2.1. Cervical Spine Anatomy Flashcards
Examination of the cervical spine involves determining whether the injury or pathology occurs in the cervical spine or in a portion of the upper limb
scanning examination
In the initial assessment of a patient who complains of pain in the neck and/or upper limb, this procedure is always carried out unless the examiner is absolutely sure of the location of the lesion
scanning examination
Cervical spine is an area in which ______ has been sacrificed for ______, making the cervical spine particularly vulnerable to injury because it sits between a heavy head and a stable thoracic spine and ribs
stability, mobility
upper cervical spine
cervicoencephalic or cervicocranial
lower cervical spine
cervicobrachial
cervicoencephalic is from C_ to C_?
C0-C2
shows the relationship between the cervical spine and the
occiput
cervicoencephalic or cervicocranial
injuries in the cervicoencephalic involves ___, ___, ___
brain, brainstem, and spinal cord
Injuries in cervicoencephalic lead to symptoms such as? (9)
headache,
vertigo,
poor concentration,
irritability,
fatigue,
hypertonia of sympathetic
nervous system,
cognitive dysfunction,
cranial nerve dysfunction,
sympathetic system dysfunction
C0 to C1; two
uppermost joints
atlanto-occipital joints
atlanto-occipital joints motions (2)
flex/extend (nodding of head): 15-20 degrees
side flex: 10 degrees
rotation: negligible
principal motion atlanto-occipital joints
flex/extend (nodding of head): 15-20 degrees
During development, the vertebral body of C1
evolves into the ___
odontoid process
type of joint of atlanto-occipital
ellipsoid
anterior membrane is
strengthened by ___
anterior longitudinal ligament
replaces the ligamentum flavum between the atlas and occiput
posterior membrane
broad band covering the dens and its ligaments,
is found within the vertebral canal and is a continuation of the posterior longitudinal ligament
tectorial membrane
tectorial membrane is a continuation of ____
posterior longitudinal ligament
two strong rounded cords found on each side of the upper dens passing upwards and laterally to attach on the medial sides of the occipital condyles
alar ligaments
alar ligaments limit ___ and ___ and play a major role in stabilizing, C__ and C__, especially in rotation
flexion, rotation
C1, C2
C1 to C2 joint
atlanto-axial joints
constitute the most mobile articulations of the spine
atlanto-axial joints
atlanto-axial joints motions (3)
flexion-extension: 10°
side flexion: 5°
rotation: 50°
primary movement of atlanto-axial joints
rotation: 50°
With rotation, there is a ____ in height of the cervical spine at this level as
the vertebrae approximate because of the shape of the
facet joints.
decrease
acts as a pivot
point for the rotation
odontoid process of C2
middle or median joint
pivot (trochoidal) joint
At the atlanto-axial
joints, the main supporting ligament is the ____, which holds the dens of the
axis against the anterior arch of the atlas.
transverse ligament of the atlas
It is this ligament that weakens or ruptures in rheumatoid arthritis.
transverse ligament of the atlas
As the ligament crosses the dens, there are two projections off the ligament, one going superiorly to the
occiput and one inferiorly to the axis. The ligament and the projections form a cross, and the three parts taken together are called the ___
cruciform ligament
At what vertebral level does the vertebral artery enter through the transverse processes?
usually starting at C6 but entering as high as C4
The vertebral and internal carotid arteries are stressed primarily by what movements? (3)
rotation, extension, and traction movements
Rotation and extension of as little as ___ have been shown to significantly decrease vertebral artery blood flow.
20°
The greatest stresses are placed on the vertebral arteries in four places:
enters the transverse process of C6
within the bony canals of the vertebral transverse processes
between C1 and C2
between C1 and the entry of the arteries into the skull
Symptoms related to the vertebral artery (7)
vertigo,
visual disturbances,
tinnitus,
nausea,
“drop attacks” (falling
without fainting),
stroke or death (rare cases)
pain in this area is commonly referred into the upper extremity
cervicobrachial area
most common mechanism
for non-penetrating injury to the vertebral artery
neck extension
cervical levels of cervicobrachial area
C3 to C7
Symptoms related to pathology in cervicobrachial
area (7)
neck and/
or arm pain,
headaches,
restricted range of motion (ROM), paresthesia,
altered myotomes and dermatomes,
radicular signs,
sympathetic dysfunction
How many are the facet (apophyseal) joints in the cervical
spine?
14
direction of the superior facets of the cervical spine
upward, backward, and medially
facet joints often included in the examination of the cervical spine
upper four facet joints in the two upper thoracic vertebrae (T1 to T2)
direction of the inferior facets of the cervical spine
downward, forward,
and laterally
rotation and side flexion both occurring with either flexion or extension
coupled movement
vertebral levels where coupled movements occur in opposite directions (2)
between C0 and C2
C7 and T1
greatest flexion-extension of the facet joints occurs where?
between C5 and C6
vertebral levels where coupled movements occur in same directions (1)
between C2 and C7
vertebral levels where degeneration most likely occur (3)
C4 to C5
C5 to C6
C6 to C7
neutral or resting position of the cervical spine
midway between flexion and extension
closed packed position
Full extension
capsular pattern
Side flexion and rotation equally limited
extension
intervertebral discs make up approximately
___% of the height of the cervical spine
25%
where no disc is found (2)
between the atlas and the occiput (C0 to C1)
between the atlas and the axis (C1 to C2)
T OR F: It is the discs
rather than the vertebrae that give the cervical spine
its lordotic shape
TRUE
functions as a buffer to axial compression in distributing
compressive forces
nucleus pulposus
acts to withstand tension within the disc
annulus fibrosus
T OR F: There are seven vertebrae in the cervical spine with the body of each vertebra (except C1) supporting the weight of those above it.
TRUE
T OR F: The facet joints may bear some of the weight of the vertebrae above, but this weight is maximal if the normal kyphotic posture is maintained.
FALSE: weight is minimal if normal lordotic posture is maintained
T OR F: The spinous process protects the spinal cord,
while the vertebral arch provide for attachment of muscles.
FALSE: Vertebral arch protects the spinal cord while spinous process provide for attachment of muscles
T OR F: In the cervical spine, the spinous processes are at the level of the facet joints of the same vertebra.
TRUE
T OR F: Generally, the
spinous process is considered to be absent or at least
rudimentary on C1.
TRUE
T OR F: The first palpable vertebra
descending from the external occiput protuberance is the
spinous process of C3.
FALSE: C2 is the first palpable vertebra
How many cervical nerve roots are there?
8
T OR F: In the cervical spine, each nerve root is named for the vertebra above it.
FALSE: In the cervical spine, each nerve root is named for the vertebra BELOW it. But the nerve root exits above the cervical vertebra level.
