THE VERTEBRAL COLUMN

ANATOMY AND POSITIONING

Margie J. Layan, RRT
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INTRODUCTION
The vertebral column is commonly called the spine ,backbone or
spinal column ,is a complex succession of many bones.
It is a part of axial skeleton.
It provides a flexible supporting column of the trunk , head and
upper body to lower limbs.
The vertebral column houses the spinal canal, a cavity
that encloses and protects the spinal cord.
The vertebral column is composed of 33 bones which are given
below.
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CONTD..
Cervical vertebrae=7
Thoracic vertebrae=12
Lumber vertebrae=5
Sacrum vertebrae=5
Coccyx=4
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LANDMARK OF SPINES

T1 =25% of the time it is the most prominent, it does not

rotate as much as C7 when the head turns.(just below of
cervical vertebra)
T2-T3 =sternal or jugular notch
T3-T4 =sternal angle
T7 = inferior angle of scapula
T9-T10 =Xyphoid process
L3-L4 =umbilicus
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SOME TERMINOLOGY
Lordosis:
The term lordosis ,meaning bent backward describes the normal
anterio-concavity of the cervical and lumber spine.
Kyphosis:
The meaning of kyphosis is described as abnormal or exaggerated
thoracic “Hump back "curvature with and increased convexity.
Scoliosis:
Abnormal of exaggerated in lateral curvature is called scoliosis.
 ANATOMY OF
CERVICAL SPINE
 CERVICAL
VERTEBRAE
 2 TYPES
– Atypical
• Axis
• Atlas
• C7
– Typical
• C 3-6
 ATLAS
• Doesn’t Have body &spinous
process
• Its ring-like, has anterior and a
posterior arch and two lateral
masses.
• Each lateral mass has superior
articular facet&inferior articular
facet.
• Superior articular facet articulate
with occipital condoyle- atlanto-
occipital joint.
• Inferior articular facet articulate
with axis superior facet –atlanto-
axis joint.
• Transverse process project
laterally from lateral mass which
is pierced by foramen
transversorium
 AXI
S
• The second cervical
vertebra
(C2) of the spine is named
the axis
• The most distinctive
characteristic
of this bone is the strong
odontoid process ("dens")
which
rises perpendicularly from
the upper surface of the
body
• Dens provide attachment at its apex to apical
ligament& on each side to alar ligament.
• Anterior surface of body gives attachment to
ant. Longitudinal ligament.
• Posterior surface of body gives attachment to
vertical limb of cruciate ligament , membrana
tectoria, post.longitudinal ligament.
 C3-C6 VERTEBRA
• The body of these four vertebrae is small, and broader from
side to side than from front to back.
• The pedicles are directed laterally and backward, and are
attached to the body midway between its upper and lower
borders, so that the superior vertebral notch is as deep as the
inferior.
• The laminae are narrow, and thinner above than below;
the vertebral foramen is large, and of a triangular form.
• The spinous process is short and bifid, the two divisions
being often of unequal size.
• The superior and inferior articular processes of neighbouring
vertebrae often fuse on either or both sides to form an
articular pillar, a column of bone which projects laterally
from the junction of the pedicle and lamina.
• The transverse processes are each pierced by the foramen
transversorium, which, in the upper six vertebrae, gives
passage to the vertebral artery and vein, as well as a plexus
of sympathetic nerves. Each process consists of an anterior
and a posterior tubercle. These two parts are joined, outside
the foramen.
 CERVICAL VERTEBRA (C7)
• It.s has a long and prominent spinous process.
Its thick, nearly horizontal, not bifurcated.
Foramen transversorium may be as large as that
in the other cervical vertebrae

On the left side it occasionally gives passage to

the vertebral artery; more frequently the
vertebral vein transverses it on both sides; but
the usual arrangement is for both artery and
vein to pass in front of the transverse process,
and not through the foramen.

Sometimes the anterior root of the transverse

process attains a large size and exists as a
separate bone, which is known as a cervical rib.
 POSITIONING OF CERVICAL VERTEBRAE
Dens
1. AP PROJECTION - FUCHS METHOD
2. AP PROJECTION - Open mouth
3. PA PROJECTION - JUDD METHOD
4. AP AXIAL OBLIQUE PROJECTION - KASABACH METHOD /R or L head rotations
5. LATERAL PROJECTION - R or l position

Cervical Vertebrae
1. AP AXIAL PROJECTION
2. LATERAL PROJECTION - GRANDY METHODl /R or L position
3. LATERAL PROJECTION / R or L position Hyperftexion and hyperextension
4. AP PROJECTION /OTTONELLO METHOD

