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Radiographic anatomy of vertebral column
- 1. RADIOGRAPHIC ANATOMY OF VERTEBRALCOLUMN Donisha K Johnson MSc. Medical technology, Semester I , Specialisation: Imaging Sciences
- 5. VETREBRAL COLUMN Thevertebral column, or spine, forms the central axis of the skeleton and is centered in the midsagittal plane of the posterior part of the trunk. The vertebral column is composed of small segments of bone called vertebrae. Disks of fibrocartilage are interposed between the vertebrae and act as cushions. The vertebral column is held together by ligaments, and it is jointed and curved so that it has considerable flexibility and resilience The seven superior most vertebrae occupy the region of the neck and are termed cervical vertebrae. The succeeding 12 bones lie in the dorsal, or posterior, portion of the thorax and are called the thoracic vertebrae. The five vertebrae occupying the region of the loin are termed lumbar vertebrae. The next five vertebrae, located in the pelvic region, are termed sacral vertebrae. The terminal vertebrae, also in the pelvic region, vary from three to five in number in adults and are termed the coccygeal vertebrae
- 6. TYPICAL VERTEBRAE Atypical vertebra is composed of two main parts—an anterior mass of bone called the body and a posterior ringlike portion called the vertebral arch The vertebral body and arch enclose a space called the vertebral foramen. In the articulated column, the vertebral foramina form the vertebral canal. The body of the vertebra is approximately cylindric in shape and is composed largely of cancellous bony tissue covered by a layer of compact tissue The superior and inferior surfaces of the bodies are flattened and are covered by a thin plate of articular cartilage and are known as the facets. The vertebral arch is formed by two pedicles and two laminae that support four articular processes, two transverse processes, and one spinous process. The pedicles are short, thick processes that project posteriorly, one from each side, from the superior and lateral parts of the posterior surface of the vertebral body. The broad, flat laminae are directed posteriorly and medially from the pedicles. The transverse processes project laterally and slightly posteriorly from the junction of the pedicles and laminae. The spinous process projects posteriorly and inferiorly from the junction of the laminae in the posterior midline.
- 8. Atypical Cervical Vertebrae The first two cervical vertebrae are atypical in that they are structurally modified to join the skull. The seventh vertebra is also atypical and is slightly modified to join the thoracic spine. The atlas, the first cervical vertebra (C1), is a ringlike structure with no body and a very short spinous process The atlas consists of an anterior arch, a posterior arch, two lateral masses, and two transverse processes. The anterior portion of the ring receives the dens (odontoid process) of the axis, and the posterior portion transmits the proximal spinal cord. The transverse processes of the atlas are longer than those of the other cervical vertebrae, and they project laterally and slightly inferiorly from the lateral masses. Each lateral mass bears a superior and an inferior articular process.
- 10. Atypical Cervical Vertebrae Theaxis, the second cervical vertebra has a strong conical process arising from the upper surface of its body. This process, called the dens or odontoid process, is received into the anterior portion of the atlantal ring to act as the pivot or body for the atlas. At each side of the dens on the superior surface of the vertebral body are the superior articular processes, which are adapted to join with the inferior articular processes of the atlas. The spinous process is horizontal in position.
- 12. Typical Cervical Vertebrae The typical cervical vertebrae (C3-6) have a small, transversely located, oblong body with slightly elongated anteroinferior borders The transverse processes of the typical cervical vertebra arise partly from the sides of the body and partly from the vertebral arch. These processes are short and wide, are perforated by the transverse foramina for transmission of the vertebral artery and vein All cervical vertebrae contain three foramina: the right and left transverse foramina and the vertebral foramen The pedicles of the typical cervical vertebra project laterally and posteriorly from the body. The laminae are narrow and thin. The spinous processes are short, have double pointed (bifid) tips, Their palpable tips lie at the level of the interspace below the body of the vertebra from which they arise. The superior and inferior articular processes are located posterior to the transverse processes at the point where the pedicles and laminae unite. Together the processes form short, thick columns of bone called articular pillar
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- 17. EVALUATION CRITERIA FORC-SPINE AP VIEW Area from superior portion of C3 to T2 and surrounding soft tissue Shadows of the mandible and occiput superimposed over the atlas and most of the axis Open intervertebral disk spaces Midsagittal plane of head and neck perpendicular to plane of IR, without tilt or rotation □ Spinous processes equidistant to the pedicles and aligned with the midline of the cervical bodies Mandibular angles and mastoid processes equidistant to the vertebrae Soft tissue and bony trabecular detail
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- 20. EVALUATION CRITERIA FORC-SPINE LAT VIEW All seven cervical vertebrae and at least one third of the T1 C4 in the center of the radiograph Neck extended so that mandibular rami are not overlapping the atlas or axis No rotation or tilt of the cervical spine Superimposed zygapophyseal joints and open intervertebral disk spaces Superimposed or nearly superimposed rami of the mandible Spinous processes shown in profile Soft tissue and bony trabecular detail
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- 23. EVALUATION CRITERIA FORATLAS ANS AXIS AP VIEW Dens, atlas, axis, and articulations between the first and second cervical vertebrae Entire articular surfaces of the atlas and axis (to check for lateral displacement) Mouth open wide Superimposed occlusal plane of the upper central incisors and the base of the skull, demonstrating proper neck flexion If the upper incisors are projected over the dens, the neck is flexed too much toward the chest If the base of the skull is projected over the dens, the neck is extended too much Shadow of the tongue not projected over the atlas and axis Mandibular rami equidistant from dens, demonstrating proper head rotation Soft tissue and bony trabecular details
