This article is designed to review all the basics around spine anatomy that would be helpful for performing procedures. Any pain management inverventionalist/proceduralist will rely on this basic anatomy, understanding of fluoroscopy images and C-arm use. It is written with a few basic goals:
- Review basic vertebrae and spine anatomy
- Discuss that in the context of fluoroscopic images and C-Arm positioning for procedures
- Outline basic principles that can set a foundation for the various articles on this site
There are generally 5 lumbar vertebrae. Most procedures revolve around knowing the basic structures of the vertebrae in the diagram and are referenced throughout this site:
- Transverse process (TP)
- Spinous process (SP)
- Superior articulating process (SAP)
- Inferior articulating process (IAP)
- Neuroforamen (NF)
AP (Anterior-Posterior) fluoroscopy view
- The spinous processes should be midline.
- Flatten the endplates at the level that you’re working on.
- With significant scoliosis you can’t get all SPs midline, so you do so at the levels you’re interested in.
Lateral fluoroscopy view
Oblique/scotty dog fluoroscopy view
- Attempt to look down the barrel of the facet joint at the level you’re working at. This means you see the facet joint straight on so it is lucent/transparent
- Scotty dog (highlighted here in green)
- Nose = TP, ear = SAP, front foot = IAP, body = lamina
EXAMPLE 1: You want to place a needle at the junction of the TP and SAP at L4 on the left (also known as a left lumbar medial branch block at L4).
Naming/Numbering of bony structures and nerve roots