ANATOMY OF SPINE

AND X-RAYS OFSPINE

DR PRATIK AGARWAL
DR SANJAY MULAY
ANATOMY OF
SPINE
PLANES AND
DIRECTION:
• ANTERIOR/VENTRAL

• POSTERIOR/DORSAL

• CRANIAL

• CAUDAL

• MEDIAL

• LATERAL

• CORONAL PLANE

• SAGITTAL PLANE

• AXIAL PLANE
 FUNCTIONS OF SPINE

1. PROTECTION OF SPINAL CORD, MENINGES, VESSELS

AND INTERNAL ORGAN.
FUNCTIONS OF SPINE

2. ALLOW FLEXIBILITY
IN ALL 6 DIRECTIONS
FUNCTIONS OF SPINE

3. ALLOW FLEXIBILITY AND

PROVIDE SUPPORT AND
BALANCE FOR UPRIGHT
POSTURE
FUNCTIONS OF SPINE

INTERVERTEBRAL DICS-
• IT PROTECT AGAINST COMPRESSIVE
FORCES.

• ALLOW EQUAL WEIGHT

DISTRIBUTION
 CURVES OF SPINE
Curvatures
■ PRIMARY CURVATURES:
Cervical(2*)
– KYPHOTIC CURVE
Thoracic(1*) – PRESENT FROM FETAL LIFE
– THORACIC (20*-40*)
Lumbar(2*)
– SACRAL
Sacral(1*)
■ SECONDARY CURVATURES:
– LORDOTIC CURVE
– DEVELOPS DURING INFANCY OR
CHILDHOOD
– CERVICAL (20-40*)
– LUMBAR (30-50*)
CORONAL PLANE:
SPINE APPEARS
SYMMETRICAL AND
STRAIGHT

ABNORMAILTY SEEN IN
CORONAL PLANE:
• SCOLIOSIS

SAGITAL PLANE:
2 KYPHOTIC CURVE
(THORACIC AND
SACRAL)
2 LORDOTIC CURVE
(CERVICAL AND
LUMBAR)

ABNORMALITY SEEN
IN SAGITAL PLANE:
• LOSS OF LORDOSIS
• KNUCKLE
• KYPHOSUS
• GIBBUS
LEVELS OF SPINE
• ADULT SPINE IS 72 CM LONG IN MEN AND 7-10
CM LESS IN WOMEN.
• TOTAL 33 VERTEBRAE
• 5 MAIN REGION-
1) CERVICAL - C1-C7
2) THORACIC - T1-T12
3) LUMBAR - L1-L5
4) SACRAL - S1-S5
5) COCCYX - C1-C4
• THERE ARE 24 MOBILE SEGMENTS AND 9
FUSED VERTEBRAE WHICH ARE IMMOBILE.
VERTEBRAL ANATOMY

COMMON FEATURES SHARED BY

MOST VERTEBRAE ARE-
1. VERTEBRAL BODY
2. POSTERIOR ARCH
• PEDICLE
• LAMINA
• SPINOUS PROCESS
• TRANSVERSE PROCESS
• ARTICULAR PROCESS
 VERTEBRAL BODY
OUTER INNER • VERTEBRAL BODY COMPOSED OF 2
CORTICAL CANCELLOUS
RIM BONE TYPES BONE TISSUE:
I. CORTICAL BONE
II. CANCELLOUS BONE

• IT BEARS 80% OF LOAD APPLIED TO

SPINE.

• IT VARIES IN SIZE, SHAPE AND

PROPORTION IN DIFFERENT
REGIONS.
POSTERIOR ARCH
■ 2 STOUT PILLARS BRIDGING VERTEBRAL BODY AND POSTERIOR
ARCH CALLED PEDICLE

■ PEDICLE GOES DORSALLY FUSING WITH PAIR OF ARCHED FLAT

LAMINA.

■ LAMINA DORSALLY FUSE IN MIDLINE TO FORM SPINOUS

PROCESS.

■ PEDICLE, LAMINA WITH SPINOUS PROCESS FORM VERTEBRAL

FORAMEN, COMPLETE OSSEOUS RING THAT ENCLOSE SPINAL
CORD.

■ TRANSVERSE PROCESS IS A STUCTURE EXTENDING FROM

JUNCTION OF LAMINA AND PEDICLE.