- 24. THORACIC VERTEBRAE Thebodies of the thoracic vertebrae increase in size from the first to the twelfth vertebrae. he posterolateral margins of each thoracic body have costal facets for articulation with the heads of the ribs The bodies of the second through eighth thoracic vertebrae contain demifacets superiorly and inferiorly. The ninth thoracic vertebra has only a superior demifacet. Finally, the tenth, eleventh, and twelfth thoracic vertebral bodies have a single whole facet at the superior margin for articulation with the eleventh and twelfth ribs The transverse processes of the thoracic vertebrae project obliquely, laterally, and posteriorly. The spinous processes are long. From the fifth to the ninth vertebrae, the spinous processes project sharply inferiorly and overlap each other
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- 29. EVALUATION CRITERIA FORT-SPINE AP VIEW All 12 thoracic vertebrae All vertebrae shown with uniform brightness and contrast (or two radiographs taken for the upper and lower vertebrae) No rotation as demonstrated by spinous processes at the midline of the vertebral bodies Vertebral column aligned to the middle of the radiograph Soft tissue and bony trabecular detail Ribs, shoulders, lungs, and diaphragm if a full field projection is made
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- 32. EVALUATION CRITERIA FORT-SPINE LAT VIEW Evidence of proper collimation and posterior field shielding, to reduce scatter radiation to posterior structures of the spine Vertebrae clearly seen through rib and lung shadows Twelve thoracic vertebrae centered on the IR. Superimposition of the shoulders on the upper vertebrae may cause underexposure in this area. The number of vertebrae visualized depends on the size and shape of the patient. T1 to T3 are not well seen. Ribs superimposed posteriorly to indicate that the patient was not rotated Open intervertebral disk spaces Soft tissue and bony trabecular detail
- 33. LUMBAR VERTEBRAE Thelumbar vertebrae have large, beanshaped bodies that increase in size from the first to the fifth vertebra in this region The transverse processes of lumbar vertebrae are smaller than those of thoracic vertebrae The lumbar pedicles are strong and are directed posteriorly; the laminae are thick. The spinous processes are large, thick, and blunt, and they have an almost horizontal projection posteriorly The mamillary process is a smoothly rounded projection on the back of each superior articular process. The accessory process is at the back of the root of the transverse process. The spinous process of the fifth lumbar vertebra is smaller and shorter, and the transverse processes are much thicker than those of the upper lumbar vertebrae. The laminae lie posterior to the pedicles and transverse processes. The part of the lamina between the superior and inferior articular processes is called the pars interarticularis
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- 37. EVALUATION CRITERIA FORLS-SPINE AP VIEW Area from the lower thoracic vertebrae to the sacrum X-ray beam collimated to the lateral margin of the psoas muscles No artifact across the mid-abdomen from any elastic in the patient’s underclothing No rotation Symmetric vertebrae, with spinous processes centered to the bodies Sacroiliac joints equidistant from the vertebral column Open intervertebral disk spaces Soft tissue and bony trabecular detail
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- 40. EVALUATION CRITERIA FORLS-SPINE LAT VIEW Area from the lower thoracic vertebrae to the coccyx using 14 × 17 inch (35 × 43 cm) IR Area from the lower thoracic vertebrae to proximal sacrum using 11 × 14 inch (30 × 35 cm) IR Vertebrae aligned down the middle of the image No rotation Superimposed posterior margins of each vertebral body Nearly superimposed crests of the ilia when the x-ray beam is not angled Spinous processes in profile Open intervertebral disk spaces and intervertebral foramina Soft tissue and bony trabecular detail
- 41. SACRUM The sacrumis formed by fusion of the five sacral vertebral segments into a curved, triangular bone The sacrum is wedged between the iliac bones of the pelvis, with its broad base directed obliquely, superiorly, and anteriorly The superior portion of the first sacral segment remains distinct and resembles the vertebrae of the lumbar region The superior surface of the base of the sacrum corresponds in size and shape to the inferior surface of the last lumbar segment, with which it articulates to form the lumbosacral junction. first sacral segment articulate with the inferior articular processes of the last lumbar vertebra At its superior anterior margin, the base of the sacrum has a prominent ridge termed the sacral promontory Each of the anterior and posterior walls of the sacral canal is perforated by four pairs of pelvic sacral foramina for passage of the sacral nerves and blood vessels. On each side of the sacral base is a large, winglike lateral mass called the ala The inferior surface of the apex of the sacrum has an oval facet for articulation with the coccyx
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- 45. EVALUATION CRITERIA FORSACRUM AP VIEW Sacrum centered and seen in its entirety Sacrum free of foreshortening, with the sacral curvature straightened Pubic bones not overlapping the sacrum No rotation of the sacrum, as demonstrated by symmetric ala
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- 48. EVALUATION CRITERIA FORSACRUM AP VIEW Coccyx centered and seen in its entirety Coccygeal segments not superimposed by pubic bones No rotation of coccyx, as demonstrated by distal segment in line with pubic symphysis
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- 53. EVALUATION CRITERIA FORSACRUM & COCCYX LAT VIEW Evidence of proper collimation and a lead rubber absorber behind the sacrum Sacrum and coccyx Closely superimposed posterior margins of the ischia and ilia, demonstrating no rotation Soft tissue and bony trabecular detail