Spine anatomy and xray of spine ppt by Dr Pratik

this ppt make you under stand basic anatomy of spine with diagnostic importance of xray in spine.

1. ANATOMY OF SPINE AND X-RAYS OFSPINE DR PRATIK AGARWAL DR SANJAY MULAY

2. ANATOMY OF SPINE

3. PLANES AND DIRECTION: ANTERIOR/VENTRAL POSTERIOR/DORSAL CRANIAL CAUDAL MEDIAL LATERAL CORONAL PLANE SAGITTAL PLANE AXIAL PLANE

4. FUNCTIONS OF SPINE 1. PROTECTION OF SPINAL CORD, MENINGES, VESSELS AND INTERNAL ORGAN.

5. FUNCTIONS OF SPINE 2. ALLOW FLEXIBILITY IN ALL 6 DIRECTIONS

6. FUNCTIONS OF SPINE 3. ALLOW FLEXIBILITY AND PROVIDE SUPPORT AND BALANCE FOR UPRIGHT POSTURE

7. FUNCTIONS OF SPINE INTERVERTEBRAL DICS- IT PROTECT AGAINST COMPRESSIVE FORCES. ALLOW EQUAL WEIGHT DISTRIBUTION

8. CURVES OF SPINE PRIMARY CURVATURES: KYPHOTIC CURVE PRESENT FROM FETAL LIFE THORACIC (20*-40*) SACRAL SECONDARY CURVATURES: LORDOTIC CURVE DEVELOPS DURING INFANCY OR CHILDHOOD CERVICAL (20-40*) LUMBAR (30-50*) Cervical(2*) Thoracic(1*) Lumbar(2*) Sacral(1*) Curvatures

9. 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

10. LEVELS OF SPINE ADULT SPINE IS 72 CM LONG IN MEN AND 7-10 CM LESS IN WOMEN. TOTAL 33 VERTEBRAE 5 MAIN REGION- CERVICAL - C1-C7 THORACIC - T1-T12 LUMBAR - L1-L5 SACRAL - S1-S5 COCCYX - C1-C4 THERE ARE 24 MOBILE SEGMENTS AND 9 FUSED VERTEBRAE WHICH ARE IMMOBILE.

11. VERTEBRAL ANATOMY COMMON FEATURES SHARED BY MOST VERTEBRAE ARE- VERTEBRAL BODY POSTERIOR ARCH PEDICLE LAMINA SPINOUS PROCESS TRANSVERSE PROCESS ARTICULAR PROCESS

12. VERTEBRAL BODY OUTER CORTICAL RIM INNER CANCELLOUS BONE VERTEBRAL BODY COMPOSED OF 2 TYPES BONE TISSUE: CORTICAL BONE CANCELLOUS BONE IT BEARS 80% OF LOAD APPLIED TO SPINE. IT VARIES IN SIZE, SHAPE AND PROPORTION IN DIFFERENT REGIONS.

13. 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.

14. POSTERIOR ARCH ARTICULAR PROCESS ( ZYGAPOPHYSES ) ANOTHER PROJECTION FROM JUNCTION OF PEDICLE AND LAMINA. 2 SUPERIOR ARTICULAR PROCESS ( PREZYGAPOPHYSES ) AND 2 INFERIOR ARTICULAR PROCESS ( POST ZYGAPOPHYSES ) 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.

15. 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 .

16. CERVICAL VERTEBRAE 7 VERTEBRAE DIFFERENTIATING FEATURE IS PRESENCE OF TRANSVERSE FORAMEN . LORDOTIC CURVE PROVIDES MOBILITY AND STABILITY TO HEAD.

17. C1 (ATLAS) NO BODY, NO SPINOUS PROCESS DEVELOP AS A RING OF BONE WITH ANTERIOR AND POSTERIOR ARCHES THAT CONNECT 2 LATERAL MSSES.

18. 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.

19. 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.

20. C3-C7 VERTEBRAE

21. 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.

22. 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

23. 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 ABSENT.

24. 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.

25. 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.

26. 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- 1 ST SACRAL VERTEBRAE WITH PROFILE RIDGE. SACRAL ALA- FLAT BROAD AREA WHERE SACRUM ARTICULATE WITH ILIUM AND PELVIS.