■ TRANSVERSE PROCESS ALLOW MOVEMENT OF SPINE AND

LIGAMENT AND STABALIZE THE SPINE BY GIVING ATTCHMENT TO
MUSCLES AND ARTICULATING WITH RIBS.
POSTERIOR ARCH
 ARTICULAR PROCESS (ZYGAPOPHYSES)
ANOTHER PROJECTION FROM JUNCTION OF
PEDICLE AND LAMINA.
 2 SUPERIOR ARTICULAR PROCESS
(PREZYGAPOPHYSES) AND 2 INFERIOR
ARTICULAR PROCESS (POSTZYGAPOPHYSES) IS
PRESENT.
 ARTICULAR SURFACE OF PROCESS IS CALLED
FACET WHICH COVERED WITH HYALINE
CARTILAGE.
 INTERVERTEBRAL FORAMEN ALLOWING SPINAL
NERVES AN EXIT POINT FROM THE CORD.
PARS INERARTICULARIS
 PART OF ARCH THAT LIES BETWEEN
SUPERIOR AND INFERIOR ARTICULAR
FACET.
 IT IS AREA OF MOST STRESSED BY
TRANSLATIONAL MOVEMENT BETWEEN
ADJACENT SEGMENT.
 IT IS SUSCEPTIBLE TO TRAUMATIC AND
STRESS FRACTURE
 DEFECT OF PARS INTERARTICULARIS
LEAD TO SPONDYLOLYSIS AND
SPONDYLOLISTHESIS.
CERVICAL VERTEBRAE
 7 VERTEBRAE
 DIFFERENTIATING FEATURE IS
PRESENCE OF TRANSVERSE
FORAMEN.
 LORDOTIC CURVE
 PROVIDES MOBILITY AND
STABILITY TO HEAD.
C1 (ATLAS)

■ NO BODY, NO SPINOUS PROCESS

■ DEVELOP AS A RING OF BONE WITH

ANTERIOR AND POSTERIOR
ARCHES THAT CONNECT 2 LATERAL
MSSES.
C2 (AXIS)
■ DURING THE DEVELOPMENT OF ATLAS, WHAT
SHOULD BE THE BODY NATURALLY FUSE TO
AXIS FORMING DENS OR ODONTOID PEG AND
PRESENTED AS BODY OF AXIS.

■ POSTERIORLY GROOVE IN THE NECK OF

ODONTOID REPRESENTS POSITION OF STRONG
TRANSVERSE ATLANTAL LIGAMMENT.

■ AT THE TIP OF ODONTOID PEG THERE IS

ATTACHMENT OF APICAL LIGAMENT. IT
CONNECTS ODONTOID TO BASE OF SKULL AT
BASION, ANTERIOR PART OF FORAMEN
MAGNUM.
ATLANTOAXIAL JOINT

■ IT IS A PIVOT JOINT.

■ ATLAS AND AXIS FORM COMPLEX

ARTICULAR SYSTEM THAT PERMITS
NODDING AND ROTATIONAL
MOVEMENTS OF THE HEAD.

■ DENS, TOOTH LIKE STRUCTURE ACT

AS CENTRAL POINT TO ALLOW
ROTATION FOR ATLAS.

■ NO INTERVERTEBRAL DISC BETWEEN

C1 AND C2.
C3-C7 VERTEBRAE
C7 VERTEBRAE
■ C7 VERTEBRAE IS REFERRED AS
VERTEBRAE PROMINENS BECAUSE
IT HAS LONGER AND LARGER
SPINOUS PROCESS COMPARED TO
OTHER CERVICAL VERTEBRAE.

■ HERE SPINOUS PROCESS IS NOT

USUALLY BIFID.
THORACIC VERTEBRAE
■ 12 VERTEBRAE

■ NATURAL KYPHOTIC CURVE.

■ PEDICLE HEIGHT INCREASES T1 TO T12.

■ APEX IS PRESENT AT T7/T8, AT THIS LEVEL

DISC HAVE MAJOR ROLE IN INFLUENCING
THE CURVE.

■ DIFFERENTIATING FEATURE-PRESENCE OF
FACET FOR ARTICULATION WITH RIB
THORACIC VERTEBRAE
■ 2 DEMI FACET PRESENT NEAR
ROOT OF PEDICLE TO
ACCOMMODATE THE HEAD OF
CORRESPONDING RIBS.

■ SMALL COSTAL FACET PRESENT

ON TRANSVERSE PROCESS
WHICH ARTICULATE WITH
TUBERCLE OF THE RIB.

