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hi guys dr. Dillard here this is a.makeup lecture for group two who missed.last.Radiology lecture we're going to go over.once again the structures of the lumbar.spine and the exact structures of the.vertebrae not only how they appear on.just cartoons but how they really look.on different types of imaging like x-ray.CT and MRI so here we go and if you want.to jump ahead and search the only slides.I'm really going to test you on are the.ones that have two stars on them there.just be there will be no MRI and no CT.on your testing just the x-ray slides.but make sure you can identify the.structures if you can take all the.little quizzes here with it with the.x-rays that have two stars on them.you'll be fine alright here we go so the.objective of this PowerPoint is to.refresh your basic spinal Anatomy which.you should know pretty good by now and.to identify radiographic structures on.the spine radiographic features of the.spine on radiographs MRIs and CTS this.is also for my upper quarter eighth.quarter students who need a little.refresher before hitting the advanced.lumbar differential diagnosis class and.just a note here you doctors of.chiropractic are experts in the spine.and therefore you need to know this.stuff.just like spine surgeons physiatrists.pain management and rehabilitation.doctors do you need to be up there so if.you don't I mean if you don't know the.components of the spine how can you call.yourself an expert right all right let's.start the very basics this is a.radiology section now you're going to.get this a lot more in-depth at our.school but this is just a little kind of.a taste of it and to kind of get you.thinking about it so x-ray is a form of.ionizing radiation it's a very short.wavelength of light just like visible.light only it's shorter than visible.light and it is considered part of the.electromagnetic spectrum there.the Elector you had this in physics I'm.sure so visible light this is the light.of the rainbow that we can see here this.is the frequency of the light gets.longer like a radio waves are very long.now x-ray is much shorter not as short.as gamma-ray but it's it's dangerous it.can penetrate its body tissue can go.right through your body and go right.through wood things like that can't go.through metals like LED this can go.through even some metals here it's very.very dangerous birth of the x-ray so.extra radiation or photons are produced.in something called an x-ray tube.specifically the x-ray is produced when.speedy electrons we know electrons right.we probably have that in grade school.these days they're very fast what you do.is you smash electrons into some type of.metal target within the x-ray tube and.the fast-moving electron will hit the.metal and stop suddenly.causes electron to release energy in the.form of heat and x-ray note that x-ray.tubes get very very hot and this is.because 99% of the energy released is in.the form of heat only 1% is in the form.of x-ray photons this phenomena is.called bremsstrahlung radiation or.breaking radiation what happens to the.photons where do they go they fly around.inside the x-ray tube but there's.something that contains the x-ray tube.that's called the column nadir and they.are funneled out the front of the column.nadir it's almost like the barrel of the.gun you can think of it as let's take a.picture of it so here's the x-ray tube.there's a cathode and an anode you'll.get into all this as you go through this.program but this green thing is the.column nadir and x-rays come out of a.tube it's almost like a gun barrel and.that's the thing you can this the whole.thing moves and shifts around you can.aim this you want to take a picture of.someone's wrist you aim it at the wrist.and we'll see you put film or some type.of photosensitive plate behind the.patient to capture the photons that make.it through not all the photons make it.through the bodies we'll see here's a.real column later here with handles so.swivels around you can adjust it it's.also got column Nation on the side so.you don't if you x-ray in the wrist you.want to blast the whole arm you can.narrow down the beam via column nation.here take a name we said this already.you aim the x-ray column inator at the.part of the body like the wrist like you.want to hit don't forget to column Nate.that means to move the lead shields in.to narrow the focus of the beam of.photons there's kind of a example here.so here's the here's the tube would be.inside the column nadir can't see the.barrel of the gun but it's aimed right.at this lumbar spine and so here's all.the settings there's kVp and mass in.time and you the photons come out they.go right through the lumbar spine and.then you have to have something to to.capture the photons in the back and this.is it used to be radiographic film but.now there's just photosensitive.sensitive plates and depending on how.many photons make it through it colors.this different shades of gray I'm.getting way ahead of myself here where.do the photons go they pass through the.body with various levels of success the.ones that ultimately make it through the.body will hit a cassette or a panel.there's different words for it which is.directly on the opposite side of the.body this cassette and panel these.contain well if you still have an old.school analog system they contain real.x-ray film just like the old type of.film that was in cameras and you know.that's what I was that when I was in.practice we used to I used to have one.of these processors and all analog.systems and you have to take that after.you after you take the x-ray the patient.you have to go in a dark room just like.photographic film and develop it.and it's a big pain in the butt the new.school nowadays they have a.photosensitive plate which is wirelessly.connected what doesn't have to be.wirelessly but it's wirelessly connected.to a computer that that basically.develops your x-ray without any.chemicals it's not more complicated.that's kind of the gist of it so when.you load your film with kis above or.when you load your cassette with film or.if it's just a photosensitive panel test.it's typically placed in something that.the patient lays on or lays up against.and those are called the Bucky's there's.a table Bucky and there's a wall Bucky.here's some old-school cassette film so.you would open these up and put your.x-ray film right in there slip it inside.the Bucky.here's a wall Bucky that the patient.would stand against you're putting your.photo photosensitive panel in or it.could be a cassette same thing loaded.with film it slides in here it would.look be positioned like this and then.you line the patient up against that so.again this is a table Bucky here you.probably won't have one of these in.practice typically chiropractors just.have raw Bucky's be nice to have one of.these but they're quite expensive but so.for table Bucky we would swing this.thing around and maybe we take an a to P.view coming down like this and there's.the there's the trade that you pull out.and you put the cassette in there and.slide it in and here in this example.here they just have a cassette placed in.a little holder behind the patient so.they didn't even have to use the pull-up.tray here okay there's a great system.then again there's table Bucky wall.Bucky this is the type chiropractors.typically have they don't our school.actually has both of these which is.wonderful but typically you'll just have.this setup so you can take standing.films so.photons have the ability to pass right.through most body tissue and the ability.to penetrate to move through body tissue.is called penetration and photons have.trouble passing through some very hard.substances remember I said they get.through the body with various degrees of.success.for example bone they don't penetrate.through very good only very few of them.make it through but something like air.that it's very easy to get through like.your lungs it can zip photons zip right.through that with no problem and hit the.film on the Bucky so important the one.star here radio opacity versus.radiolucency very important concept when.photons get through the body and hit the.film they are turned into various shades.of grey the more photons that get.through the body and hit the film the.blacker that region of the film becomes.that's a very important concept right.and that blackness is called.radial lucency oh look at that.radiolucent pleasin in that patients.bone could be cancer another word.usually used on MRI is hypo intensity oh.that lesion is very hypo intense so hypo.intensity is another word for blackness.so this is very important stuff to know.when photons have when photons have.difficulty getting through the tissue.like let's say they get run into bone.not many of them can get through all the.way through the bone and hit the hip the.film in the back then that region that.is scarce of photons is more white it's.less exposed so this whiteness is called.radial path City radio path City and MRI.it's called hyper intensity oh look at.that radio-opaque lesion in the.patient's lung most of the photons got.through and turned the lung black except.for that big white maybe a lymph node or.something that's how you use the term.you don't say oh look at that white.Fang said look at