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For imaging of the spine one routinely uses conventional X-ray, CT and MRI.
On X-ray and CT, one can visualise the bony structures as well as the soft tissues.
MRI allows to visualise soft tissues, ligaments, discs, and the myelum, as well as thebone marrow, but not the bone itself.
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The cervical spine has 7 vertebra.
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On the AP-view one can see:
1/ bony structures
2/ air (pharynx, larynx, trachea, lungtops)
3/ soft tissues (muscle, skin, )
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Are the bony structures of the vertebrae well aligned?
1/ do the proc. transversi form a smooth continuous line?
2/ are all pedicles visible and are they well aligned?
3/ are all proc. spinosi well aligned?
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One can perform this lateral view x-ray in a trauma-patient in supine position by
positioning the x-ray tube lateral from the patient.
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The lateral view visualises the AP alignment of the vertebrae.
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1: C1: atlas
2: C2: dens
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C1 (atlas), C2 (axis) , C7 and D1 are not entirely visualized on X-rays, due to
superimposition of the
- Mandibula and teeth for AP views of C1 and C2.
- clavicula and 1st rib for AP views of C7-D1
- shoulder for lateral views of C7-D1
The open-mouth x-ray visualizes C1-C2 on an AP-view.
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The swimmer X-ray provides good visualisation of C7, since it avoids
superimposition of the shoulders.
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In a !view the X-ray penetrate the subject in an oblique way.
Doing so, the neuroforaminae (neural foramina), through which the nerve roots exit,
become visible.
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Spine in a trauma-patient
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Visualisation of the neuroforaminae.
Typically a neuroforamen has an oval shape. It resembles a keyhole (round largeopening at the top, smaller oval opening at the bottom)
The nerve root runs in the upper large round part. The lower part is normally filledwith fatty tissue.
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Left panel: T1w sagittal slice of the C-spine:
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Cerebrospinal fluid is dark (hypointense)
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The disc is gray
- Cortical bone is blcak; the bone marrow is gray (fatty substance)
Right panel: T2 weighted sagittal slice:
- The CSF is hyperintense: it surrounds the myelum
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The myelum is gray
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The discs are hyperintense: the are hydrated. Only C2-C3 is dark: dehydration: a
sign of degeneration.
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Left panel: Axial T1w slice.
Right panel: Axial T2w slice. Note the anterior en posterior nerve roots, that willfuse into 1 spinal nerve rot.
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MR myelogram.
This is a heavily T2w image (long echo time) in which water is selectivelyvisualised: thus, one visualises the CSF.
Note the delineation of the spinal canal, and the nerve roots.
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On an AP-view we try to find the 12 dorsal vertebrae: each has ribs attached to it.
The bifurcation of the trachea superimposes on D5.
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In a supine position in a trauma patient
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The dorsal spine has a specific curvature: kyphosis.
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In a supine position in a trauma patient.
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The lumbar spine has a specific curvature: lordosis.
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On the oblique view of the lumbar spine, the outline of a dog can seen.
The parts of the dog are as follows:
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the transverse process-the nose;
- the pedicle-the eye;
- the pars interarticularis-the neck;
- the superior articular facet-the ear;
- the inferior articular facet-the front leg.
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A break in the neck of the dog, or a dog collar, corresponds to a fracture in the
region of the pars interarticularis, which is specific for spondylolysis. It is
important to recognize as it is a cause of low back pain.
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A break in the neck of the dog, or a dog collar, corresponds to a fracture in the
region of the pars interarticularis, which is specific for spondylolysis. It is important
to recognize as it is a cause of low back pain.
In case of bilateral spondylolysis the vertebral body can shift
anteriorly: spondylolisthesis.
Spondylolisthesis describes the anterior displacement of a vertebraor the vertebral column in relation to the vertebrae below.
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MRI of the lumbar spine:
Left:
T2 and T1 weighted sagittal slices.
The myelum ends at the level of vertebral bodies L1-L2: the conus medullaris.
The conus medullaris ("medullary cone") is the terminal end of the spinal cord.
After the spinal cord tapers out, the spinal nerves continue as dangling nerve roots
called cauda equina.
This terminal nerve root tail is referred to as the filum terminale
Upper right:
Axial T2s slice at the level of the disc L4-L5.
Bottom right:
MR myelogram of the lumbar spine. Normal delineation of the nerve roots.
Centrally in the spinal canal one can see the cauda equina.
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Fractures can be caused by excessive
Flexion
Extension
Compression
Or a combination of the above
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Anterior of the vertebral body with a fracture of the superior end-plate.
The posterior wall is intact.
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In this case the posterior wall is also fractured.
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Fractuur van grond naar dekplaat met verplaatsing van de posterieure muur naar
dorsaal, dwz naar/in het spinale kanaal.
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The posterior wall is displaced into the spinal canal. This can cause compression and
injury to the myelum.
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Aan de anterieure zijde vergroot de tussenwervelruimte.
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Traumas die een rotatie letsel kunnen teweegbrengen.
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Left: with fracture of the proc. transversus.
Right: rotation of the vertebral body.
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Widening of the facet joint.
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Traumas die shearing injuries kunnen veroorzaken.
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At level L4L5
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Left: T2w image; Right T1w image:
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Anterolisthesis of L3 on L4
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Hypertrophic ligamenta flava
As a consequence the spinal canal is narrowed at the L3L4 level.
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MR myelogram: spinal canal stenosis: narrowed CSF spaces.
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