■ FROM T10-T12 ONLY SUPRIOR

COSTAL FACET PRESENT,
INFERIOR COSTAL FACET
LUMBAR VERTEBRAE
■ 5 VERTEBRAE

■ NATURAL LORDOTIC CURVE

■ MOST WEIGHT IS CENTERED AND

SUSTAIN GREATER STRESS.

■ HAVE MAMILLARY PROCESSES WHICH

GIVE ATTACHMENT OF THICK LOWER
DIVISION OF DEEP PARASPINAL
MUSCLES.

■ SUPERIOR ARTICULAR SURFACE

DIRECTED DORSOMEDIALLY WHEREAS
INFERIOR ARTICULAR SURFACE DIRECT
TOWARDS VENTROLATERALLY.
LUMBAR VERTEBRAE
■ BODY LARGE, FAIRLY FLAT AND BROAD IN
SHAPE.

■ PEDICLES ARE SHORTER, THICKER AND

OVAL SHAPED.

■ SPINOUS PROCESS ARE THICKER AND

SQUARE SHAPED.

■ INTERVERTEBRAL FORAMEN ARE LARGE

BUT INCREASED INCIDENCE OF NERVE
ROOT COMPRESSION.

■ VERTEBRAL FORAMEN TRIANGULAR IN

SHAPE.
SACROCOCCYGEAL VERTEBRAE
■ APPEARS TRIANGULAR

■ CONSIST OF 5 FUSED SACRAL VERTEBRAE AND 4

COCCYGEAL VERTEBRAE.

■ TRANSMIT BODY WEIGHT TO HIP.

■ MEDIAL SACRAL CREST- PRESENT POSTERIORLY

OVER FUSED SPINOUS PROCESS, ARTICULAR
PROCESS AND TRANSVERSE PROCESS

■ SACRAL PROMONTORY- 1ST SACRAL VERTEBRAE

WITH PROFILE RIDGE.

■ SACRAL ALA- FLAT BROAD AREA WHERE SACRUM

ARTICULATE WITH ILIUM AND PELVIS.
INTERVERTEBRAL JOINT
■ INTERVERTEBRAL JOINT
ALLOW PROPER
FUNCTIONING OF VERTEBRAL
COLUMN.

■ CONSIST OF-

– VERTEBRAL END PLATES

– INTERVERTEBRAL DISC

– APOPHYSEAL JOINT
VERTEBRAL END PALTES
■ CONSIST OF HYALINE CARTILAGE
AND FIBROCARTILAGE IN YOUNG.

■ IN ADULTS CONSIST OF
FIBROCARTILAGE

■ THICKNESS 0.6-1 MM

■ WEAKEST PART OF DISC

■ FUNCTION:

– NUTRITION OF DISC

– PREVENT BULGING OF NUCLEUS

INTO VERTEBRAL BODY
INTERVERTEBRAL DISC
• COMPOSED OF-
1. ANNULUS FIBROSUS- (TOUGH RING)
o CONSIST OF CONCENTRIC LAMINAL LAYER OF TYPE 1
COLLAGEN.
o IT CONTAINS AND LIMIT THE EXPANSION OF NUCLEUS.
1. NUCLEUS PULPOSUS- (SEMI FLUID GEL)
o CONSIST OFTYPE 2 CALLAGEN ARRANGED IN LOOSE MESH
SEMI FLUID PROTEIOGLYCAN GEL.
o MAKES 40- 60%.
o ABLE TO CHANGE SHAPE AND TRANSMIT PRESSURE IN
ALL DIRECTIONS.
o IT PROVIDE ELASTICITY AND COMPRESSIBILITY.
INTERVERTEBRAL DISC
 CUSHION LIKE STRUCTURE.

 PREVENT AGAINST COMPRESSIVE FORCES.

 OVERALL BODY HEIGHT DECREASES BY 15-20 MM DURING

DAY WHICH IS RECUPERATED DURING NIGHT

 NUTRITION- DISC IS AVASCULAR AFTER 10 YRS AND RELIES

ON DIFFUSION OF NUTRIENT SUCH AS OXYGEN, GLUCOSE
AND SULFATE.

 3 BIOMECHANICAL GOAL-

 WEIGHT DISTRIBUTION FROM 1 VERTEBRAE TO ANOTHER.

 FLEXIBILITY ALLOW FLEXION, EXTENSION, LATERAL

BENDING AND ROTATION.

