4. Cervical Spine Flashcards
which vertebrae does the ‘atlas’ refer to
C1
what is the superior articulation of C1
base of skull (occiput)
what is the joint between the base of skull and C1 called
atlanto-occipital joint
what 3 movement types are permitted at the atlanto-occipital joint
extension and flexion
slight lateral flexion
comparing between the C1 to a normal cervical vertebrae and C2 what does it lack that all others have
vertebral body
how do the superior articular facets of C1 compare to the other vertebrae
larger, broader and flatter for C1
is the articular facet for the C2 dens on the anterior or posterior arch
anterior arch
what is the transverse antlantal ligament’s function and where is it located
maintains the dens process in articulation
on the C1 anterior arch holds the odotoid peg in place
which vertebrae is the axis
C2
how many joints make up the atlanto-axial joint
and what joint is this between
between C1 and C2
3 joints
2 between articular facets and 1 between the dens and anterior arch of C1
what movements are permitted between C1 and C2
rotation
how many cervical vertebrae are there and how many cervical nerves are there
7 vertebrae
8 nerves
where in relation to their respective vertebrae do the C1 and 2 nerve roots emerge and is the same true for all other cervical nerves?
cervical roots emerge superior tp their respective vertebra while thoracic and lumbar nerve emerge beneath their vertebrae
hence there is an extra c8 nerve
C1 nerve is above C1 transverse process
C7 nerve is above C7 transverse process and C8 emerges below the C7 transverse process
how many cervical vertebrae are there
how many are typical vertebrae
which ones are the atypical vertebrae
7
5 typical
C1 and 2 are atypical
what distinguishes a cervical vertebrae from a thoracic or lumbar vertebrae
presence of a transverse foramen
why are the transverse processes gutter shaped
this is where the spinal nerves and important arteries run so create a gutter in the bone
what do you notice about the C7 spinous process
very long and not bifid so appear more thoracic in form
first spinous process you can see on the skin and a good surface landmark
where are the uncinate processes of the cervical vertebrae and what joints do they form
from the uncovertebral joints
its the upper lip of the vertebral body edge s which articulate with the body of the vertebrae above to form the joint
___ joints are unique to the cervical region
what movements do they permit and limit
synovial joints
permit = flex/extension
limits lateral flexion and rotation
what are the intervertebral discs primarily made of and what joints do they create and where are these joints located
fibrocartilage
forms symphysis joints between the adjacent vertebrae (all midline joints are symphyses)
how many IV discs are there in the cervical region
why
6
no disc between the C1 and C2 vertebrae as C1 doesnt have a body and dens projects upwards
the IV discs are name after which vertebrae
the ones above and below (eg between C5/6 = C5-6 disc)
how would you describe IV disc appearance on the x-ray images
radiolucent (dark)
the cervical spine transmits what portion of the spinal cord
first portion
where is the spinal cord formed
brain stem
what space does the spinal cord run through in the cervical vertebrae
spinal canal
what is the intervertebral foramina formed by and why would it be a region of interest clinically
its the gap formed between the pedicle/transverse processes of adjacent vertebrae
narrowing of these spaces due to inflammation, arthritis or trauma may lead to neurological symptoms by compression of nerve roots (especially in the neck and upper limb)
what is the larynx’s primary function
ie. its a _____ structure
airway structure
which 3 structures is the pharynx split into
nasopharynx
oropharynx
laryngopharynx
where is the nasopharynx located behind
nasal cavity
where is the oropharynx located behind
oral cavity
where is the laryngopharynx located behind
behind the larynx
which cavity is the primary entrance for food
which cavity is the primary entrance for air
what do you notice about the passage of food and air in relation to each other in this region and what consequences might this have
food = oral cavity
air = nasal cavity
they cross each other so food is at risk of going down airways
is the trachea above the larynx
no its below
the larynx’s main structure is a tube made of what 3 structures
what are they bound together by
2 cartilaginous structures and one bone bound to eachother by fibro-elastic membranes
from superior to inferior what are the 2 cartilaginous structures and one bone of the larynx
which forms the adams apple
hyoid bone
thyroid cartilage
circoid cartilage
thyroid cartilage
after the cricoid the airway becomes known as
trachea
what is the difference between the cricoid cartilage and other 2 (hyoid bone and thyroid cartilage)
the cricoid is a full ring but others are ‘C-shaped’
proximally the epiglottis is made from ___ ____
elastic cartilage
how is epiglottis anchored to the thyroid and hyoid?