Cervical Intervertebral Foramina

1. AP AXIAL OBLIQUE PROJECTION /RPO and lPO positions
2. PA AXIAL OBLIQUE PROJECTION /RAO and LAO positions
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ANATOMY OF T-SPINE
• The thoracic spine is the longest region of the spine, and by some
measures it is also the most complex.
• Connecting with the cervical spine above and the lumbar spine below, the
thoracic spine runs from the base of the neck down to the abdomen.
• It is the only spinal region attached to the rib cage.
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CONTD..
• Consists of body, pedicle, lamina, spinous process, transverse process
and superior & inferior articular processes.
• Bodies of vertebrae increases in size fromT1 to T12
• The superior thoracic body resembles with the cervical body & inferior
with the lumbar body.
• They are distinguished by the presence of facets on the sides of the
bodies for articulation with the heads of the ribs, and facets on the
transverse processes of all, except the eleventh and twelfth, for
articulation with the tubercles of the ribs.
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INDICATIONS
• Any cases of Trauma
• Fracture
• Dislocation
• Foreign body
• Kyphosis
• Subluxation
• Tumor
• Osteoarthritis
• osteoporosis etc.
Zygapophyseal joints
are the only synovial joints
in the spine, with hyaline
cartilage overlying
subchondral bone, a
synovial membrane and a
joint capsule; they comprise
the postero-lateral
articulation between
vertebral levels
Your lumbar
spine consists of the five
bones (vertebra) in your
lower back. Your lumbar
vertebrae, known as L1 to
L5, are the largest of your
entire spine. Your lumbar
spine is located below
your 12 chest (thoracic)
vertebra and above the
five fused bones that
make up your triangular-
shaped sacrum bone.
Millard recommended the Scotty dog sign,
whereby the outline of a dog with a collar
around its neck is seen in the oblique view
of the lumbar spine) .The collar
corresponds to a bone fracture in the
pars interarticularis, that is, a pars defect
(spondylolysis).
Scoliosis is a sideways curvature of the
spine. Scoliosis is a sideways curvature
of the spine that most often is diagnosed
in adolescents. While scoliosis can occur
in people with conditions such as
cerebral palsy and muscular dystrophy,
the cause of most childhood scoliosis is
unknown
 PA (AP) PROJECTION: SCOLIOSIS SERIES
• To determine the degree and severity of scoliosis.
• A scoliosis series frequently includes two AP (or PA)
images taken for comparison, one erect and one
recumbent.
• Patient Position—Erect and Recumbent Position.
• Part Position
• Align midsagittal plane to CR and midline of table
and/or IR.
• Ensure that no rotation of thorax or pelvis exists, if
possible.
• Scoliosis may result in twisting and rotation of
vertebrae, making some rotation unavoidable.
• Place lower margin of IR a minimum of 1 to 2 inches (3
to 5 cm) below iliac crest (centering height determined
by IR size and/or area of scoliosis) Central Ray
CR perpendicular to IR.
PA (AP) PROJECTION:
SCOLIOSIS SERIES
 ERECT LATERAL POSITION: SCOLIOSIS SERIES
• Spondylolisthesis, degree of kyphosis,
or lordosis.
• Patient Position—Erect Lateral
Position
• Part Position
• Align midcoronal plane to CR and
midline of table and/or IR.
• Ensure that no rotation of thorax or
pelvis exists.
• Place lower margin of IR a minimum of
1 to 2 inches (3 to 5 cm) below level
of iliac crests (centering Central Ray
determined by IR size and patient CR perpendicular to IR.
size). Centre IR to CR
 ERECT LATERAL
POSITION: SCOLIOSIS
SERIES
 PA (AP) PROJECTION—FERGUSON METHOD: SCOLIOSIS SERIES
• This method assists in differentiating deforming (primary) curve from compensatory curve.
• Two images are obtained—one standard erect AP or PA and one with the foot or hip on the
convex side of the curve elevated.
• Patient Position—Erect
• Place patient in an erect (seated or standing) position facing the table, with arms at side.
• For second image, place a block under foot (or hip if seated) on convex side of curve so that
the patient can barely maintain position without assistance.
• Part Position
• Align midsagittal plane to CR and midline of table and/or IR.
• Ensure that no rotation of thorax or pelvis exists, if possible.
• Place IR to include a minimum 1 to 2 inches (3 to 5 cm) below the iliac crest.
PA (AP) PROJECTION—FERGUSON METHOD: SCOLIOSIS
SERIES

PA with block under foot on

PA erect
convex side of curve
PA (AP) PROJECTION—FERGUSON METHOD: SCOLIOSIS
SERIES

Without lift With lift

 AP (PA) PROJECTION—RIGHT AND LEFT BENDING: SCOLIOSIS
SERIES
• Assessment of the range of motion of the
vertebral column.
• Patient Position—Erect or Recumbent Position
• Part Position
• Align midsagittal plane to CR and midline of table
and/or IR.
• Ensure that no rotation of thorax or pelvis exists, if
possible.
• Place bottom edge of IR 1 to 2 inches (3 to 5 cm)
below iliac crest.
• With the pelvis acting as a fulcrum, ask patient to
bend laterally (lateral flexion) as far as possible to
either side.
• If recumbent, move both the upper torso and legs to
achieve maximum lateral flexion. CR
• Repeat above steps for opposite side. • CR perpendicular to IR.
AP (PA)
PROJECTION—RIGHT
AND LEFT BENDING:
SCOLIOSIS SERIES
its L bending
 LATERAL POSITIONS—HYPEREXTENSION AND HYPERFLEXION: SPINAL
FUSION SERIES

• Assessment of mobility at a spinal fusion site.

• Two images are obtained with the patient in the lateral position (one in hyper flexion and one
in hyperextension).
• Patient Position—Recumbent Lateral Position
• Part Position
• Align midcoronal plane to CR and midline of table and/or IR.
• Hyperflexion
• Using pelvis as fulcrum, ask patient to assume fetal position (bend forward) and draw legs up
as far as possible.
• Hyperextension
• Using pelvis as fulcrum, ask patient to move torso and legs posteriorly as far as possible to
hyperextend long axis of body.
• Ensure that no rotation of thorax or pelvis exists
LATERAL POSITIONS—HYPEREXTENSION AND HYPERFLEXION:
SPINAL FUSION SERIES
Hyperflexion Hyperextension

Central Ray
CR perpendicular to IR.
Direct CR to site of fusion if known or to center of IR.
Hyperflexion HYPEREXTENSION