Hướng dẫn đọc XQ cột sống cơ bản

1. Sơ lược giải phẫu cột sống: 1.1. Đặc điểm chung: + Cột sống có từ 32 34 đốt và chia thành 5 đoạn: Đoạn cổ. Đoạn ngực. Đoạn thắt lưng. Đoạn cùng. Đoạn cụt. + Mỗi đốt sống gồm có: Thân đốt. Cuống sống. Hai mỏm ngang. Một mỏm gai (gai sau). Bốn mỏm khớp (hai khớp mấu sống trên và hai khớp mấu sống dưới).

Giải phẫu cột sống

Và XQ cột sống

BSNT Vũ Ngọc Anh

ANATOMY OF

SPINE

Chức năng cột sống

1 Bảo vệ tủy sống, màng tủy, mạch máu và các tạng

FUNCTIONS OF

SPINE

2 Cho phép vận động

dễ dàng cả 6 động tác

FUNCTIONS OF

SPINE

3 Cho phép đứng thoải mái

và thăng bằng

CURVES OF

– Cong ra sau – Biểu hiện ngay từ bào thai – CS ngực (20*-40*)

– Xương cùng

■ SECONDARY CURVATURES:

– Ưỡn ra trước – Hình thành từ thời kỳ sơ sinh và

trẻ em

– CS cổ (20-40*) – CS thắt lưng (30-50*)

*)

2 đường cong ra sau (THORACIC AND SACRAL)

2 đường cong ra trước (CERVICAL AND LUMBAR)

Bắt thường trên phim nhìn mặt phẳng đứng dọc :

• Mất đường cong sinh lý

• Khớp

• Gù

• Lún, xẹp cá thân ĐS

C1

(ATLAS)

C2

(AXIS)

ATLANTOAXIAL JOINT

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 NOTUSUALLY BIFID

THORACIC

■ 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

ROOT OF PEDICLE TO ACCOMMODATE THE HEAD OF CORRESPONDING RIBS.

■ SMALL COSTAL FACET PRESENT

PROCES S

WIT H

ON TRANSVERSE WHICH

ARTICULATE TUBERCLE OF THE RIB.

■ FROM T12

T10-ONL Y FACET COSTA L

SUPRIO

R PRESEN T,

FAC ET

COSTAL INFERIO

R ABSENT.

LUMBAR

■ 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.

■ SUPERIO R

DIRECTED

ARTICULAR DORSOMEDIAL

LY

SURFAC E WHEREA S

INFERIOR ARTICULAR SURFACEDIRECT TOWARDS VENTROLATERALLY.

■ VERTEBRAL FORAMEN TRIANGULAR IN

SHAPE.

SACROCOCCYGEAL

■ CONSIST OF 5 FUSED SACRAL VERTEBRAE AND 4 COCCYGEAL VERTEBRAE.

■ TRANSMIT BODY WEIGHT TO HIP.

■ MEDIAL SACRAL CREST- PRESENT POSTERIORLY

X-RAYS OF

SPINE

GOAL OF X-RAYS OF SPINE

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 SPINE

C-■ LATERAL VIEW CERVICAL SPINE

NORMAL RADIOLOGICAL FINDING IN

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 PINE■ 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 PINE■ ANTEROPOSTERIOR VIEW OF LUMBAR VERTEBRAE

RADIOGRAPH OF LS SPINE- AP/ LATERAL/ LATERAL

FLEXION AND LATERAL EXTENSION VIEW

IN THORACIC SPINE IS

OF

ARTICULATI

ON RIB WITH PRESENT

FACE T OVE R 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

■ 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

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

KYPHOSI S

■ 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

S

PARS

■ DEFECT

IN INTERARTICULARIS

■ OBLIQUEVIEW

OF SPINEIS

IMPORTANT TO SHOWDEFECT IN PARS INTERARTICULARIS

■ SCOTTISH DOG WITH COLLAR SIGNSEEN IN X-RAY

S

■ DEFECT IN PARS INTERARTICULARIS WITH DISPLACEMENT OF ONE VERTEBRAE OVER OTHER (ANTERIOR

> POSTERIOR)

■ OBLIQUE IMPORTAN T

VIEW OF SPINE IS 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

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

OSTEOARTHRI TIS

THANK YOU