Positioning Test 3
Terms
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- C1-atlas-has
- no body
- C2- Axis-has
- a dens or odontoid process
- Each cervical vertebrae has a
- lateral mass or pillar which is the anatomy with the superior articulating process and the inferior articulating process on bottom
- All cervical vertebrae have
- transverse foramen which house the vertebral arteries and veins from the posterior circulation of the cerebrum
- All spinous processes of the typical cervical vertebrae also have
- bifid tips
- ⬢ This view does not demonstrate the C1/ C2 joint space
- Judd
- Positioning for Judd
- prone with hands positioned at level of face; extend head so OML so it forms a 37 degree angle with tabletop
- CR for JUDD
-
o perp. entering MSP just distal to the level of the mastoid tips
- ⬢ a good addition to AP and Lateral views when pt. Is unable to open their mouth at all for the odontoid
- Kasabach
- Positioning for Kasabach
-
⬢ Postioning
o supine; 45 degrees right or left and adjust IOML perp. to table
- CR for Kasabach
-
⬢ CR
o 10-15 degrees caudal entering at a midpt. Between EAM and outer canthus
- ⬢ done to show AP of the entire cervical spine C1 through C7
- ottonello
- Evaluation for Kasabach
-
all Cspine demonstrated C1- C7 with mandible blurred out or obliterated
- AP axial Pillars
- although lateral masses are dem. Other structures are seen including C 3 through T4 thoracic vertebrae, the laminae, and spinous processes
- Postioning for AP axial pillars
- o Supine and hyperextend as much as possible without causing discomfort to pt. If too much do oblique position it is recommended
- CR for AP axial pillars
-
CR-
o 20 to 30 degrees caudal entering thyroid cartilage and MSP
- Eval for AP axial Pillars
-
⬢ Evaluation
o Verterbral arches with articular pillars in profile and open joint spaces between articulating processes
- Positioning for AP AXIAL OBLIQUE PILLARS
-
⬢ Positioning-
o Supine, rotate head 45 degrees away from side of intrest; if lower cervical and upper thoracic of interest rotate 60 to 70 degrees instead
- AP AXIAL OBLIQUE PILLARS
-
⬢ CR-
o Position IR so top edge is at the level of the mastoid tip; 30 to 40degrees caudal to center of IR ensuring that C spine is directed longitudinally to exposure area
- EVAL FOR AP AXIAL OBLIQUE PILLARS
-
⬢ Evaluation
o Verterbral arches with articular pillars in profile; open joint spaces between articular processes
- POSITIONING FOR TRAUMA C
-
⬢ Positioning-
o No movement; place IR under pt. Or backboard centered to C4 transversely and mastoid tip longitudinally
- CR FOR TRAUMA C-SPINE
-
⬢ CR-
o Direct a double tube angle 45 degrees medially and 15-20 degrees cephalic centering at the IR; CR in most cases will enter a point between MSP and MCP at level of thyroid cartilage
- EVAL FOR TRAUMA C
-
⬢ Evalution-
o Open intervertebral foramina at the side farthest from the tube
- weight bearing method showing intervertebral joints
- lumbar intervertebral disks
- why is lumbar intervertebral disk a PA projection
- divergence of beam causes rays to be almost parallel to disk spaces also will limit radiation to breast and gonadal area
- Positioning for Lumbar intervertebral Disk?
- Erect; PA; align MSP with vertical grid; transversely L3; both sides are done for comparison
- central ray for lumbar intervertebral disk?
- 15 to 20 caudal
- spinal fusion is done to demonstrate?
- mobility of intervertebral disk space at site of spinal fusion at least 6 months following surgery
- spinal fusion can also be done to show what?
- HNP and early evaluation early signs of scoliosis
- Positioning for spinal fusion?
- supine with MSP on table
- Central Ray for Spinal Fusion
- at the level of L3 perp.
- Kovacs is used to demonstrate what?
- used to show L5 intervertebral foramina in profile
- Positioning for Kovac?