that hyper-intense.Lygia or look at that radio-opaque.lesion in the lung that is alarming got.it so here's all the shades of grey.there's pure white.so the x-ray film which is called a what.an image the x-ray image after you.expose let's say that risk that produces.an image that image could have very.white regions and different shades where.they where the x-ray beam or where the.photons didn't get through maybe around.the edges of the hand between the.fingers there's no tissue so it's going.to be really black there.okay shades of grey just what I just.said radiographic image commonly but.incorrectly called an x-ray x-ray is.really the photon x-ray photons really.you don't say oh look at this x-ray but.in reality I mean everybody calls it an.x-ray if you want to be correct.look at this radiographic image look at.this MRI image look at the sea you don't.say look at this x-ray anyway so some.regions of the film get hit again with.lots of photons some regions get hits.with little photons and that causes the.different shades of gray.why again photons penetrate the body.tissue of various degrees of success we.talked about this already.some bodies made up of so many different.types of tissue and each has its own.tissue density and hardness photons pass.through in different quantities all of.the photons get through the lung tissue.just about therefore it's black hardly.any of them get through the bone tissue.and therefore it has a very low quantity.of photons make it through and therefore.the the film is white I think you.understand this already let's look at.some example here's a routine chest film.where the patient with chest pain what's.pleuritic chest pain you'll need to know.this by fifth quarter mods we'll learn.it now pleuritic that means that they.take a deep every time they breathe in.it seems like someone's stabbing them.with a knife that's very very painful so.do you see the pathology well let's look.at this first so this is a a 2p or this.is really a p2 a view you can also call.it a coronal view of the chest and you.use different techniques so you the.speed of the photons isn't it great so.it captures more notice you can't really.see the bones I can see the bone.superimposed but this is called a chest.film or soft tissue film so the photons.didn't have a lot of speed and punching.power as we want them to be absorbed.more into the tissue so for example this.you can see with the structure this is a.heart here so it's more it's more.radio-opaque right now this opaque is.this region here where the descending.aorta is that's because the photons have.to go through the descending aorta they.have to go through the vertebra.therefore not of a lot of them have made.it through now over here in the lung.tissue they've made it through much.easier and that's why this is this is.darker in color more radiolucent.in color or hypo intense in color get.the idea here's the Hemi diaphragms here.alright those are very strong you'll see.in gross Oh gross one or goes to gross.to will see these they're very muscular.structures therefore they photons have.trouble getting through these angles.which aren't very sharp actually should.be very sharp these are costophrenic.angles you always look here for.pneumonia or any type of fluid when the.patient's standing up will accumulate.here so this patient actually has fluid.in both lungs more so on this side now.do you see the pathology and I don't.expect you to see I'd be very happy if.you saw this but notice the lung tissue.see these this is the vasculature and.these are all the bronchi of the.bronchial tree and it goes right to the.end here this is the chest wall look at.the side where's that vasculature it's.gone and if you look very closely you.can see a line right here.so what is this that's the lung so the.patient has is called a pneumothorax.where maybe he I'm not sure the cause of.it I don't see any chest trauma but he.sometimes you can get a bleb which is a.little hole in this in this lung and you.leak air into the pleural cavity which.is a space between the chest wall the.visceral and parietal pleura we'll learn.about that and grows too but this is all.filled up with air so what's squishing.the lung the lung is collapsed alright.let's look at this give me a second you.can pause and take a look tell me what.you see what region the spine is it.there's the sacrum this is the lumbar.spine okay so here's the vertebral.bodies here right here's the disk space.you need to know this stuff.now obviously this is a great example of.something incredibly radio-opaque in.fact this is a hundred percent.radiopaque none of the photons made it.through the this thing what is this.thing this is an artificial disc.replacement so actually a 2-level a dr.it's called i think this is a prestige.ER so prestige i think or pro tears it i.think it's a prestige but it's one.there's several different types of.artificial discs in here here's an.another's so none of the photons made it.through therefore the film is completely.unexposed behind that get it okay and.some of you say oh my god it looks like.screws and that is screws this is an.anterior lumbar interbody fusion with a.peek cage this is standard this is not.these don't these aren't working out so.good actually I don't I don't recommend.people get these so we'll talk about an.eighth quarter there's another example.now what do you see here well this bone.is more but well this these images are.more radio-opaque right they're wider so.more photo.are having trouble getting through this.patients lumbar spine this is a lateral.view right here's the spinous processes.there's the vertebral body we'll talk.about all that disk space here don't see.any cages here so this is a normal spine.how about this one.whoo it doesn't look good does it.well the photons are not having any.trouble punching through this bone.compare the color of this bone to this.so this is a patient with osteoporosis.and it's the finding here is osteopenia.the patient is also P mnek now he's got.he doesn't have a lot of bone density so.you see these this is classic osteo.pinna you have these whites like.somebody took a white crayon and colored.the vertebral endplates in here so I'll.see a prosess we got a slip here we'll.talk about this in a little while this.is a grade 1 spondylolisthesis can't.really tell it doesn't look to be an.isthmus or type 2a which we'll talk.about anybody see anything else go well.we got some monk Berg's medial sclerosis.here we got a little calcification and.abdominal aorta good we got bone on bone.here all right so that's severe.degenerative disk disease you can call.it as well as arthritis right there's.bone spurs you can call that spondylosis.something else I know somebody in first.group actually caught this look at the.spinous processes what's happened to.this one got an avulsion fracture here.so that's a fracture you can see a.Lucent line through there so that.supraspinous ligament has probably.patient reflection extension injury and.ripped piece of the bone off here now.what do you see Oh another chest film.right there's the heart okay so the.photons have more trouble here now you.can see the actually the vertebrae.there's the pedicles here's all the ribs.we'll go into this more detail a little.bit there's the heart there's the right.side of the heart left side of the heart.light left ventricle here.so Larry look at the photons ripped.right through here no problem they.completely exposed the film so very.radiolucent here I know everybody's.going ok what's going on here what in.the heck is that that is incredibly.radiopaque that's a hundred percent all.photons were blocked it must be when all.photons are blocks got to be some type.of metal and it is if you look closely.you can see this this this kind of.scurvy thing here which is more.radiolucent right that's a tube with air.what what is a tube with air.it's the trachea and why is it curved.like this because there's something.blocking it so we got somebody swallowed.a quarter and it actually got into the.windpipe or the trachea and it's causing.starting to cause an ADD electus it.looks like ok you got the idea all right.now let's get into the lumbar anatomy.part here and let's go over the anatomy.we're going to talk about the other.views the axial view sagittal view.coronal view and by the time you get to.eighth quarter if you're an eighth.quarter student watching this you need.to know this stuff cold or you will not.pass this class.it's despite both quarter this stuff.should be old hat so make sure you know.this so let's talk about it what the.heck is a spine do and remember this is.first quarter - so eighth quarter people.hang in there you know this the spine it.supports the a pin the appendicular.skeleton so all the arms and the legs.everything attaches to the spine it also.transmits the downward force of gravity.and the downward force of your head in.your trunk transmits that through the.sacrum through l5 s connection with the.sacrum so that's called axial load.transmits axial load it also allows for.body movement right it's where you band.in you twist and you rotate.called flexion-extension is moving back.flexing is bending to touch your toes.and you know what rotation is those are.the three motions of the trunk it also.protects the spinal cord and