a
degenerative or congenital
condition predominantly seen at the
L5–S1 level. This condition almost
exclusively involves the lumbar
spine
•67The AP and PA oblique
projections are helpful in
demonstrating spondylolysis.
What is the definition of this
condition?
• Spondylolysis is defined as the
breaking down of the vertebra,
usually at the pars
interarticularis of the lumbar
vertebrae. It is an acquired bony
defect that may affect one or both
sides of the lamina between the
articular processes of the
vertebrae.
68
•
•
•
•
•
•
•
•
A body
E transverse process
D pedicle
O superior articular
facet, left
P pars
interarticularis, left
R inferior articular
facet, left
I apophyseal
(interfacetal) joint, left
V disk space
69
Spondylolisthesis
70
CRITIQUE
71
CRITIQUE
72
CRITIQUE
73
CRITIQUE
74
75
X-TABLE LATERAL
76
SACRUM COCCYX
AP AXIAL
SACRUM – CEPAHLIC
COCCYX – CAUDAL
LATERAL (s)
77
78
79
80
Flex
legs
shield
81
82
83
84
AP AXIAL L5 SI SPOT
HIBBS
85
86
87
88
89
90
91
92
93
94
95
96
97
98
SACRAL ILIAC JOINTS
AP – AXIAL
BOTH OBLIQUES
(SIDE UP)
99
100
101
102
“HIBBS” METHOD
103
Unilateral (usually bilateral)
104
105
PA - With no rotation of patient
106
107
108
109
110
111
112
SIDE UP
(SIDE UP)
SIDE DOWN
SIDE UP
113
SPINE – POSITIONS FOR
BEST SEEN?
• INTERVERTEBRAL FORAMEN
• ZYGOAPOPHYSEAL ARTICUALTIONS
•
•
•
•
C.SP
T.SP
L.SP
SI joints
114
Scoliosis series
115
116
117
LONG SID 72” +
14 X 36” GRID CASSETTE
118
119
120
121
122
SHOULD
INCLUDE
TO
ACETABULUM
123
124
125
126
127
128
72 – 80 “ SID
129
130
131
132
133
• Scoliosis cassette
• 14x 36”
• Different speed
screens
• Top to bottom
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Remove bucky tray
135
OTHER POSTIONS
LECTURE ONLY
• What projections can be taken to
determine the range of motion of the spine
at the level of the spinal fusion?
• FLEXION / EXTENSION
• BENDING (LATERAL)
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bending
•These projections are functional studies of the lumbar spine to
determine the range of motion of the spine at the point of spinal fusion.
• Following spinal fusion surgery, the orthopedic physician or
neurosurgeon may order a study to evaluate the flexibility of the spine.
•These projections will require the patient to assume different positions to
determine how much flexibility of the spine has returned.
•Early signs of scoliosis and herniated intervertebral disk or HNP can be
evaluated with these projections.
137
138
Flexion / extenison
139
140
What is HNP ?
• HNP refers to
Herniated Nucleus
Pulposus
• a situation in which
the nucleus pulposus
extrudes through an
aspect of the annulus
fibrosus of the
intervertebral disk.
141
laminectomy
• The term laminectomy is defined as the
surgical removal of the bony arch of one or
more vertebrae. Laminectomy is
performed to remove a portion of the
intervertebral disk to relieve compression
of the spinal cord or one of the spinal
nerves due to HNP. An aspect of the bony
arch must be removed to provide access
to the herniated disk.
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MORE IMAGE REVIEW
NEXT WEEK
REVIEW ELSEIVER AS WELL!