anatomy of the cervical spine

Question 1

primary function of cervical spine

Answer 1

mobility, support, and protection of spinal canal and neural structure- supports head

Question 2

snstomy of cervical spine

Answer 2

7 vertebra, intervertebral discs, pairs of existing nerve routes, cervical lordosis- average 40° (most in C1-2), CO- Occiput, approx 50% of flexion-extension motion occurs at C0-C1- nodding action, approx 50% rotation occurs at C1-2, less movements occuring at C2-C7

Question 3

cervical nerve roots

Answer 3

8 spinal nerve roots- C0-C7, C0-2 convex facets that sit within 2 large facets on uppermost facet of articular pillar on C1, cervical root 1 atlas (between C0-C1)

Question 4

structure of a typical cervical vertebra

Answer 4

C3-C6, vertebral body, TP, transverse foramen (foramen transversarium), ant and post tubercles, pedicle, articular pilar- horizontal to vertical, lamina, bifid SP- less in lower cervical spine, vertebral foramen

Question 5

joints of von Lushka

Answer 5

uncovertebral joints- synovial plane, overlapping disc of 1 vertebra on vertebra below, has ligamentous support on outer aspect on both sides

Question 6

atypical vertebra- atlas C1

Answer 6

doesn’t have vertebral body or SP,ring shaped, 2 lateral masses- TP, biconcave superior articular surface, anterior arch (articular facet- synovial plane- with odontoid), posterior arch/tubercle, inferior articular surface, 2X transverse foramen, TP

Question 7

atypical vertebra- axis C2

Answer 7

has an odontoid peg/process- replaces body in C1- projects superiorly, articular surface on most superior aspect, with facet on anterior arch of C1, 2 lateral articular facets, 2 TP and foramen, lamian (2 narrow), bifid SP

Question 8

atypical vertebra-C7

Answer 8

most prominent- vertebra prominence

Question 9

atlanto- occiput joint

Answer 9

occipital condyles (convex), joint between occipital and C1, superior articular facet on atlas (concave), convex facets on C1, synovial plane joint- supported by capsule and ligaments, and membranes

Question 10

atlanto-axial joint- C1-2- median joints

Answer 10

median joints- at the dens and anterior arch of C1, synovial pivot joint, articular surfaces- convex rectangular facet on the front of dens, concave facet inner aspect of ant arch at the atlas, post surface of the dens articulates with transverse lig- has synovium and hyaline cartilage of lif- attached to either side of ant arch of atlas- allows rotation to shake head

Question 11

atlanto-axial joint- C1-2- lateral joints

Answer 11

zygapophyseal joints, synovial plane joints

articular surface- 2 concave facets of the atlas articulates with 2 convex facets if the axis

Question 12

upper cervical spine ligaments

Answer 12

transverse ligament (atlantal cruciform ligament), alar ligament (2X), apical ligament, tectorial membrane, ligamentum nuchae, posterior atlantoaxial, anterior atlantoaxial

Question 13

transverse ligament

Answer 13

divides the ring of the atlas into 2 compartments, ant- dens, post-spinal cord, thin layer of articular cartilage on its anterior surface for articulation with dens , transverse lig holds the dens and atlas in close approximation, primary function is to prevent anterior displacement of the atlas and axis, in patients with RhA- effecting joints in neck- issue with additional atlanto-axial movement- can cause damage to spinal cord

Question 14

alar ligament

Answer 14

attached either side of the dens and attach to medial aspect of the occiput, relaxed in extension and taught in flexion, prevent distraction of C1 on C2, limits flexion, rotation, side flexion of same side

Question 15

apical ligament

Answer 15

apex of the dens to the anterior edge of the foramen magnum, prevents unwanted longitudinal distraction of the occiput from the cervical spine

Question 16

tectorial membrane

Answer 16

continuation of the PLL, extends from the posterior aspect dens to the occipital bone within the anterior edge of the foramen magnum, prevents unwanted flexion

Question 17

ligamentum nuchae

Answer 17

continuation of the supraspinous lig, extends from SP C7 to external occipital protuberance, deep part attaches to post aspect of the atlas, limits flexion

Question 18

posterior atlanto-axial membrane

Answer 18

continuation of the lig flavum, connects the lamina of C1-2, changes name of ligamentum flavum

Question 19

anterior atlanto axial membrane

Answer 19

continuation and broadening of ALL, circumferential support of the head of upper cervical spine, attached to anterior aspect of dens to an aspect of atlas

Question 20

lower cervical spine ligaments

Answer 20

ALL, PLL, ligamentum flavum, intertransverse lig, interspinous lig, ligamentum nuchae, supraspinous lig

Question 21

vertebral artery

Answer 21

comes of ascending aorta. goes through all the anterior foramen transversarium, because C1 is lateral due to lateral mass- goes through at 90°, joints opposite number from other side which join to form the basilar artery

Question 22

ROM- flexion and extension

Answer 22

flexion- 70°- visual estimation, patient should get chin to sternum or chin to within 2 fingers width of sternum
extension- 70°- patient should be able to get forehead parallel to ceiling for full range to be achieved

Question 23

ROM- side flexion and rotation

Answer 23

rotation- approx 90°- visual estimation patient should be able to get nose level with acromion process
side/ lateral flexion
approx 45°- goniometry by placing the axis at C7/T1 and aligning the moveable arm with the external occipital protuberance

Question 24

cervical protraction and retraction

Answer 24

protraction- upper- extension, lower flexion

retraction- upper flexion, lower extension

Question 25

bony points

Answer 25

temporomandibular joint, angle of mandible, mastoid process, foramen magnum, occipital condyles, external occipital protuberance, nuchal line, TP C1, C2-R3 SP, bifid SP, articular pillar, TP anteriorly, ligamentum nuchae

Question 26

accessory movements

Answer 26

PA, unilateral PA- either side of SP, transverse