 STRENGHT TO PREVENT ANY INJURY DURING MOVEMENT.

LIGAMENTS
■ IT IS CONNECTING TISSUE FROM 1 BONE TO
ANOTHER.

■ MAINTAIN STABILITY IN UPRIGHT POSITION PROTECT

AGAINST TENSILE FORCE.

■ 6 LIGAMENTS ARE THERE-

– ANTERIOR LONGITUDINAL LIGAMENT

– POSTERIOR LONGITUDINAL LIGAMENT

– SUPRASPINOUS LIGAMENT
– INTERSPINOUS LIGAMENT

– LIGAMENTUM FLAVUM
– FACET OR ARTICULAR CAPSULE ( SURROUNDS
ZYGAPOPHYSEAL JOINT ALLOW MOVEMENT IN
SAGITTAL PLANE)
ANTERIOR LONGITUDINAL LIGAMENT
■ EXTENDS FROM ANTERIOR ASPECT OF
BASE OF OCCIPUT VIA THE ATLAS DOWN
THE ANTERIOR SURFACE OF EACH
VERTEBRAE AND DISC UPTO SACRUM.

■ 20 MM WIDE

■ PREVENT ANTERIOR SEPARATION OF

EACH VERTEBRAL BODY WHEN IN
EXTENSION AND FLEXION.
POSTERIOR LONGITUDINAL LIGAMENT

■ POSTERIOR TO BODY AND DISC

■ EXTENDS FROM POSTERIOR

ASPECT OF BASE OF OCCIPUT VIA
ODONTOID PEG DOWN UPTO
COCCYX.

■ BROADER OVER DISC AND

NARROWER OVER BODY.
LIGAMENTUM FLAVUM AND INTERSPINOUS
LIGAMENT
■ LIGAMENTUM FLAVUM:

– SHORT AND THICK

– PROTECT DISC BY LIMITING MOVEMENT.

– YELLOW LIGAMENT DUE TO DISTINCTIVE

COLOUR.

– MOST ELACTIC TISSUE IN BODY

■ INTERSPINOUS LIGAMENT:

– SERIES OF SHORT LIGAMENT THAT CONNECT

ADJACENT SPINOUS PROCESS

– IT LACKS CONTINUITY
SUPRASPINOUS LIGAMENT AND INTERTRANSVERSE
LIGAMENT
■ SUPRASPINOUS LIGAMENT:

– FIBROUS CORD ATTACHES AT TIP OF

EACH SPINOUS PROCESS.

– IT CEASES BETWEEN L4-L5 VERTEBRAE.

– BELOW THIS THORACOLUMBAR FASCIA

TAKES OVER ROLE OF PROVIDING
STRENGTH AND SAGITTAL MOVEMENT OF
LS SPINE.

■ INTERTRANSVERSE LIGAMENT:

– IT LIMITS LATERAL FLEXION OF SPINE

 MUSCLES
■ CREATES COVER OF SOFT TISSUE

■ PERMITS MOVEMENT AND STABILITY OF SPINAL

COLUMN.

■ IT IS KNOWN AS PARASPINAL MUSCLES.

■ ROLE OF PARASPINAL MUSCLES-

– STABALIZATION OF BONES

– INFLUENCE POSTURE

– IT INFLUENCE MOVEMENT- EXTENSION, FLEXION AND

ROTATION.
 ANTERIOR MUSCLES
■ GROUP OF MUSCLE ASSOCIATED WITH FLEXION.

■ LONGUS CAPITIS- FROM LATERAL MASSES TO

FORAMEN MAGNUM.

■ LONGUS COLI- FROM ATLAS TO T3.

■ PSOAS MAJOR- IN LUMBAR REGION AND EXTEND

TO THE HIP.

■ PSOAS MINOR- LIES ON SURFACE OF PSOAS

MAJOR FROM T12-L1.
POSTERIOR MUSCLES
■ DEEP LAYER-
– INTERSPINATE MUSCLES
– INTERTRANSVERSALE MUSCLE

■ INTERMEDIATE LAYER-
– TRANSVERSOSPINALIS- EXTEND FROM
TRANSVERSE PROCESS TO SPINE.
I. MULTIFIDUS
II. SEMISPINALIS CERVICIS
III. SEMISPINALIS CAPITIS
IV. SEMISPINALIS THORACIS
 POSTERIOR MUSCLES
■ SUPERFICIAL LAYER- ERRECTOR
SPINAE