by a ligament
what is the epiglottis function and how does its form produce that function
depresses when food is passing down to prevent it entering the larynx
unlike other cartilages its made of elastic cartilage - that plus the ligaments holding it to the hyoid/thyroid helps it spring back open after food has passed
the pharynx is the most anterior/posterior set of spaces in its region
posterior
the laryngopharynx is found directly ___ to the larynx and is created by a series of muscles that mostly attach to ___________
posterior
posterior aspect of laryngeal structures
why is the laryngopharynx primarily muscular while the larynx and trachea have cartilage
pharynx must expand to accommodate food
larynx needs structure to stop it collapsing
why is the airways are mostly made of C-shape structures
pharynx/oesophagus can expand into the airways a little as food passes down (vertebral column isnt very forgiving)
what is the consequence of the cricoid’s full ring structure
potential site of constriction/blockage as things pass down
the cricoid marks the transition of ___ into the ____
laryngopharynx into the oesophagus
which laryngeal structure approximates the location of the carotid bifurcation
hyoid anterior aspect
what is the vertebral level roughly does the oesophagus begin
C6 (C5-6)
what is the vertebral level that corresponds with the hyoid bone
C3 (C3-4)
what is the vertebral level does the trachea begin
C6 (C5-6)
same as the oesophagus
what arteries are the largest of those in the neck and how do they run up the neck
common carotid arteries
run vertically up each side of the neck in the carotid sheath
which 2 arteries do the common carotids split into
external and internal carotid artery
out of the internal and external carotid arteries which primarily supplies the brain
what does the other artery do
internal = supplies brain
external = supplies things external to the cranium mostly (eg neck, face, mouth, nose, ears etc)
what other arties also supply the brain in addition to the internal carotid artery? where do they arise from
the vertebral arteries which arise off the subclavian arteries
describe the course of the vertebral arteries in relation to the cervical vetebrae
they course through the transverse foramina of C1-6 (NOT C7!!)
which veins runs with the carotid vessels in the carotid sheath
internal jugular veins
the IJVs join the ___ veins to form the _____ ___ at the root of the neck
subclavian veins
brachiocephalic trunks
the brachiocephalic trunks form at the root of the neck behind which joints
sternoclavicular joints
which structures does the sternocleidomastoid muscle attach to and what aspects do they attach
attach to the medial aspect of the clavicle and manubrium
which 2 vessels can be located deep to the sternocleidomastoid muscle
carotids and IJVs
the thyroid gland sits atop the trachea between which 2 vessels
what is the thyroid glands position relative to the thyroid cartilage
between the carotids and IJV
relative to the thyroid cartilage, the thyroid gland is more inferior (mostly around the trachea but lateral parts may extend up to the level of the thyroid cartilage)
describe the flow of blood from the aortic arch to the brain in terms of the order of arteries they flow through on the right side
aortic arch -> brachiocephalic trunk
brachiocephalic trunk -> right subclavian and right common carotid
right subclavian -> right vertebral
right common carotid -> right external and internal carotid
describe the flow of blood from the aortic arch to the brain in terms of the order of arteries they flow through on the left side
aortic arch -> left common carotid and left subclavian
left subclavian -> left vertebral
left common carotid -> left external and internal carotid
the IJV turn into which veins
brachiocephalic trunks
the vagus nerves supply _____ innervation to which structures
parasympathetic innervation
supplies almost all the thoracic and abdominal viscera
the vagus nerves run down the neck in the ___ ___ between which 2 vessels
carotid sheath
between the common carotid and IJV on each side
each vagus nerve gives off to which nerve
recurrent laryngeal nerve
the left and right RL nerve takes what path to innervate the larynx and control the airways
left hooks around the arch of the aorta
right hooks around the right subclavian artery
hooks around major artery and runs back up between the trachea and oesophagus and posterior to the thyroid gland
what is the consequence of damaging the RL nerves
laryngeal pathology results in hoarse voice and airway obstruction
which nerves run lateral to the vagus nerves
phrenic nerves
which muscles do the phrenic nerves run over and which artery and vein do they pass between
run over anterior scalene muscles
pass between the subclavian artery and vein on each side
what does the phrenic nerve innervate and what is its root value
innervates diaphragm
nerve roots C3-5
what is the phrase to remember what the C3-5 roots innervate
C3,4,5 keeps the diaphragm alive
what nerve roots form the cervical plexus and what areas and functions of the body do they innervate
C1-4
neck = sensory and motor
what nerve roots form the brachial plexus and what areas and functions of the body do they innervate
C5-T1
upper limb = sensory and motor
