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MINCER - EXAM 3 > C-Spine Anatomy > Flashcards

C-Spine Anatomy Flashcards

1
Q

What is the name of the supraspinous ligament as it continues to cranium?

A

Ligamentum Nuchae (or nuchal ligament)

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2
Q 
True / False 
Ligamentum Nuchae (or nuchal ligament) is fibroelastic
A

True

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3
Q

What is the function of Ligamentum Nuchae?

A

It helps passively support the weight of the head in an upright position (fibro-elasticity helps with this).
Important midline attachment for muscles

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4
Q

What is the course of the vertebral artery in the neck?

A
  • Vertebral artery is a branch of the subclavian A
  • ascends through transverse foramina to foramen magnum
  • combines with contralateral vertebral A to form Basilar A
  • it runs through the transverse foramen, right along the axis of flexion/extension (which is important so that it doesn’t get too stretched with these big cervical movements).
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5
Q

What is the vertebral artery’s relationship to cervical nerve roots?

A

immediately anterior to cervical nerve roots

Goes through the transverse foramen

the location of the vertebral artery is at the axis of flexion/extension (mediolateral axis) to help protect it during flexion/extension

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6
Q

What movements can disrupt the vertebral artery more than E and F

A

Rotation and LF

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7
Q

What are the symptoms of vertebral artery compression?

A

symptoms of decreased blood flow with certain head positions (also known as vertebrobasilar - ischemia)

  • dizziness
  • vertigo
  • fainting (syncope)
  • visual disturbances with head turning

symptoms can be a result of an obstruction of blood flow due to compression of a vertebral artery

Remember the 5 D’s (dizziness, drop attacks [falling suddenly without losing consciousness], dysphagia, dysarthria, and diplopia)

Also from class: ataxia, nausea, numbness of unilateral face, nystagmus, fainting

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8
Q
  1. Describe the general size and shape of the central (vertebral) canal in the C-spine.
A

fairly triangular

large relative to the size of the segment

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9
Q

What is the clinical significance of the size and shape of the central (vertebral) canal in the C-spine?

A

largest at the top C1

-because of the brainstem location and the cervical plexus forming in that area

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10
Q

The diameter of the central (vertebral) canal is greatest in what position?

A

flexion

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11
Q

The diameter of the central (vertebral) canal is least in what position?

A

extension

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12
Q

Where is the uncinate process and what motion would it prevent?

A

A bony upward projection arising from each side of the upper surface of any of the cervical vertebrae numbered three to seven and forming a raised lateral margin

limits lateral translation

gives a little stability (in this highly mobile part of the spine) without hindering movement too much

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13
Q

Describe the joints of Lushka.

A

Uncinate processes articulate with the vertebral body above to form the joints of Lushka.

They serve to limit lateral translation (they shouldn’t be very much weight bearing)

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14
Q

What is the relationship of the joints of Lushka to spinal nerves?

A

Located just anterior to spinal nerves

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15
Q

What would be the clinical significance of DJD at one of the joints of Lushka?

A

When loaded chronically, may form osteophytes, which may then impinge on spinal nerves (“crimp the nerve’s style”)

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16
Q

What’s the name of the PLL as it continues cranially?

A

Tectorial Membrane.

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17
Q

What is the function of the Tectorial Membrane?

A

helps hold the head onto the neck

helps hold dens, supports dens

can limit flexion and extreme extension (like in whiplash)

(PLL is wider than lumbar version in C-spine, while the ALL is narrower than the lumbar counterpart)

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18
Q

What ligaments attach to the dens?

A

Alar ligaments (hold dens to skull)

Also known as “check” ligaments

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19
Q

What motions would the alar ligaments check (restrict)?

A

Rotation

Lateral flexion

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20
Q

Why is ligamentous instability around the dens important to recognize?

A

Whenever you encounter a patient that has neck pain as a result of trauma or cervical instability, you should always inspect the integrity of the transverse ligament before any other exam measures.

When the transverse ligament is damaged, the atlas can slide forward on the dens, decreasing the size of the vertebral canal for the spinal cord to go through.

This can result in neurological symptoms, such as pain, weakness, a lump in the throat, etc. In this compromised position, any movements can impinge upon the spinal cord and cause potentially irreversible damage.

21
Q

What is the position of the dens in relation to the brainstem? Why is it important?

A

brain stem is right behind the dens (brain stem is king of the hill), but safe because of heavy ligamentous stability (trauma can damage these, subsequently the dens can damage the BS)

22
Q

What is the role of the dens?