the exiting.nerve roots as well as the fecal sac so.there's a whole the vertebral canal.which does that and then it can the.basic is important and a lot of eighth.quarter students didn't even know this a.lot of the basic functional unit of the.spine is called a motion segment you.need to know that motion segment and.that is a vertebra disk vertebra.sandwich so here's a motion segment.here's l3 vertebra here's the l3 disk.here's the l4 vertebra and these.specifically vertebral bodies but don't.forget this is the rest of the vertebra.back here right so we have a different.here's a a 2p view here's a p2 a view.meaning posterior to anterior and these.are also collectively you could say.these are coronal images which is a view.from the front and this is a lateral.view or a sagittal view right there's.that auricular surface of the sacrum.there for the auricular surface of the.ilium and that's the SI joint ok muscles.I'm not going to dwell too much on these.but a lot of times when you're writing.your soap notes you just call these.collectively the paravertebral.musculature or the PVM that's what.that's probably good enough for your.soap notes but remember we have the.ileal Costas lumborum here's the muscle.to the outside we'll be able to see.these on MRI and there here's the.longest thoracis these go all the way.down to the sacrum the spine Allis.Erastus muscles right here it starts.about at l1 sometimes l2 so it doesn't.really go all the way through the lumbar.spine but those are part of the pair of.t-bone muskets are or together these.three are call.director spinae muscles erector spinae.muscles and they go a long way they go.all the way up to the cervical spine.very important muscles you got serratus.posterior inferior it's right here we.can see that in our specimen in lab they.can't really see thee well we can see.the internal external obliques but not.as well alright so there's one more.member of the actually quite an.important member this is stuck very.firmly to the bone to mammillary.processes and this is a multiphoton.muscle is actually a lot of research on.this part of the pair of T bro muscles.but this is a really when you talk about.strengthening the core to increase the.stability of lumbar spine this is the.muscle right this is a very important.muscle and you got quadratus lumborum.this muscle right here we can see that.the inter traveling these little muscles.aren't that important to us but the.inner transverse eres group of muscles.it's important because we during surgery.you can actually use this as a bed you.can if you want to fuse two transverse.processes together you can use these.inner transverse area muscles as a bed.and you can lay bone graft material on.top of that and it supports that okay.eighth quarter students you need to know.this picture cold you might as well.learn it now in first quarter as well.this is a motion segment we talked about.that remember that a nerve you have a.spinal cord I could get too much into.neurology but I want to introduce this.now you have a nerve spinal cord comes.all the way down to l1 l2 the nerve.roots are embedded in the substance of.the spinal cord so you can't see nerve.roots like this but when you get down.below l1 l2 they actually hang cannon in.the fecal sac the thecal sac runs all.the way down fry them and magnum all the.way down to s2 but below l1 l2 you can.see the nerve roots hanging in the.thecal sac and behind the vertebral.bodies they actually rip out of the.thecal.that's called buddied and then they go.around the pedicle and they come out the.whole the intervertebral frame under the.neural frame and that is called after.they unite that's called a spinal nerve.that contains motor and sensory fibers.and spinal nerve is very short-lived.notice it splits into two components it.splits into an anterior primary ramus.which goes down makes up the big.powerful this case would be the femoral.nerve the sciatic nerve is also made by.the anterior ramus that's all the.farther we'll go now so that's really.important but this posterior ramus is.important that's very short-lived post.here ramus and yellow here splits almost.immediately into two or three pieces the.one I'm more interested in is this one.right here the medial branch the medial.branch as you can see gives life to the.facet joints in fact an l2 root spinal.nerve the medial branch of l2 actually.supplies its own facet joint and the.facet joint below so very important.you'll be tested on that you should be.testing it in this corridor it's really.important concept but I'm not sure if.you are but by the time you get to me.you will be tested so make sure you.understand that the spinal nerve I mean.mean indirectly via the medial branch of.the posterior ramus applies the facet.joints so if you wreck this facet joint.and you chew it up and you rip up the.articular cartilage inside and if a pain.generator.well that pain is coming right down this.media branch here that's the way the.pain travels there's procedures where.you can burn this nerve and eliminate.that that pain although you have to be.careful with that because this medial.branch notice how it does other stuff.too right it's got these branches these.go to the multiphoton muscles and give.them life so you burn this nerve via.rice atomy the procedures.you reckon a little bit of that multi.fat I muscled above alright so make sure.you know though there's there's a medial.Thursday now these are coming out of the.plane of the page toward us.so this one is hugging the bone here and.these two are more toward the tip of the.transverse process here so this is the.lateral branch this is the intermediate.branch very important and here's what.we're talking about the vertebral canal.here's the fecal sac it's important that.you know it's also called the dural sac.here's the holes where the punch out.holes where the roots will be traversing.or nerve roots of the cauda equina will.each leave to go do their job I actually.I didn't but the artist actually removed.all the nerve roots all that you see.here is the dura mater which is the.thecal sac the rack code matters very.thin attached to the bottom so this is.actually the correct nor subarachnoid.space which is the thecal sac ste.cossack stops down here at s2 this is.the phylum terminalia which is thought.to anchor this then what's this.structure called conus medullaris.thought to anchor that down and this.filum terminale ER which is Pia mater.rips right through the end of the thecal.sac goes all the way down attaches to.the the back of the first coccygeal.segment here right I don't think I need.to say anything more but you should know.these structures right conus medullaris.is the end of the official spinal cord.II but the nerve roots need to go all.the way down so they come out here of.the conus it's a very dangerous area at.one disc herniations are big trouble.alright that's enough of that.alright let's meet the axial views so.here's the an overhead this is an axial.view the mnemonic is hat horizontal view.xu transverse view hat they're all aks.radiology use axial view.so notice how the bones get bigger as.you go lower so here's an l1 vertebra.right make sure you know all these.components we'll talk about them.specifically in a minute l2 is getting.bigger l3 is getting bigger why are they.getting bigger because more force the.further you go down especially l4 and l5.the more axial load force it has to.endure l5 has more axial load force than.any place therefore it is evolved into a.big creature now this one some of you.may notice look at the transverse.processes we'll go over this if you.don't know what transverse processes are.but these had little airplane wings.suspend this process there's the pedicle.vertebral body ring apophysis these are.real bones by the way look at these.things why are they so big this is not.normal so that artists or whoever put.this together probably shouldn't have.used this because they shouldn't look.more like this this is a transitional.segment this is an example of sake.realization this bone has taken on.characteristics of the sacrum so it's.kind of a hybrid bone half half lumbar.vertebra it's more lumbar vertebra but.it's got some characteristics of the.sacrum in this case spatulate a.transverse processes what's this hole in.the middle this is a vertebral foramen I.guess if you're looking at just one bone.as a vertebral foramen collectively when.these are put together these form a.tunnel for the seco sac and this is.called the vertebral canal central.canals neikei it's not a good a KA.though because there's a central canal.through the center of the spinal cord so.that's not a good term to use make sure.you know this you need to know all these.parts so everything I just said but this.is and this is how I explained it to my.you know my patients a vertebra has two.components it's made up of a block of.bone called the vertebral body in the.front and then the.say arch like the st. Louis Arch going.over the back and that arch creates a.space and a protective safe place for.the Seco sack and spinal cord fecal sac.in the lumbar spine spinal cord cervical.thoracic spine all right now this post.here arch is made up of several.components it's first it's hooked to the.vertebral body by these pedicles these.pedicles are very strong in