27. INTERVERTEBRAL JOINT INTERVERTEBRAL JOINT ALLOW PROPER FUNCTIONING OF VERTEBRAL COLUMN. CONSIST OF- VERTEBRAL END PLATES INTERVERTEBRAL DISC APOPHYSEAL JOINT

28. 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

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

30. 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.

31. 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)

32. 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.

33. 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.

34. 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

35. 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

36. 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.

37. 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.

38. POSTERIOR MUSCLES DEEP LAYER- INTERSPINATE MUSCLES INTERTRANSVERSALE MUSCLE INTERMEDIATE LAYER- TRANSVERSOSPINALIS - EXTEND FROM TRANSVERSE PROCESS TO SPINE. MULTIFIDUS SEMISPINALIS CERVICIS SEMISPINALIS CAPITIS SEMISPINALIS THORACIS

39. POSTERIOR MUSCLES SUPERFICIAL LAYER- ERRECTOR SPINAE ILIOCOSTALIS LONGISSIMUS SPINALIS CERVICIS SPINALIS THORACIS

40. MUSCLES OTHER MUSCLES- CONTROLLING MOVEMENT OF THE SPINE SERRATUS POSTERIOR SUPERIOR RHOMBOID MINOR TRAPEZIUS RHOMBOID MAJOR LATTISMUS DORSI SERRATUS POSTERIOR INFERIOR

41. 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.

42. 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.

43. 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.

44. 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.

45. 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 1 ST THORACIC NERVE LUMBAR PLEXUS : DUE TO ANTERIOR DIVISION OF UPPER FOUR LUMBAR NERVE AND 12 TH THORACIC NERVE. SACRAL PLEXUS : DUE TO LUMBOSACRAL CORD, ANTERIOR DIVIDION OF UPPER THREE SACRAL NERVE AND SECTION OF 4 TH SACRAL NERVE.

46. 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.

47. X-RAYS OF SPINE

48. 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

49. 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)

50. 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

51. NORMAL RADIOLOGICAL FINDING IN C-SPINE ANTEROPOSTERIOR VIEW OF CERVICAL SPINE D: INTERVERTEBRAL DISC U: UNCOVERTEBRAL JOINT T: TRANSVERSE PROCESS SP: SPINOUS PROCESS

52. OPEN MOUTH VIEW

53. SWIMMERS VIEW

54. FUNCTIONAL VIEW

55. 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

56. 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

57. 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

58. RADIOGRAPH OF LS SPINE- AP/ LATERAL/ LATERAL FLEXION AND LATERAL EXTENSION VIEW

59. RADIOGRAPHIC ANATOMY OF THORACIC SPINE ADDITIONAL FEATURE IN THORACIC SPINE IS ARTICULATION OF RIB WITH FACET PRESENT OVER VERTEBRAL BODY.

60. 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.

61. FLEXION INJURY EXTENSION INJURY

62. COMPRESSION FRACTURE OF L1 VERTEBRAE TRANSVERSE FRACTURE AT L3 VERTEBRAE

63. 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

64. SCOLIOSIS HOW TO MEASURE COBBS ANGLE? DRAW A LINE PARALLEL TO SUPERIOR END PLATE OF MOST TILTED VERTEBRAE AT UPPER END OF CURVE. 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.

65. FULCRUM BENDING RADIOGRAPH IN CASE OF SCOLIOSIS

66. 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.

67. DEFECT IN PARS INTERARTICULARIS

68. 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

69. 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

70. 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

71. POTT’S SPINE

72. POTT’S SPINE

73. SIGN OF HEALING IN CASE OF POTT’S SPINE

74. TUMOR SCLEROTIC LESION SECONDARY TO PRIMARY TUMOR FROM PROSTATE, BREAST,LUNGS ETC … . LYTIC LESION SECONDARY TO MULTIPLE MYELOMA

75. FACET JOINT SUBLUXATION FACET JOINT DISLOCATION

76. HANGMAN FRACTURE : FRACTURE OF PEDICLE OF C2 JAFFERSON FRACTURE : FRACTURE OF C1 VERTEBRAE WITH NO ALINGMENT OF LATERAL MASSES

77. OSTEOARTHRITIS

78. THANK YOU