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Thoracolumbar Spine

Thoracolumbar Spine

A. Alignment: lateral film

  • Assess the anterior and posterior vertebral lines.

A. Alignment: AP film

  • Spinous process line.
  • Lateral vertebral body line.
  • Interpeduncular distance: should increase gradually from cranial to caudal.

B. Bones: lateral film

  • Denis’ three columns (Instability occurs when injuries affect two contiguous columns (i.e. anterior and middle column or middle and posterior column):
    1. ANTERIOR COLUMN ⇒ ALL, anterior 2/3 of the vertebral body & anterior 2/3 of the intervertebral disc (annulus fibrosus).
    2. MIDDLE COLUMN ⇒ posterior 1/3 of the vertebral body, posterior 1/3 of the intervertebral disc (annulus fibrosus) & PLL.
    3. POSTERIOR COLUMN ⇒ everything posterior to the PLL (pedicles, facet joints + articular processes, ligamentum flavum, neural arch and interconnecting ligaments).
  • Anterior and posterior borders of vertebral bodies are of similar height.

B. Bones: AP film

  • Vertebral bodies of similar height and width.
  • Transverse processes should be intact.

S. Soft tissue

  • Assessthe paraspinal lines.


1. Goodman, L. and Felson, B. (2015). Felson's principles of chest roentgenology. 3rd ed. Philadelphia, PA: Elsevier, Saunders.
2. Dähnert W. Radiology Review Manual. LWW. (2011) ISBN:1609139437. Read it at Google Books - Find it at Amazon
3. Elizabeth Puddy, Catherine Hill; Interpretation of the chest radiograph, Continuing Education in Anaesthesia Critical Care & Pain, Volume 7, Issue 3, 1 June 2007, Pages 71–75, https://doi.org/10.1093/bjaceaccp/mkm014

Ⓒ A. Manickam 2018

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