fact this is.the strongest piece of the vertebra if.you put this in a vise and crush it.these will have the most take more.newtons of force to crush the pedicles.than anything else next we have these.columns of bone like like pillars and.these are called the articular pillars.they have a real articular cartilage.facet joint on the top and on the bottom.those are the true articular facets even.though you'll see in a minute we kind of.have a slang word a facade is another.word for zig epatha seal joint will talk.about that amento and notice there's a.superior articular pillar and an.inferior articular piller where the too.neat and where the pedicle comes in.there's a weak area of bone this is the.weakest spot of bone right behind the.pedicle and right in the middle of the.articular pillar this is called the pars.interarticularis and this is the culprit.in spondylolysis and spondylolisthesis.and many types of them not all types of.the degenerative dysplastic there's.different are different types of spinal.but the one you'll run into most of the.time is a is Mik type 2a.spondylolisthesis anyway let's continue.with this posterior arch then we have.something that looks like a roof of the.house in fact this is called the roof of.the vertebral canal and these are.laminar they're two laminate that are.fused together in the middle and that.makes up the roof now some authors say.that the spinous process here also makes.up part of the roof and it's fused in.the middle others don't so I don't think.it does I think it's just a.attachment and then we have the same.members on the other side and then we.have some attachments off this arch of.bone.we have transverse processes or like.airplane wings and then this is like the.rudder and spinous process if you put.your hands behind your head and run your.fingers down you can feel that quite.nicely here's just another another image.I don't think there's anything new.except I did put the roof here I.remember the the roof is really the.lamina together and then the floor of.the vertebral canal is the back of the.vertebral body in the disks which we.don't see here and here we can see the.superior articular Fassett that's.Highland cartilage just like the.cartilage is around around the tibia or.around the tibia and femur so it has.pain fiber and it can be trouble if that.gets wrecked here's just another view I.think I said this there's the root this.is actually this is the root of the.transverse process that's new roof and.floor motivo frame and I think we got.everything else mammillary processes we.talked about that in the lab the little.bumps off the superior articular process.the very very deep my opinion you cannot.palpate these probably 99% of people but.there they are their attachment for.multiphoton there's accessory process.sometimes they're very developed in.people attachments I cite for muscle as.well and all this yellow stuff this is.the this is the posterior arch ring.apophysis that's where the growth occurs.in the bone has a little extra whiteness.in it now this is important so by the.time you get to the eighth quarter you.better know this stuff or you're going.to be behind the eight-ball so now this.is a cut through the disk see this disc.would sit right on top of this bone here.oops.so let's look at this disc has two parts.has a jelly-filled nucleus / pulsus.about 80% water the cells the nucleus.the nuclear cells produce proteoglycans.were which are like little SpongeBob's.absorb Bob water like crazy and because.of the pressure coming down this would.squirt out like toothpaste like a grape.so luckily we have like a steel-belted.radio like the tread of steel-belted.radio we have an annulus fibrosus which.is made up of about 20 things called.lamellae and it's a type 2 collagen it.has a ortho drama.design where the belts of collagen leia.is it 45-degree angles to each other off.the top of my head we'll get into it.that deep hopefully they should get into.it that deep in class and then the disc.important here is the disc has the.ability to feel pain the sino vertebral.nerve is innervates the disc a long time.ago they didn't think the disc could.cause pain but now we know from.radioactive tracing studies that there's.definitely the function of nociception.so if you rip your tread of your tire.and this nucleus per pulse is especially.if it's degenerated gets into this outer.periphery it can cause an inflammation.and some people cause horrible disco.genic pain I'm not going to get into.that any more than that.eighth quarter we will I think I have.youtube videos on that already but so.here's the sign of vertebral nerve in.orange notice the Saturn vertebral nerve.I didn't draw and I should have I.reflected make a note to myself right.now - I have a more updated picture.cartoon of this sign of a t-bill nerve.also connects to the front of the thecal.sac so if you get a herniation or a.tumor or something irritating the front.of the thecal sac it can also cause low.back pain okay notice the sign over.t-bill nerve dumps into the ventral.ramus so a few of the fibers actually go.down.dorsal root ganglia should be on the.other side a student pointed out to me.which is true it should be more.posterior but most of the fibers of pain.actually go through the sympathetic.system through the gray ramus community.cons into the sympathetic trunk up to l2.and enter the trunk through the the door.through the sensory division of l2 which.is very strange I don't want to get too.deep into this so there's our dorsal.ramus there's a vent or ramus there's a.spinal nerve we talked about all that.already important concept now when.you're looking at overhead views l1 to.l4 you're going to see there's foreigner.key nerve roots that can get compressed.by the disk herniation you got the.exiting nerve roots here and you got.traversing nerve roots these will become.the exiting nerve roots a little bit.below this but usually these are inside.the thecal sac and protected by the dura.however as you go down these will bud.out of the thecal sac how five they're.already out of the thecal sac so the.traversing s1 nerve roots are out of the.thecal sac some people believe they are.more susceptible to injury because.they're not protected by a lot of.cerebrospinal fluid they're kind of on.their own sometimes at l4 you'll see.them in this cartoon they're actually.butted out so you can see alright enough.about that and I think we've talked.about that already your vertebral disc.is named how do you name an.intervertebral disc by the bone that.sits on top of it and it's part the.anterior disc and vertebral body is part.of what's called the anterior column.when you have anterior lumbar interbody.fusion you fuse the anterior column with.a spacer it's made up of before we just.talked about that I don't need to say.that again 80% water I talked about that.it actually supports in a healthy disc.it takes on 80% of the axial load so set.joints take on 20% when your curve is.messed up when you have a hypo lordotic.curve.use up the biomechanics and you can.where spine out prematurely if you rip.the disc the the site where they.actually load passes through is no.longer the nucleus actually is on the.posterior annulus which is filled with.nerve endings right so you get can.irritate those nerves even more we.talked about the lamellae and I talked.about that already what are the axial.views good for so a whole bunch of.things but disk herniation czar really.easy to spot on the axial view in fact.it's the only way if you just look at.one sagittal view you can't tell whether.it's a disc bulge or disc herniation you.have to look at the axial view so.there's an example okay here's an.overhead view just like just like this.flips going our way just like this.picture right keep that in your mind.same thing now this disc is degenerated.you can't see the nucleus but you can.see the back of the disc you can see the.facet joints here we'll talk about these.in a minute but look at this big black.structure so this is a patient I had an.awful lot of leg pain so this is a disc.extrusion it's just that one of the.types of herniation.what else are the the axial view is good.for it well you can look at the facet.joints so let's talk about this SI.joints is all about chiropractors right.we're experts in the facet joints we.find fixations or facet joints that.aren't moving well and we make them move.through manipulation and it's thought to.maybe there's no reason solid research.on this but it makes sense that if if.you can keep joints moving it will slow.the degeneration process because the.joints require movement to help feed the.articular cartilage so it makes sense.again no great research though the.apophis heal joints support we said that.20% they actually make up the posterior.column of the spa.the true diary of joints they have a.capsule snow via fluid nose your septum.what's that noses up to fiber that's.pain carrying fiber they beacon they can.become stuck or fixated and that's as I.just said they can speed that speeds the.degenerative process and that's what's.chiropractic is all about it's the most.common or second most common cause of.chronic low back pain.what's chronic mean in this country.three months pain that's been going on.for three months and the rest of the.world six months I like