IMAGING OF VERTEBRAE
IMAGING OF VERTEBRAE
IMAGING OF VERTEBRAE
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<strong>IMAGING</strong> <strong>OF</strong> <strong>VERTEBRAE</strong><br />
IMAGES FROM CROSS-SECTIONAL ANATOMY TUTOR PROGRAM<br />
1) REVIEW VERTEBRAL COLUMN AND BACK<br />
2) <strong>VERTEBRAE</strong> ARE USEFUL LANDMARKS FOR<br />
ORIENTATION IN CT, MRI IMAGES<br />
3) LOOK AT VIEWS <strong>OF</strong> <strong>VERTEBRAE</strong> ON X-RAYS IN LAB
1) SAGITTAL PLANE -<br />
divides body in RIGHT<br />
and LEFT parts (Median<br />
Sagittal Plane-divides<br />
body into right and left<br />
halves)<br />
2) CORONAL PLANE -<br />
divides body into FRONT<br />
and BACK parts<br />
3) HORIZONTAL PLANE<br />
Plane = transverse plane -<br />
cross section-divides<br />
body into TOP and<br />
BOTTOM parts<br />
perpendicular to long axis<br />
of body<br />
ANATOMICAL PLANES<br />
Coronal<br />
Sagittal<br />
Horizontal
AXIAL CT SERIES<br />
FEET<br />
- generates sections in<br />
HORIZONTAL PLANE<br />
- VIEW FROM<br />
FEET<br />
- viewing patient in<br />
hospital bed from his/her<br />
feet
ORIENTATION IN IMAGES - seemingly right/left reversed<br />
Series In Horizontal<br />
Plane = Axial Series<br />
ANTERIOR<br />
PATIENT'S<br />
RIGHT<br />
PATIENT'S<br />
LEFT<br />
POSTERIOR
INTENSITIES STORED AS PIXEL VALUES<br />
CAN<br />
'RESECTION'<br />
SERIES<br />
<strong>OF</strong> DIGITAL<br />
IMAGES IN<br />
ANY PLANE<br />
PATIENT'S<br />
RIGHT<br />
PATIENT'S<br />
LEFT
TYPICAL VERTEBRA – by convention thoracic<br />
1. BODY – anterior, solid transmits weight<br />
2. VERTEBRAL ARCH – posterior, surrounds vertebral canal, spinal<br />
cord; consists of a) PEDICLES – project from body<br />
b) LAMINAE – unite to form arch posteriorly<br />
ant.<br />
BODY<br />
VERTEBRAL<br />
{<br />
ARCH<br />
PEDICLE<br />
TRANSVERSE<br />
PROCESS-<br />
LATERAL<br />
LAMINA<br />
SPINOUS PROCESS -<br />
POSTERIOR<br />
3. TRANSVERSE AND SPINOUS PROCESSES - projections<br />
from arch for muscle, ligament attach
RIBS- have bumps for articulation with vertebra<br />
Vertebrae<br />
Dorsal view<br />
of skeleton<br />
Ribs<br />
Head –<br />
Articulates<br />
with facet on Body<br />
Tubercle –<br />
Articulates<br />
with facet on<br />
Transverse process
CT <strong>OF</strong> THORACIC VERTEBRA
USE FOR ORIENTATION<br />
SUBS<br />
IS<br />
T5<br />
TRAP<br />
RHOMB.MAJ.