– ILIOCOSTALIS

– LONGISSIMUS

– SPINALIS CERVICIS

– SPINALIS THORACIS
 MUSCLES
■ OTHER MUSCLES- CONTROLLING MOVEMENT OF THE SPINE

– SERRATUS POSTERIOR SUPERIOR

– RHOMBOID MINOR

– TRAPEZIUS

– RHOMBOID MAJOR

– LATTISMUS DORSI

– SERRATUS POSTERIOR INFERIOR

SPINAL CORD
■ SPINAL CORD IS SURROUNDED BY THREE
MEMBRANES-

– DURA MATER- EXTERNAL LOOSE SHEETH WHICH

DOESNOT ADHERE TO CORD.

– ARACHNOID- THIN DELICATE LAYER BETWEEN

DURA MATER AND PIA MATER.

– PIA MATER- INNERMOST LAYER WHICH ADHERE

TO CORD.

■ SUBDURAL SPACE CONTAIN SEROUS FLUID.

■ SUBARACHNOID SPACE CONTAIN CSF.

■ ALL NERVE DIVIDE INTO ANTERIOR AND

POSTERIOR SEGMENT WHICH CONNECT TO THE
CORD VIA ANTERIOR AND POSTERIOR NERVE
ROOT.
 SPINAL CORD
■ HOUSED WITHIN VERTEBRAL FORAMEN AND PROTECTED BY
BONE ALL AROUND.

■ EXTENDS FROM FORAMEN MAGNUM TO WHERE IT

CONNECTS WITH MEDULLA OBLONGATA AND ENDS AT
LOWER BORDER OF L1 .

■ BELOW THIS LEVEL IT DIVIDED AS CONUS MEDULLARIS,

SEEN AS BUNDLE OF FILAMENTS.

■ BUNDLE CONSIST OF LUMBAR AND SACRAL NERVE ROOTS.

■ THEY RESEMBLE HORSE’S TAIL AND ARE CALLED CAUDA

EQUINA.

■ AT MOST DISTAL PART IT IS ATTACHED TO COCCYX BY FILUM

TERMINALE.
 SPINAL NERVES
■ 31 PAIR OF SPINAL NERVES-

– CERVICAL: 8 PAIRS

– THORACIC: 12 PAIRS
– LUMBAR: 5 PAIRS
– SACRAL: 5 PAIRS

– COCCYGEAL: 1 PAIR

■ C1 NERVE ROOT EXIT BETWEEN OCCIPITAL AND C1

■ C2 EXIT BETWEEN C1 AND C2.

■ IN CERVICAL SPINE NERVE ROOT EXIT ABOVE THE LEVEL IT IS

NAMED.

■ WHEREAS OTHER REGION NERVE ROOT EXIT AT THE SAME

LEVEL IT IS NAMED.
SPINAL NERVE
■ ALL NERVE DIVIDE INTO ANTERIOR
AND POSTERIOR SEGMENT WHICH
CONNECT TO THE CORD VIA ANTERIOR
AND POSTERIOR NERVE ROOT.

■ ANTERIOR NERVE ROOT ACT AS

MOTOR NERVE WHEREAS POSTERIOR
NERVE ROOT PROVIDES SENSORY
INFORMATION.
 SPINAL NERVE
 PLEXUS NETWORK IS AN ADDITIONAL BRANCHES OF THE
NERVES.
 THROUGH CONTINOUS DIVISION AND REFORMATION,
PLEXUS IS FORMED.
 4 PLEXUS-
 CERVICAL PLEXUS: DUE TO ANTERIOR DIVISION OF
UPPER 4 CERVICAL NERVES.
 BRACHIAL PLEXUS: DUE TO MERGER OF LOWER 4
CERVICAL NERVE AND 1ST THORACIC NERVE
 LUMBAR PLEXUS: DUE TO ANTERIOR DIVISION OF
UPPER FOUR LUMBAR NERVE AND 12TH THORACIC
NERVE.
 SACRAL PLEXUS: DUE TO LUMBOSACRAL CORD,
ANTERIOR DIVIDION OF UPPER THREE SACRAL NERVE
AND SECTION OF 4TH SACRAL NERVE.
 DERMATOMES
 SENSORY COMPONENT OF EACH
SPINAL NERVE DISTRIBUTES TO A
SEGMENTAL PART OF SKIN CALLED
DERMATOME.
 PATTERN FOLLOWS SEGMENTAL
DISTRIBUTION OF UNDERLYING
MUSCLE INNERVATIONS.
 TESTING THE SENSATION ON THE SKIN
AS WELL AS TESTIONG POWER IS
USEFULL IN DETERMINING THE
PRESENCE OF A NERVE, SPINAL
TRACT OR SPINAL CORD LESION.
X-RAYS OF
SPINE
 GOAL OF X-RAYS OF SPINE
■ TO DIAGNOSE