six months.better actually like four months better.but that doesn't kind of goes against.the flow there's something magical about.that four month mark but its pain that's.been around for a long time number one.causes a tear within the disc that is.maybe herniated maybe not herniated he's.a nice cartoon I modified it quite a bit.but here's a facet joint so here's the.inferior articular process of which one.l3 and it's meeting the superior.articular process of l4 together they.form the facet joint and this isn't.naked like this it had but it does have.articular cartilage on the top of it and.they this facet articular facet of the.superior articular process in our ticket.of a set of the inferior articular.process meet to form the facet joint and.here's one that has a real capsule but.these are fill we just said that these.are innervated have a double nerve.supply right there innervated by their.own they're innovated by their own like.l4 would innervate its l4 facet joint.but it's also innervated by the one.above.so the l3 would also give a twig to this.as well all right there's the capsule.around here's the body vertebral body.which is deep into the page here's the.spinous process which is coming out of.the plane of page there's the disc and.here is the real where.the articular or the inferior articular.Fassett would be it's the same as right.here alright so important to know that.image now what are we looking at.x-ray CT or MRI this is an MRI this is.an axial cut through the l4 disc and you.can see the disc is actually bulging.these should be have a little concavity.here so this is a good example of a.bulging disc you can't see the neural.foramen here at all the thecal sac is.right here this is a t2-weighted so.anything with a water content shows.bright white like this these are the.nerve roots of the cauda equina right.here these are traversing nerve roots.the set joint is right here superior.articular process inferior articular.processes right here together they form.the zig epatha sealed joint or z joint.or as it's commonly called in this.country that's a set joint now it's not.a good name because the facets are.really the articular it's really an.inferior facet and are together set and.superior articular set but we call these.if a set it's better if we can call them.the Z joint or zig apotheca joints but.that will never happen.sassette joint is what they are so these.would be the traversing nerve roots here.if this is out for Lisa give it.traversing l5 nerve roots and these.would be the exiting same numbers the.disc.l4 so traversing l5 nerve roots exiting.l4 nerve roots here.IVF would be you can see the little.space right here spinous process lamina.there's all the parts ok articular set.is made up of everything I just said so.you can read that but the whole Fassett.the same as Z joint is a deposits of.joint this is the sassette this whole.region here notice that the angles of.the Fassett change as you go up at l5 s1.they're very coronal.facing more in a coronal type plane if.we look at the a 2p view this is an.overhead view of them but as by the time.you get to l1 l2 they're more sagittal.e4 more in the sagittal plane it's very.important this design is important for.stability when this design is deviated.from it can be a source of chronic pain.you get a you screw up the biomechanics.and you can overload one and under load.the other let's see what else is.actually good for we can also use actual.views to look for malformations of the.facet joints something called for.centralism you're going to have a lot of.patients with this condition causes a.biomechanical dysfunction let's take a.look give you a second what is this it's.that same view we're looking at but this.is not an this is a CT scan ok this is a.CT scan there's the disc right here you.get a little bit of bone coming through.on this cut these are cuts we'll talk.about cuts in a little while there's the.fecal sac right here what's these see.those little things I ligamentum flavum.very little thick in this patient but.the point of this it here's the.slingshot so if this is elf for which it.is this is all l4 stuff he'll force.minus l4 lamina l4 inferior articular.process the only thing that's not l4 are.these big things here which make up the.anterior and posterior border of the.vertebral canal so these are the.superior articular process coming up.from below these are all 5 property here.ok.but the point of this is to look at the.facet joint this how are they angled on.this overhead view this one is very.coronal that's normal.this one is too sagittal so this is.called Fassett tropism something you're.born with.it's a chronic pain patient one of these.sets could be.a source of pain because it's been.biomechanically destroyed because of.this unevenness disk sets versus chronic.pain research demonstrates the number.one cause we said this already of.chronic pain is an annular tear with or.without herniation the disc closed.second is a dysfunction of the set third.place maybe 10% of the cases dispersed.despite what SI bone who is a device.manufacturer for fusion equipment for.the SI joint published some papers which.I think are way out of whack sit at.sacroiliac joint problems probably seven.to ten percent of chronic pain nothing.like disc and facet joints let's talk.about cuts I've been talking about that.so when you look at an MRI CT you have.the option at looking through many.different slices it's like we put the.spine in a in a meat slicer and slice it.up into into many different pieces and.we can pull one of those cuts out and.look at that cut with x-ray there's no.cut it's like your spine got squished.flat by a steamroller.and you're looking at everything.squished together so for example if you.if you look at this is a CT contrast the.CT myelogram all this white stuff you.don't normally see on CT scan but this.if you like Owen is 2.5 this is from you.can put this cut line this cut line pops.up and so we can go through this cut.line whatever this cut line cuts through.so literally like pulling a slice out.and throwing it on the table and looking.at it an overhead manner and that's what.this is so this is a cut not through the.disc right the disc is right here it's.right through the vertebral body and in.fact it will be through the pedicles why.can't we see the pedicles or the.pedicles well because the cut is going.right to the center of the spine.pedicles are on the left and right of it.so we don't see the.uncle's here okay but let's look at what.that cut goes through so this is the.vertebral body here's the the aorta here.here's the vena cava.so as major muscle you can see the.shadows of them vertebral body so here's.the pedicles they are part of the.posterior arch so here's the spinous.transverse processes accessory processes.are here where's the facet joints they.should be right here where how can we.don't see the facets because we're cut.right between them this is actually the.pars interarticularis this is the middle.of the articulate pillar you get that.spinous processes here multiphoton you.can see quite nicely longus this.thoracis is here ileal costs Alice.lumborum is right here you can see their.compartmental muscles and most.importantly the fecal sac you can see it.very nicely see how it's covered and you.can see this is Dai contrast material.within the fecal sac so it lights up all.the traversing nerver are traversing.nerve roots which collectively are.called the horse's tail or cauda equina.okay get it okay you think you got it.everything I said now take a quiz write.everything I just said is right there.and you should also note that number.seven here that's the exiting nerve root.that's going to go out the hole a couple.slices down so that's already budded.remember I said the nerve roots bud see.so this nerve root probably buttered.right about here so they bud behind the.vertebral bodies but it's already budded.so we can see it that's the only tricky.one there I think okay now let's look at.this one so here's a cut it's not.through the vertebral body anymore.now it's going right through the disk.okay so when we look over here there's.the disk okay the parts are a little bit.different where's the pedicles we're in.between the pedicles these are the Ivy.office right in here there's no pedicles.now you can see this better an MRI I'm.sorry the these are the neural foramen.or intervertebral frame but now we can.see the thecal sac still spinous lamina.now if this is a cut which disc is this.what's the rule so l3 vertebral body.must be the l3 disc it conquers it so.the l3 disc.what is this property who who is all.this stuff this is all belongs to l3 so.inferior articular process of l3 lamina.of l3 spinous process of l3 but who's.this those are the superior articular.processes from l4 they're coming up we.caught a slice of them together what is.this thing together this is the facet.joint and it's got some arthritic change.doesn't it we got a little bone spur.growing off the back of it here okay got.it see it's not that hard think you got.it take this quiz.okay nothing tricky there let's look at.some MRI images now it's the same type.of deal.but now MRI shows soft tissue better.than bone so this is a say through the.vertebral body or through the disc how.do you know what where's the