CERVICAL VERTEBRA<br />
BODY<br />
ant.<br />
– body is small<br />
Foramen Transversarium - in<br />
transverse process (C1-C7) for<br />
vertebral artery & veins<br />
TRANSVERSE<br />
PROCESS<br />
post.<br />
SPINOUS PROCESS – bifid (divided) for Ligamentum nuchae<br />
lat.<br />
view<br />
ARTICULAR FACETS<br />
- angled superiorly &<br />
medially
CERVICAL VERTEBRA - CT<br />
Body - small<br />
Foramen Transversarium
LUMBAR VERTEBRA<br />
spinous<br />
process<br />
lamina<br />
pedicle<br />
Bodies - hefty<br />
Pedicles - stout<br />
Lamina - thick<br />
Spinous Processes- broad<br />
body<br />
Articular processes<br />
in sagittal plane
LUMBAR VERTEBRA AXIAL CT<br />
L3<br />
L5<br />
Articular process<br />
Articular process
LATERAL VIEW <strong>OF</strong> VERTEBRA<br />
4. Spinal nerves leave<br />
vertebral canal via<br />
INTERVERTEBRAL<br />
FORAMINA -between<br />
vertebrae;<br />
bordered by – Superior and<br />
Inferior Vertebral Notches<br />
Sup. Vertebral Notch<br />
Inf. Vertebral Notch<br />
5. SUPERIOR AND INFERIOR<br />
ARTICULAR PROCESSES -<br />
(zygapophyses) - Articular<br />
facets form joints between<br />
adjacent vertebrae (Orientation<br />
of facets determines<br />
movement)<br />
6. Bodies -<br />
joined by<br />
intervertebral<br />
discs
MOVEMENTS <strong>OF</strong> <strong>VERTEBRAE</strong> IN DIFFERENT REGIONS-<br />
Determined by orientations of articular facets<br />
a. CERVICAL (C3-C7)-<br />
permit considerable flexionextension,<br />
lateral flexion,<br />
rotation - useful-move head<br />
b. THORACIC<br />
permit some rotation – little or<br />
no flex-extend (also limited by<br />
ribs); useful- no flex down on<br />
heart, lungs<br />
c. LUMBAR<br />
permit flex-extend, little or no<br />
rotation; useful- help increase<br />
abdominal pressure;<br />
dangerous- increase load<br />
pressure on vertebral discs<br />
Cervical (C3-C7)-facets angled<br />
superiorly and medially<br />
Thoracic - facets in coronal plane<br />
Lumbar- facets in sagittal plane
VERTEBRAL LIGAMENTS<br />
View inside vertebral canal<br />
1. ANTERIOR<br />
LONGITUDINAL<br />
LIGAMENT -<br />
Strong band on<br />
anterior side<br />
2. POSTERIOR<br />
LONGITUDINAL<br />
LIGAMENTweaker,<br />
narrower<br />
band<br />
3. LIGAMENTA<br />
FLAVA - yellow<br />
elastic bands<br />
connecting<br />
laminae
SAGITTAL SECTION<br />
4. INTERSPINOUS AND SUPRASPINOUS LIGAMENTS -<br />
connect spines<br />
INTERSPINOUS<br />
ANT<br />
SUPRASPINOUS<br />
Greatly thickened in cervical region to form LIGAMENTUM<br />
NUCHAE- from Ext. Occip. Protuberance of skull to C7;<br />
Support Head, Provide muscle attachments
JOINTS BETWEEN <strong>VERTEBRAE</strong><br />
1. Joints between<br />
articular processes -<br />
synovial plane joints<br />
permit Sliding<br />
Movements<br />
2. Intervertebral Discinterposed<br />
between<br />
bodies
ant<br />
ORIENT TO MEDIAN MRI<br />
SAGITTAL<br />
PLANE<br />
BODY<br />
ant<br />
post<br />
SPINE<br />
BODY<br />
SPINE<br />
post
LUMBAR MRI
STRUCTURE/<br />
FUNCTION <strong>OF</strong><br />
INTERVERTEBRAL<br />
DISC<br />
Shock<br />
absorbers in<br />
young quite<br />
strong<br />
trauma to<br />
vertebra<br />
