7) Cervical Spine Flashcards
Typical cervical vertebrae
C3-6
Small kidney shaped VB
Short pedicels pass pesterolaterally
Long narrow laminae pass posteromedially
Short bifid Spinous process
Large 🔺 vertebral foreman
Stout transverse process arising from the lateral aspect of the body of pedicel
Foreman Transversium= for the vertebral artery in each transverse process
Articular surfaces Cx
Large inferior and superior articular processes which have articular facets
Direction of facets:
Superior: superoposterially
Inferior: inferoanteriorlly
Typical thoracic vertebrae
T2-8
❤️ shaped VB
Short pedicels project posteriorly
Laminae project towards midline
Long spinous process slopes downwards : middle Tx spins almost vertical
Small circular vertical foreman- no need to form a plexus for peripheral nerves
Articular surfaces Tx
1) Inferior Costal facets- sides of VB
2) Long thick rounded transverse process project posterolaterally and slightly upwards: costal facet on anterior surface near the tip facing anterolaterally for the tubercle of the rib
***Articular processes project almost vertically and have articular facets ⬇️
3) Superior facets are concave transversely facing posteriorly superolaterally
4) Inferior facets are convex transversely facing Anteriorly and inferomedially
Atypical Tx
1
9
10
11
12
Classification of typical Cx and Tx joints
Anteriorly = 2nd cartilaginous
Posteriorly= zygoapophyseal
Static stabilisers
IV disc Anterior longitudinal ligament Posterior longitudinal ligament Intertransverse ligament ligamentum flava Interspinous ligament Supraspinous ligament =Cx LIGAMENTUM NUCHAE
Ligamentum nuchae
Midline 🔺 fibroelastic septum
= large SA for muscle attachment doesn’t limit extension = larger range
External occipital protuberance - - - - C1-7 spinous processes
Atypical Cx vertebrae
C1= ATLAS: Bears very little resemblance to any other vertebra: no body or spinous process
C2 = AXIS : strongest of the cervical vertebrae has most of the features of a typical CX vertebrae
C7 = very long non-bifid process has similarities to TX vertebrae possessing a larger body and a smaller vertebral foreman
Transition point
C1 Atlas
Slender anterior and posterior arches joined on each sides by a lateral mass and has articular surfaces
Superiorly + Inferiorly= articular surfaces
Transverse processes laterally= Foreman transversearium
Posterior tubercle= quite like spinous process
Large vertebral foreman for spinal cord or pass through
See file
What’s in the Foreman transversearium
Vertebral vesselesnans sympathetic nerves go up to brain
C2 Axis
Dens of axis= c1 c2 articulations
Small round transverse process
Bifid spinous process
See file
Atlanto Occipital joint
2 Separate multiple joints
C0+C1
Synovial joint between occipital condyle on inferior aspect of skull - - - facet on superior surface of lateral mass of atlas
2 joints = single ellipsoid joint
Atlanto Occipital joint
Static stabilisers
Anterior Atlanto occipital membrane
Posterior Atlanto occipital membrane
Ligamentum nuchae
Other ligaments and membranous structures passing between C2 and occipital bone of skull
Anterior occipital membrane
Densely woven fibres
Thicker centrally by upward prolongation of ALL
Blends laterally with anteromedial capsule
*Anterior arch of atlas to in front of anterior margin of foreman magnum on base of skull
Posterior atlanto occipital membrane
Posterior margin of foreman magnum and below ——— upper boarder of posterior arch of atlas
Blends posteriormedial joint capsule
Lateral attachment to atlas it arches over the vertebreal artery and 1st cervical nerves
Lower arch part is thickened and may ossify
1st cervical never passes posterior to atlanto occipital joint
Ligamentum nuchae
🔺 midline fibroelastic septum extending upwards
Spinous process 7th cervical vertebrae attaches to ———- external occipital protuberance and crest
Deep part= posterior tub if atlas and spinous processes of all cervical vertebrae
Neck muscle attatchment without limiting extensions
Movements at atlanto occipital joint
Flexion: Retraction = double chin
Extension: protraction= piking chin
20°
Lateral flexion: 8°
Atlanto Axail joints
Articulation between C1 -2
Atlas and Axis
3 joints:
2 lateral= synovial plane
1 Median= synovial pivot
All produce rotation
Static stabilisers
Transverse ligament
Apical ligament of Dens
Membrane rector is
Alar ligament
ALL
Anterior antlanto axail membrane
Posterior ntlanto axail membrane
Ligamentum nuchae
Ligamentum flava
Anterior antlanto axail member
Lower boarder if anterior arch of C1 and upper boarder of C2
Reinforced centrally by ALL as it comes up to attatch to anterior tubercle of anterior arch of atlas
Posterior antlanto axail membrane
Lower boarder of posterior arch of C1 —— upper boarder of laminae of C2
Fills gap men loses segmental level
Transverse ligament
Thick strong band acting behind The dens keeps it against against anterior arch of atlas
Covered fibrocartilage
From the middle of the ligament Small tubercle
Atlas
Superior band= middle of transverse ligament ascending to attatch to the anterior edge of foreman magnum
Inferior band= lower boarder middle transverse ligament passes downwards attatch es to posterior aspect of the body of C2
2 longitudinal bands together with the transverse ligament constitute the cruciform ❌ligament of the the atlas
Alar ligament
Passes obliquely superolaterally from each side of apex of dens to medial side of occipital condyle
Short strong rounded band
Rotation side flexion
Apical ligament
Slender band lying immediately in front of the upper longitudinal band of the cruciform ligament
stretching from the apex of the dens to the anterior edge of foreman magnum in between the diverging alar ligaments
Tectorial membrane
Broad sheet fascia continuous with posterior longitudinal ligament
Extends from back of the body of axis to the occupital bone within the anterior edge of the foreman Magnum as far laterally as the hypoglosdens cruciform and alar ligaments
Synovial bursa Between membrane and median part of the transverse ligament of atlas
Blends spinal dura matter
What pushes dens against anterior arch
X
Atlanto-Axial joint
ROTATION
15° each side
Combination of gliding and rotational movement of the head and C1 simultaneously C2
Anterior arch of C1 and transverse ligament pivot around the stationary dens of C2
Inferior facets of the lateral masses of C1 glide over the superior facets of C2 one gliding forward and the other backwards
Rotation + Alar ligament
Rotation is accompanied by slight vertical descent of the head on C to approximately 1 mm
Due to orientation of the articular surfaces of the lateral atlantoaxial joints the alar ligament slacken therefore delaying their action in limiting rotation at this segmental level
Boundaries of intervertebral foreman
Oval shape
Pedicels of successive vertebrae above and below
Vertebral bodies and discs Anteriorly
Articular processes and facet joints between processes posteriorly
Exciting nerve roots from each level which combine and form the brachial plexus