pedicles.it's not through the body there's.beautiful looking IDs I could drive a.truck for those things those are the.neural foramen or the intervertebral.foramen or the IVFs so this is a disk.level axial cut through the l3 disk you.can see the nucleus is a young person.you can see the nucleus per pulsus you.can see the annulus fibrosus very nicely.here you can't see the lamellae we don't.our technology is not that good but.there's 20 rings of lamella here keeping.this nucleus from squirting out the back.now importantly it's a nice high quality.image here's the slingshot or the Y in.the back so this property is all l3 I'm.not going to go through it but I guess.I'll go through inferior articular.processes lamina spinous process this is.again called the roof of the vertebral.canal and the floor of the vertebral.canal disc is bulging a tiny tiny bit.but not usually they're concave but it's.this is normal now importantly the fecal.sac now you can't see it as nice as you.could with the contrast in there but.it's right here so cerebal spinal fluid.all this white stuff t2-weighted image.shows up white anything with fluid shows.up way including inflammation so these.are the traverse seen which one's l4.nerve roots traversing out for nerve.roots who are these those are traversing.l5 nerve roots you can even see the s-1.nerve roots down here right these have.not butted off out of the thecal sac yet.they're there getting up to this but off.position now they move up like they line.up like airplanes on the tarmac waiting.their turn to take off and these are.waiting now where's the l3 nerve.here they are right here l3 nerve roots.those are called the exiting l3 nerve.roots okay.multi fat i normal a little bit of fat.here as normal these are normal-looking.multi fat I think you got it take the.quiz now first quarter don't worry about.this eighth quarter you better be able.to know all these structures or you'll.be in trouble right just some more stuff.or quizzes think of another quiz now so.take the quiz what's going on with this.patient number chronic pain patient come.on the eighth quarter students better.see this should know this already look.at the Fassett satchel two coronal.Fassett tropism this is another case of.one of these probably this one looks a.little more beat up to me one of these.Fassett joints how do you tell which for.centering it is eighth quarter students.for that block you can inject an.anesthetic inside this if this is the.cause of the pain if you inject an.anesthetic in here better knock out the.pain if it doesn't it's not the cause of.the pain eighth quarter exit what else.are the actual image is good for spinal.stenosis tell my students seen you're.going to be seeing more and more of this.than I did as the baby boomers get old.this is almost surpassing the rate of.disc herniation surgery it's a big.problem let's look at it here's a recent.client of mine who had horrible.bilateral leg pain couldn't walk more.than four blocks without horrible pain.interestingly if he sat down then.forward a little bit the pin would go.awake.walk another four blocks that's called.what eighth quarter students Nick.neurogenic intermittent claudication.almost always caused by spinal stenosis.here's a pedicle cut through the.pedicles okay fecal sac.it's a little narrow there but kind of a.tight squeeze little short pedicles but.it's fine you can see the nerve roots.hanging out here everybody's happy now.let's go down a few cuts and look what.happens this should not change in size.now let's look at it Wow what happened.it's completely squished this is severe.spinal stenosis central spinal stenosis.why is it squished.look at these Groucho Marx eyebrows.what's that eighth quarter students good.ligamentum flavum has 20 kinds bigger.than it's supposed to be severe ligament.and flavum hypertrophy squish the thecal.sac from the back now this is a.technologist did not give me a nice cut.down the plane of the disk so I'm seeing.bone and I'm but I'm seeing a slice.through the back of the disc here so.this is a bulging disc it's crushing the.front of the thecal sac the lateral.recesses are open so this is not lateral.stenosis but what's in this region right.here good traversing l5 nerve roots so.this patient has pain on the top of the.feet they're extensor hallucis is shot.no power and both sides that matches the.l5 dermatome got it multiphoton muscles.are also at radiologists we'll never.comment on this but you primary health.care providers or you spine specialist.better look at this and say better send.this patient for some strengthening.right strengthen that core will help.stabilize this eighth quarter students.you should also have noted this so we've.got a little ram these kind of this ram.cheap porn.this cheap porn you know how Ram has.those curly horns we got kind of curly.arthritis here we have a slip here's the.superior articular process it's supposed.to meet the inferior articular process.purse perfectly we got a little bit of.slip of that that's called a.degenerative that's a type three.spondylolisthesis so we won't talk about.that today but I have videos on that I.think already definitely eighth quarter.we will talk about that it's another.what is that it's another herniation.it's the same one I think how about the.coronal view from the front all right.now we're getting through first quarter.students are going to be tested on this.in your eighth quarter better no let's.take a minute to look at this what do.you see a little curvature that's not a.scoliosis but this is a normal-looking.lumbar spine got 12.there's the 12th rib always look for.that see here's a normal what are these.things transverse processes see how.these are normal.they're always a little bit bigger but.they're not like that bone we saw so.this is normal let's go through the.parts so I always tell students always.look for the eyes and the nose.so the eye would be right here photons.are having trouble getting through the.thickest strongest part of the bone.which is the pedicle there's the other.one.there's the nose okay that's the spinous.process lamina would be right in this.region here's the articular piller would.be in this region so just above the.pedicle actually superimposed upon the.pedicle we have the superior articular.process right here by itself it's.meeting this this is the inferior.articular process spinous process again.transverse process again you can see the.inferior end plate of which bone l3.superior input how come you see two of.these things I saw some crazy.chiropractor video saying I cured.someone.disk and look it was completely fen and.now it's healed by my treatment well the.doctor took the picture when the patient.was acute so when he got better the.curve in the spine came back and he.didn't take into account that these are.both the inferior ticket in plates the.disc is right here you can't say oh this.is bone on bone look you can't see this.disc space like this one you can see a.nice disc space here but this the disc.is still there it's just because of the.curve so here's part of the the.posterior articular portion of the.superior in play and here's the front of.the superior articular or what am I.saying this is a vertebral endplates so.this is the front part of in place of.the back part but see how it's remember.this is x-ray so you got run over by a.steamroller we can't see different cuts.everything's together this big hole here.is called the inter laminar space.that'll be on your test for scorer.students make sure you know ribs this is.this is 12 up here all right the.vertebral body of t12 where is it.spinous process remember spinous.processes are down low so here's it.spinous process here this is a spinous.process of 11 so these are the 12 ribs.the floating t12 ribs the shadow so as.major shadow this black thing well let's.see the photons got through that pretty.easy so it must be air or gas so that's.that's gas in the descending colon how.about look closely here you can see.something see that the border of it good.that's your kidney that's when you.there's your the kidney shadow it's.called kidney shadows SI joints we.talked about those in another video.okay there at 45-degree angles so you.see multiple planes first hako tubercle.nice 1 second sacred tubercle alright.got it.everything I just said so study this.what elements the pulley sometimes you.hear this posterior elements.post your elements are just like the.stuff on the posterior arch so we have.articular pillars or considered.posterior elements lamina spinous.processes napa transverse processes.though.why aren't they posterior elements.because they have a different ember.logical origin so technically they're.not grouped like that.it's from vogue Duke of course he's the.these that he's the king he's the gold.standard he's the God of lumbar spine.anatomy been cited more than anybody.else with regard to lumbar spine.got some great books as my students know.all right so take the quiz identify the.structure anybody see anything wrong to.pause the video and look real closely.the number look for the eyes.there's the pedicles give you a hint.there you can do it anybody say anything.wrong so answers what's wrong.good some of you see it fracture look at.this transverse look at this one.fractured.now what are we looking at x-ray