fractures<br />
a) Nucleus<br />
pulposusinner<br />
gelatinous<br />
core<br />
b) Anulus fibrosus -<br />
collagen fibers &<br />
fibrocartilage
MRI <strong>OF</strong> 'SLIPPED DISK' FROM SNELL'S TEXTBOOK<br />
ANTERIOR<br />
POSTERIOR<br />
HERNIATION<br />
<strong>OF</strong><br />
NUCLEUS<br />
PULPOSUS
DAMAGE TO INTERVERTEBRAL DISC<br />
Posterolateral<br />
lateral<br />
post<br />
POSTERIOR<br />
LONGITUDINAL<br />
LIGAMENT<br />
ANTERIOR<br />
LONGITUDINAL LIGAMENT<br />
Typically in Postero-Lateral Direction, lateral to Posterior Longitudinal<br />
Ligament; often L4-L5 or L5-S1; can lead to nerve compression at<br />
intervertebral foramen
NORMAL CURVATURES <strong>OF</strong> VERTEBRAL COLUMN<br />
Ant Post<br />
Cervical<br />
curvature<br />
Thoracic<br />
curvature<br />
Lumbar<br />
curvature<br />
Sacral<br />
curvature<br />
Primary - concave anterior - remains<br />
In thorax and sacrum<br />
Secondary - concave posterior<br />
a. Cervical curvature - concave<br />
posteriorly - help support head<br />
b. Lumbar curvature<br />
- concave posteriorly<br />
- develops with walking<br />
- helps support trunk, upper body<br />
c. Lateral curvature - Right handed<br />
concave to side opposite<br />
handedness - helps to carry<br />
bags of money<br />
R L
LUMBAR CURVATURE ON LATERAL X-RAY<br />
LATERAL X-RAY -<br />
TRANSVERSE<br />
PROCESSES<br />
LOOK LIKE<br />
RINGS<br />
Transverse<br />
process
INTERNAL STRUCTURE <strong>OF</strong> BONE<br />
Long bone in cross-section<br />
OUTER COMPACT (CORTICAL) BONE<br />
INNER SPONGY BONE<br />
COMPACT<br />
SPONGY
LATERAL<br />
VIEW<br />
IN LATERAL<br />
VIEW SEE<br />
TRANSVERSE<br />
PROCESSES<br />
ON END<br />
Transverse<br />
process<br />
ATTENUATION HIGHEST<br />
(X-RAY IS MOST WHITE)<br />
WHEN PASS THROUGH<br />
MOST COMPACT BONE
ANTERIOR-POSTERIOR<br />
(AP)<br />
X-RAY <strong>OF</strong> LUMBAR<br />
<strong>VERTEBRAE</strong><br />
Pedicles look like<br />
‘eyes’<br />
PEDICLE<br />
SPINE
AP VIEW<br />
PEDICLE<br />
SPINE<br />
SEE<br />
PEDICLES AND<br />
SPINES ALONG<br />
THEIR LENGTH
ABNORMAL CURVATURES<br />
KYPHOSIS ‘hump’<br />
back, exaggerated<br />
curvature; often in<br />
thorax of elderly;<br />
concave anteriorly<br />
SCOLIOSIS<br />
abnormal lateral<br />
curvature (‘kink’ in<br />
spine); can be due<br />
to hemivertebra<br />
LORDOSIS<br />
exaggerated<br />
lumbar curvature<br />
concave<br />
posteriorly
LATERAL X-RAY THORACIC SPINE<br />
NORMAL ADULT<br />
ELDERLY PATIENT<br />
T11
ERECTOR SPINAE<br />
1. Act to extend trunk<br />
2. Located dorsal to vertebral column<br />
3. Innervated by dorsal primary rami of<br />
spinal nerves<br />
SPINALIS- most medial – spinous<br />
process to spinous process<br />
LONGISSIMUS- intermediatetransverse<br />
process to transverse<br />
process<br />
ILIOCOSTALIS- lateral – ilium and<br />
ribs to ribs and transverse<br />
processes<br />
Deep: Transversospinalis – transverse<br />
process to spinous process
<strong>IMAGING</strong> <strong>OF</strong> <strong>VERTEBRAE</strong><br />
IMAGES FROM CROSS-SECTIONAL ANATOMY<br />
TUTOR PROGRAM<br />
TRANSVERSOSPINALIS<br />
ERECTOR SPINAE
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