– CAUSE OF BACK PAIN OR NECK PAIN

– FRACTURE

– ARTHRITIS

– SPONDYLOLISTHESIS

– DEGENERATION OF DISC

– TUMOR

– ABNORMALITIES OF CURVATURE

– CONGENITAL ABNORMALITIES
 X-RAYS OF CERVICAL SPINE
■ DIFFERENT VIEW FOR CERVICAL SPINE:

– ANTEROPOSTERIOR VIEW

– LATERAL VIEW

– ODONTOID (OPEN MOUTH) VIEW

– SWIMMERS VIEW

– LATERAL VIEW WITH TRACTION OF BOTH ARM

– FUNCTIONAL VIEW (LATERAL FLEXION AND EXTENSION VIEW)

NORMAL RADIOLOGICAL FINDING IN C-SPINE
■ LATERAL VIEW CERVICAL SPINE

■ F: FACET JOINT

■ SP: SPINOUS PROCESS

■ H: HYOID BONE

■ Ph: PHARYNX

■ Tr: TRACHEA

■ PREDENTAL SPACE

■ RETROPHARYNGEAL SPACE

■ RETROTRACHEAL SPACE

■ POSTERIOR CERVICAL LINE FROM C1 TO C3

NORMAL RADIOLOGICAL FINDING IN C-
SPINE
■ ANTEROPOSTERIOR VIEW OF
CERVICAL SPINE

■ D: INTERVERTEBRAL DISC

■ U: UNCOVERTEBRAL JOINT

■ T: TRANSVERSE PROCESS

■ SP: SPINOUS PROCESS

OPEN MOUTH VIEW
SWIMMERS VIEW
FUNCTIONAL VIEW
 X-RAYS OF THORACOLUMBAR SPINE
■ DIFFERENT VIEW FOR THORACOLUMBAR SPINE:

– ANTEROPOSTERIOR VIEW

– LATERAL VIEW

– FUNCTIONAL VIEW (LATERAL FLEXION AND EXTENSION VIEW)

– OBLIQUE VIEW

– FERGUSON VIEW: 20* CAUDOCEPHALIC ANTEROPOSTERIOR

– ANGLED CAUDAL VIEW: FOR FACET OR LAMINAR PATHOLOGICAL CONDITION

RADIOGRAPHIC ANATOMY OF LUMBAR
SPINE
■ LATERAL VIEW OF LUMBAR SPINE
– B: BODY OF VERTEBRAE
– D: INTERVERTEBRAL DISC
– P: PEDICLE
– F: FACET
– Fo: INTERVERTEBRAL FORAMEN
– I: INFERIOR ARTICULAR PROCESS
– S: SUPERIOR ARTICULAR PROCESS
– SP: SPINOUS PROCESS
RADIOGRAPHIC ANATOMY OF LUMBAR
SPINE
■ ANTEROPOSTERIOR VIEW OF
LUMBAR VERTEBRAE

– I: INFERIOR ARTICULAR PROCESS

– S: SUPERIOR ARTICULAR PROCESS

– P: PEDICLE

– L: LAMINA

– T: TRANSVERSE PROCESS

– SP: SPINOUS PROCESS

RADIOGRAPH OF LS SPINE- AP/ LATERAL/ LATERAL
FLEXION AND LATERAL EXTENSION VIEW
RADIOGRAPHIC ANATOMY OF THORACIC
SPINE ■ ADDITIONAL
FEATURE IN
THORACIC SPINE IS
ARTICULATION OF
RIB WITH FACET
PRESENT OVER
VERTEBRAL BODY.
DENNIS THREE COLUMN CLASSIFICATION

■ FOR TREATMENT OF SPINAL INJURIES, IT IS

CRUCIAL TO ASSESS STABILITY OF SPINE .

■ IN 3 COLUMN CLASSIFICATION, SPINE IS

DIVIDED INTO 3 COLUMN.

■ WHEN ONLY 1 COLUMN IS DISRUPTED ,

SPINE IS STABLE.