CT MRI.can't be an MRI you can't see the soft.tissue very well can't be an x-ray.because this is definitely a single.slice through these things what are.these things.vertebral bodies we know what that is.this is a this is a from the front this.is a coronal view.there's your psoas major kidneys.vertebral body so that's a cut through.the vertebral bodies how about this one.and in fact let's do a quiz to see how.good you are.what's another coronal but now we've.sliced deeper don't want to give it away.yet some weird white things in here -.what are those things those are pedicle.screws this patient had a two-level.fusion.what are those structures okay I'm going.to go I'm going to tell you the answers.now so all right well transverse process.CMO routed the transverse process.through the transverse process meats.well this is all the articular piller.this whole thing superior articular.process inferior articular process.what's in the middle good par Center.articular you could say articular color.the whole thing what's this vertebral.canal fecal sac you really can't see.that fecal Saget.prefers you say vertebral canal how.about this SI joint.okay pedicle screws in the pedicles.pedicles would be also superimposed.getting a little piece it's really.articular pillar pedicle would be in.that area though okay does your answers.what good are pears about these coronal.images well they're great for.classifying scoliosis will learn the.lengthy system in eighth quarter people.struggle with that I got a YouTube video.on that I suggest you read that before.8th corridor watch that how's this one.look what do you see here this is a.wicked lanky 5c scoliosis in a girl.looks like she is I don't see riser sign.I don't think it's probably in her late.teens maybe early twenties even so.pretty bad scoliosis probably jeez 100.degrees maybe more very chronic low-back.paint all sorts of trouble cosmetic.problems shoulders a parade level though.how come because it's a link e5 it only.affects lumbar throughout lumbar region.so throughout with lumbar lumbar curve.there's a little curve in the thoracic.but not very much so this is this is a.corrective procedure it's called an.anterior selective fusion there's a.posterior-anterior selective fusion will.learn about to fix these things talk.about that in eighth quarter you can see.the surgical staples here oh yeah there.is riser sign so this is a younger.person you can see the see risers side.the Epistle plate hasn't fused yet.pretty good alright gotta you got to be.impressed with that really straighten.this procedure really constraint things.out I'm not going to go off on a tangent.there okay sagittal images very.important images here's the parts look.at this one first vertebral body disc.which disc that one inferior inflate.superior employee see how you can see.both sides of it like that.see here's the one coming out of the.plane of the page to us but here's.another another one you can see.sometimes you get a double an x-ray or.extra everything's flat so sometimes you.can see both which IV Ephesus the right.or left it's neither.remember this is steamrollered if this.is an x-ray we're looking at so it's.both the right and the left here's this.is tricky this part here this is the.transverse process coming out of the.plane of the page an x-ray everything is.flat sometimes we can see the other.transverse process as well so they look.like double structures spinous we know.inferior articular process superior.articular process mammillary process.back here this bump don't think it's.labeled that's mammillary process neural.foramen neural foramen ah is plural no.frame in a single and what else guess.that said what's the ligament in between.which isn't here interest - what's the.ligament on the top super spinous.ligament okay first quarter better know.all this stuff see it's not actually is.not that hard let's let you study it you.can take the quiz I'm going to go.through these now so you if you don't.want to spoil the quiz stop it now start.with the easy one spinous process not.enough what level what level well.remember when we're palpating spinous.process if you go up one inter spinous.space mammillary processes will be there.so this is spinous process of there's.the sacrum.five-four-three l3.there's the l3 disc what's this thing.neural foramen or intervertebral foramen.or IVF which one can't tell it's both of.them.they're superimposed okay what else we.got how about this little nub right here.CP articulate process of l3 inferior.articular process of l2 now be careful.be careful give you hints coming out of.the plane of the page right at us.good transverse process what's this.another transverse process see this bone.is twisted a little bit the transverse.processes weren't when we squished it.flap this one was off kilter which ones.closer to the Bucky this one to get away.from the Bucky things get magnified and.get bigger so if I were to put a left.marker here which would indicate which.side was next to the Bucky then this.would be the left this would be the.right okay we don't slow bone spur.starting here think that's that.vertebral body.here's n plate and for your M play.here's another part of it remember.steamrollered this one happened to be.steamrollered perfectly flat so we can't.see but this one had a little curve in.it maybe a little moral snowed another.one here you can see both in plates.alright you got it.there's the answers let's try this one.now it could be a second to look at it.alright I'm going to give you the answer.so if you're taking the quiz you better.stop it so what type of image CT MRI.x-ray you can see the discs beautifully.this is an MRI in fact it's a.t2-weighted MRI which is the one that.you should look at t one you can look at.proton density fat's at there's all.kinds of them but don't worry about.those what's that orange side it's a cut.line but I don't have to took the.overhead view out for now all right.so vertebral body which one.so is that fiber who is that this is a.rudimentary disc if this is still s one.part of the sacrum you'll see these on.MRI you can see you're better you can.see a rudimentary disc here remember.they by the time you're 20 you're all.five sacral segments fused together.alright so that's a cut through the l4.disc this is l4 vertebral body fecal sac.cerebral spinal fluid there's a.traversing nerve root part of the cauda.equina which disc is that number two l-3.disc how about number five inter spinous.ligament number four there's a spinous.process so between is the inter spinous.ligament and what else can I show you.here how about this right here this.black thing what holds the roof of the.post er just together.it's ligamentum flavum sometimes this.can be this big sometimes I can come way.out here I can hypertrophy like crazy.and call central stenosis.CT MRI x-ray so I'm going to spoil us if.you're taking the quiz stop it.CT is it through the is it a midsagittal.cut or a parasagittal cut and sagittal.means a cut right between the pedicles.parasagittal because I can see the.intervertebral frame in here quite.nicely okay so let's go through them.vertebral body what's this vertebral.body of who l4 number-8 inferior in.plate superior in plate what about this.space right here.it's the disk space or that's the disc.of l3.how about this number 7 and this very.short all right it should be way longer.than this.this guy's got congenital stenosis those.are the pedicles right how about this.whole thing right here articular teller.just made up of a this part superior.articular process number 5 all this.inferior articular process number 4 mmm.that looks weird.well it's meeting what meets the.inferior articular process superior.articular process which one or they.squish together no it's a right or a.left we don't know we'd have to see the.other cut we need to see the sagittal.let's see where the cut line is but it's.definitely on one of the sides all right.I think this is probably long enough.here we should be done there pretty.quick what are these lateral images good.for spondylolysis and spondylolisthesis.as well as degenerative disc disease you.gerrant enjoy what's one word for.degenerative disc disease and.degenerative joint disease spondylosis.spondylosis I didn't put.that in here what's this whoa this is.trouble right.your palpating this patient's back and.you have a big hole in their back it's.called the step sign watch out for those.that almost always means that the.vertebral bodies have slipped off their.base which is the vertebral body below.so this has slipped more than halfway.looks like about 3/4 of the way that's a.grade three spondylolisthesis this.patient didn't have an articular CP.articular process so the facet didn't.work so that's what caused the slip plus.there's some did we'll talk more about.this case in eighth quarter and let's.see what's this one now you fifth.quarter students did terrible at this.this is a spondylolisthesis there's many.different flavors spawned eloped to.which is it's mixed bondola type 2a smek.spondylolisthesis or a fracture the pars.occurs but the important thing to.remember is you have to assess the.degree of slip so this one slipped.less than 25 close to 25 but I don't.think it's more than 25 percent so 0 to.25 via the mayor Dean system is a type 1.spondylolisthesis