- Lateral recumbent position; center plane 1.5 posterior to MCP to midline of table ; rotate pt. Anterior 30 degrees while keeping thorax in lateral position; flex knee on side up to maintain obliquity
- Central Ray for Kovacs
- 15-30 caudal
- Lumbar vertebrae have
- large bodies
- Extending laterally from pedicles are
- transverse processes
- The superior and inferior articulating processes are
- part of the lamina
- With the bony area b/w the articular processes being the
- pars interarticularis
- Lamina- unite posteriorly to form
- spinous processes
- o Center of disk is called; it is a mass of gelatinous pulp which acts as a shock absorber
- nucleous pulpous
-
The outer portion of disk is the which is made of fibers that are would about in rings
-
annulus fibrous
- When subject to pressure (standing) the disks spread out, sudden severe pressure can cause
- the disk to rupture with the nucleus pulpous pertruding through the annulus fibrosis which causes pressure on the spinal cord known as HNP or herniated pulpous or slipped disk
- are 4 irregular shaped cavities filled with CSF which lubricates and protects brain and Spinal cord
- Ventricles
- ______one in each hemisphere
- 2 lateral ventricles
-
Contains choroid plexus-
Can be divided into: -
network of tiny blood vessels that produce CSF
anterior, posterior, and inferior horns and a body
- foramen of Monroe) is a narrow opening lateral ventricles indirectly to each other and directly to the third ventricle
- interventricular foramen
- CSF passes through 3rd ventricle into 4th through cerebral aqueduct which is also known
- aqueduct of sylvius
- From fourth ventricle CSF blows into subaracnoid space via
- the foramen of Magendie also know as the median aperature
-
⬢ Consists of outside layer of white matter and inner layer of grey matter
- spinal cord
- spinal cords extends from
- aprox. Foramen magnum to L2
- Spinal Cord is enclosed by
- 3 meningeal layers
- what are the 3 layers that encloses the spinal cord
-
1. pia mater
2. arachnoid
3. dura mater - between pia mater and arachnoid space and is continuous with ventricle s of brain
- subarachnoid space
- Distal end of spinal cord is ______ with its tip at level of L2
- conus medularis
- Conus Medullaris and spinal nerves extending past the level of L2 together form an area called
- cauda aquina know as horses tail
- Dura mater -> _____->arachnoid layer-> ______-> pia mater
- subdural space; subarachnoid space;
- fingerlike projections that extend into the dura mater to return CSF into bloodstream
- subarachnoid villi
- ⬢ Radiologic examiniation of CNS structures within spinal canal after introduction of contrast into the subarachnoid space
- myelography
- what type of contrast is used for myelography
- ⬢ A water soluable iondinated contrast or gaseous contrast maybe used
- Myelograms require an ____technique
- aseptic
- Depending of radiologist insertion of needle may be done
- prone or lateral
- Usually a ____ spinal needle is placed ____ into subarachnoid space at level of _____ with use of fluoroscopy
- 20-22 guage; intrathecally ;L2 – L3 or L3 –L4
- ⬢ During exam, the patients head should remain extended to prevent contrast flow past the
- foramen magnum
- Once Myelograpy is complete, patient supine with head elevated
- 30-45 degrees
- A ______ maybe done after the exam
- post myelogram CT
- Recovery time for myelography is
- 4- 8 hours
- Headaches are common if patient sits up more than 45 degrees and caused by
- air passing through subarachnoid space into ventricles of brain
- ⬢ Aka spinal tap
- spinal puncture
- CT of head usually done prior to show evidence of ______ ; if there is pressure a spinal tap could cause severe complications
- intracranial pressure;
- ⬢ Done to withdraw CSF from subarachnoid space
- spinal puncture
- They are not recommended if pt has had a myelogram in the previous ____; why?
- 2 weeks; there might be contrast in spinal column so could be withdrawn with CSF and could result in false lab results
- Positioning for spinal puncture?
- Depending on doctor maybe in left lateral postion or prone
- Injection site for spinal puncture?
- o Spinal needle is inserted at L3 L4 level
- ⬢ Radiological exam of the intervertebral disk by introduction of a water soluable ionated contrast media into disk by way of a double needle entry
- diskography
- Under fluoro, a large outer needle is used to perform the spinal puncture and reach the ____ of the disk; once the outer needle is in place a smaller needle is advanced into the ____
- annulous fibrosus; nucleus pulposus
- ⬢ This can be done separate in combination with myelography
- diskography
- ⬢ Done as intradisk therapy by way of injection of chymopapain into the nucleus pulpous of the injured disk
- chemonucleosis
- o enzyme extracted from the papaya tree which reduces intradisk pressure when injected into the nucleus pulposus
- chymopapain
- Chemonucleolysis is an alternative to the ____
- laminectomy
- ⬢ Surgical chipping away of the bony arches of one or more vertebrae in order to relieve compression of the spinal cord caused by bone displacement or herniated disks
- laminectomy
-
Laminectomy
If more than one vertebrae’s _____ is removed the vertebrae may be fused together for added support of the spine - lamina
- Done in place of chemonucleolysis or laminectomy
- diskectomy
- ⬢ First perform a diskogram, needle is removed and replaced with a ___
- trocar
- _____ is sharp pointed surgical instrument contained in a cannula; used for aspiration purposes ; connected to a double lumen suction tube through which nitrogen and saline are introduced
- trocar
- used to shave away the HNP; while the resulting fragments are suctioned out
- trocar
- _____ is much safer than a laminectomy and requires a much shorter recovery time
- Laminectomy
- what are the two positions for viewing the dens?
- Kasabach and Judd
- which view is used in conjunction with the AP and lateral projections of the C-spine?
- Kasabach
- What vertebrae is demonstrated when you rotate the head 45-50 degrees for the AP axial oblique (pillars)
- C2-C7 and T1
- What vertebrae are demonstrated when you rotate the head 60-70 degrees for the AP axial oblique pillars?
- C6 and T1-T4
- BOLD
- BOLD