■ WHEN 2 OR MORE THAN 2 COLUMN IS

INVOLVED, SPINE IS UNSTABLE.
FLEXION INJURY EXTENSION INJURY
COMPRESSION FRACTURE OF L1 VERTEBRAE TRANSVERSE FRACTURE AT L3 VERTEBRAE
SCOLIOSIS
■ ABNORMAL CURVATURE OF SPINE WITH LATERAL
COMPONENT OF MORE THAN 10*.

■ ASSESSED RADIOLOGICALLY WITH SINGLE AP LONG

FILM OF THORACIC AND LUMBAR SPINE TAKEN IN
PATIENT WITH ERECT POSITION.

■ COBBS ANGLE OF 10* OR MORE IS CONSIDERED

ABNORMAL.

■ ROTATION OF VERTEBRAE WITH 1 PRIMARY AND 2

SECONDARY CURVES.

■ FULCRUM BENDING RADIOGRAPH TO DETERMINE

FLEXIBILITY OF SCOLIOTIC CURE
SCOLIOSIS
■ HOW TO MEASURE COBBS
ANGLE?
1. DRAW A LINE PARALLEL TO
SUPERIOR END PLATE OF
MOST TILTED VERTEBRAE AT
UPPER END OF CURVE.
2. DRAW A LINE PARALLEL TO
INFERIOR END PLATE OF
MOST TILTED VERTEBRAE AT
LOWER END OF CURVE.
■ ANGLE BETWEEN THESE TWO
LINE OR ANGLE BETWEEN
TWO LINE PERPENDICULAR
TO ABOVE TWO LINE IS COBBS
ANGLE.
FULCRUM BENDING RADIOGRAPH IN CASE
OF SCOLIOSIS
 KYPHOSIS
■ EXCESSIVE BACKWARD CONVEXITY OF SPINE.

■ ASSESSED RADIOLOGICALLY WITH SINGLE

LATERAL LONG FILM OF THORACIC AND LUMBAR
SPINE TAKEN IN PATIENT WITH ERECT POSITION.

■ COBBS ANGLE IS MEASURE TO EVAVLUATE

SEVERITY.

■ HYPEREXTENSION FILM TO DETERMINE

FLEXIBILITY ON HYPEREXTENSION.
DEFECT IN PARS INTERARTICULARIS
SPONDYLOSIS

■ DEFECT IN PARS
INTERARTICULARIS

■ OBLIQUE VIEW OF SPINE IS

IMPORTANT TO SHOW DEFECT IN
PARS INTERARTICULARIS.

■ SCOTTISH DOG WITH COLLAR SIGN

SEEN IN X-RAY
SPONDYLOLISTHESIS

■ DEFECT IN PARS INTERARTICULARIS

WITH DISPLACEMENT OF ONE
VERTEBRAE OVER OTHER (ANTERIOR
> POSTERIOR)

■ OBLIQUE VIEW OF SPINE IS

IMPORTANT TO SHOW DEFECT IN
PARS INTERARTICULARIS.

■ SCOTTISH DOG HEAD AWAY FROM

THE BODY SIGN SEEN IN X-RAY
 POTT’S SPINE
■ X-RAY FINDING IN TB OF SPINE:

 EARLY CASE, MINIMAL LOSS OF DISC SPACE

 COMPLETE LOSS OF DISC SPACE

 DESTRUCTION OF VERTEBRAL BODIES WITH LOSS OF DISC SPACE

 ADVANCED DESTRUCTION AND WEDGING OF VERTEBRAE

 PARAVERTEBRAL ABSCESS

 PSOAS ABSCESS

 RETROPHARYNGEAL ABSCESS
POTT’S SPINE
POTT’S SPINE
SIGN OF HEALING IN
CASE OF POTT’S SPINE
TUMOR
SCLEROTIC
LESION
SECONDARY TO
PRIMARY TUMOR
FROM PROSTATE,
BREAST,LUNGS
ETC….

LYTIC LESION
SECONDARY TO
MULTIPLE
MYELOMA
FACET JOINT SUBLUXATION FACET JOINT DISLOCATION
 JAFFERSON FRACTURE: FRACTURE OF C1
VERTEBRAE WITH NO ALINGMENT OF
LATERAL MASSES

HANGMAN FRACTURE: FRACTURE OF PEDICLE OF C2

OSTEOARTHRITIS
THANK YOU