if it slips between 20.and 50% so any slip and you measured by.this corner here to this corner these.are supposed to be like these see these.corners are right together.there's no slip here this corners here.this one's way up here so the said grade.one almost a grade 2 spawned blow flips.up to 50% so grade 2 passed 50% between.1575 to grade 3 between 75 and a hundred.percent it's a grade 4 if it slips slips.off the cliff it's called a spawn loka.ptosis some call it's grade 5 spawn blow.spinal oppa ptosis is better got it.that's quick quiz here what's this.no.not ligamentum flavum that's.ligamentum flavum right here it's.splitting that there's one getting ready.to come out of its hole it's getting.ready to bud this is see these are all.the traversée nerve roots hanging out.collectively they're called the cauda.equina this is the thecal sac disc l3.disc now what's happened to this l4 disc.it's black it's all so thin so.significant degenerative joint disease.look at this thing what's that.it's Corden you better know by now see.not you'll know soon that's called a.high intensity zone or H pi Z what does.that mean well if you stick a needle in.this person's disk fill it up with a dye.contrast material it's about an eighty.five percent chance that dye will leak.right out the back of the disc and.research has demonstrated this is the.meeting point of a full thickness radial.tear in a concentric tear talk about.that in eighth quarter and one of them.one show I guess that's it this is going.to be too long oh this is interesting.eighth quarter this is going to be on.your midterm I know is humid term this.will be on your final well the first.quarter you can see what this CT or MRI.definitely CT sacrum is here oh five.vertebral body oh four l3 what disc is.that l3 disc which hole was that neural.foramen right or left don't know need.the need to see to cut the sachet or the.axial view to see this in free articular.process super articular process this.pedicle now the reason I put this up.here Oh what's this.superior ticket process this region so.the reason I put this up pedicle this is.the middle of their ticular pillar pars.interarticularis see a difference this.is normal.see how thickened I mean it's still weak.but it should be this is a normal shape.point what the heck is going on here.why is this so skinny look at this one.so it even looks as a disruption in the.cortex there oh look at this check the.corners what do we got grade 1 grade 2.grade 3 its grade 1 spondee.spondylolisthesis how about this one.well there's the corner there this one.slipped as well that's another grade 1.spondee 2 double spawn blows what's this.one look at this one.that retro Alice thesis that's called.but not really gets because this bone is.slipped forward I think this is in.position just fine.but what's going on here this is this is.called a type 2b spondylolisthesis so.it's a s MEC spondylolisthesis what is.spec means fracture I don't see a.fracture I either do I the fracture has.healed and it's fractured and it's.healed and it's fractured and it's.healed and it's made this really thin.and long see how long this is looks like.a greyhound this is called greyhounds.side so this is still considered it has.MEC spondylolisthesis but it's a type B.meaning you happen to catch it when it.healed you see this in gymnasts and.especially will fracture they're their.powers and it's healed and they went.back to gymnastics and fractured again.repeated that cycle several times and it.turns into a very vulnerable in this.every time it heals it can be filled.with pain sensitive nerve fiber all.right are we done.may our Dean system there's we already.went through that so use the back.corners here there's the.corner so this one is slipped as I.should have made it to look closer but.anything from 0 to 25 is a grade 125 250.is a grade 250 75 is a grade 3 okay oh.this we're not done we're almost done so.there'll be a couple traffic images as.well exactly the same as the lumbar.images except for these things so you.have some facets for the articulation of.the ribs so these are called transverse.costal facets these are called.then there's an inferior and superior.costal demi facet and those are for.articulations of the ribs here's a.better view.so the superior costal demi Fassett.inferior costal demi Fassett you can't.really see these on x-ray though this is.just for anatomy here transverse costal.facet l1 would only have one I'm sorry.tt one would have one same width same.less Tia 11.Arno's t12 both have one I forget that.there check that off the top of my head.and notice the spinous remember we did.that in a lab that dolly parton nine to.five rule you go up to inter spine of.spaces and over to find the TP but look.at that how how far the TP that's where.you palpate look at how far the TP is up.from the spinous process there's a view.from the back you can see the.articulations of the ribs here but again.look at the spinous process look at how.far the let's do number nine so you go.up one inter spine of space to inter.spine of spaces and out couple.centimeters.there's the TP and the rib and that.superior dummy Fassett can't really see.it though so two stars make sure you can.find these structures this will be on.first quarter your tests as well so.what's that.so I'm going to give answer so turn it.off well I don't see any ribs here.that's a rib so that must be the 12th.rib so it's a posterior 12th rib and you.know the punic abilities to get pedicle.lamina spinous interlaminar kind of.bubble here but superimposed over the.vertebral body how about this what's.this supposed to your rib of that make.sure you say of T 11 patients a little.osteo P neck aren't they just like.somebody took a white crane and drew.there all right you can find out other.stuff well some of you might wanna get.that.okay now we're really going to let's.talk about see now we're not going to.get into this but it can get incredibly.complex though you can see this is.probably low t3 t4 t5 maybe need that.side view to tell for sure but you can.see the articulations with the ribs.transverse process and vertebral body.what's this you know this CT is similar.to x-ray photons have zipped right.through this material really easy turn.the film black completely expose the.film these are lungs all right these are.vessels within the lungs of contrast how.about this big thing that's your aortic.arch right there we're not you don't.need to know that though.scapula maybe grows to maybe I can put.that girls to their scapula sternum all.right that's enough what way too long.but do you understand everything I said.in this you you're going to be really.good with respect to the lumbar spine.thanks for watching there's some.references see in the next video.

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X Ray And Imaging Outpatient Order Form Lake Forest Hospital Lfh FAQs

Here are some questions along with their answers to clear up the doubts that you might have.

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Can an xray show ovarian cysts?

Pregnancy test: A corpus luteum cyst can cause a false positive on a pregnancy test. Ultrasound: This imaging test uses high-frequency sound waves to create an image of your uterus and ovaries. CONCLUSION: Mature ovarian cystic teratomas have rarely been reported to secrete HCG. They can be an infrequent source of HCG production and may lead to emergency surgery to treat a suspected extra-uterine pregnancy.

Does an abdominal xray show ovaries?

The answer to the specific wording of the question is No, because ovaries are officially included in ultrasound with a different name - pelvic ultrasound. But if rephrase your question - "Is it possible to visualize the ovaries with abdominal ultrasound?". And the answer will be Yes. Because pelvic ultrasound can be transabdominal and transvaginal! So Transabdominal pelvic ultrasound is a kind of abdominal ultrasound.

Does an abdominal ultrasound Show the ovaries?

The answer to the specific wording of the question is No, because ovaries are officially included in ultrasound with a different name - pelvic ultrasound. But if rephrase your question - "Is it possible to visualize the ovaries with abdominal ultrasound?". And the answer will be Yes. Because pelvic ultrasound can be transabdominal and transvaginal! So Transabdominal pelvic ultrasound is a kind of abdominal ultrasound.

What does an abdominal xray show?

Bones in the spine and any abnormalities (bag of cocaine u are attempting to smuggle etc.) also the outline of all the abdominal organs will be visible

What will abdominal xray show?

In the magisterial Auschwitz 1940 - 1945, Central Issues In the History of the Camp, the figure of 802 is given, with very roughly 40% successful. Carefully planned escapes, obtaining medicines, sophisticated resistance, prisoner organizations, and coordinated efforts to save lives were far more prevalent and successful than one might imagine. There is an entire genre of Auschwitz scholarship regarding these issues. A successful escape in April, 1944 by two men brought to the Allies and western governments the first highly detailed and verifiable proof of what was happening in Auschwitz. There Continue Reading

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