A

provides lots of mobility, so you want that spike but you need to at least hold it still (alar ligaments and transverse ligament of the atlas)

23
Q

Describe the role and the position of the transverse ligament.

A

The transverse ligament is responsible for keeping the anterior facet of the atlas against the dens of the axis. It attaches on the medial side of each large, lateral process of the atlas with the anterior side of the middle part touching the odontoid process. This creates a wide space in the vertebral canal for the spinal cord to pass through, posteriorly.

24
Q

What are the predominant motion(s) that occur at OA and how much of this motion occurs here?

A

Sagittal plane: 15* total
Flexion: 5*
Extension: 10*
“little nodding” motion

Frontal plane (lateral flexion): 5*

25
Q

What are the predominant motion(s) that occur at AA (and how much of this motion occurs here?)

A 
50% of transverse plane motion (rotation) occurs at C1-C2
Horizontal plane (rotation): 35*-40*

Sagittal plane: 15* total
Flexion: 5*
Extension: 10*

26
Q

What is the facet orientation in the mid C- spine?

A

between frontal and horizontal planes (inclined anteriorly)

45 degree oblique

27
Q

What is Fryette’s law for cervical?

A

rotation ann lateral flexion in the same direction

R rotation: R lat flex + R rotation…. R Lat flex: R Lat flex + R rotation.

28
Q

How are facets sliding with movement?

A

With Flexion: superior and anterior

With Extension: inferior and posterior

29
Q

The facet orientation allows what motions?

A

Allows all motions, although combined lateral flexion and rotation are most natural

30
Q

Describe what happens to the contact area of the facet joint during the motion of flexion

A

decreases in surface area

31
Q

Describe what happens to the diameter of the IVF during the motion of flexion

A

increases

32
Q

Describe what happens to the contact area of the facet joint during the motion of extension:

A

is maximized for maximized load bearing

33
Q

Describe what happens to the diameter of the IVF during the motion of extension

A

decreases

the superior segment slides inferiorly causing a slack capsule

34
Q

What is excessive extension limited by?

A

Largely limited by impaction of the spinous processes, so we don’t need as much soft tissue to limit excessive extension

35
Q

Describe forward head position (FHP)

A

the upper cervical spine is in an extended position, while the lower cervical spine is in a flexed position.

36
Q

What muscles get adaptively shortened in FHP? (general rule)

A

Anything posterior to axis of upper c-spine can get adaptively shortened (occipitals)
Anything anterior to the axis of the lower c-spine can get adaptively shortened (SCM)

37
Q

What happens with the facets during lateral flexion?

A

the ipsilateral facets approximate (slightly) and the contralateral facets distract (slightly).

ipsilateral facet slides down
contralateral facet slides up

38
Q

Describe the ALL in the C- spine:

A

ALL is narrower compared to lumbar

in C-spine hyperextension is mostly limited by impaction of the spinous processes, so we don’t need as much soft tissue to limit excessive extension.
Not a “down-hill” force in the cervical spine, like in lumbar (ie. weight of body that would cause shifting of the vertebrae)

39
Q

Describe the PLL in the C- spine:

A

PLL is wide compared to lumbar

we need more protection for the brainstem so wider makes sense
There is not a lot of bony mass to limit flexion

40
Q

Contraction of bilateral sternocleidomastoid muscles causes what motion(s)?

A

flexion and protrusion

they are long/superficial flexors

41
Q

Contraction of unilateral sternocleidomastoid muscles causes what motion(s)?

A

ipsilateral lateral flexion

contralateral rotation

42
Q

Contraction of bilateral suboccipital muscles causes what motion(s)?

A

extension

(they are short/deep extensors?

43
Q

(true or false)

C1 is palpable. If so, what part?

A

True. Can palpate transverse processes

gentle handling

just inferior to mastoid process

Can contralaterally lateral flex head or ipsilaterally rotate head to get the transverse process to “pop out” while palpating

44
Q

(true or false)

C2 is palpable. If so, what part?

A

True. Can palpate the spinous process.

The first spinous process you feel as you drop off the skull toward the spine.

Some of the other spinous processes are too close together to feel so you may document that you mobilized mid C-spine instead of on a certain segment.

45
Q

What is the “articular pillar”?

A

In the cervical vertebral column, the articular processes collectively form the articular pillars

46
Q

A patient with an inflamed cervical nerve root on the right is likely to have pain with what motions?

A

extension
right lateral flexion
right rotation

47
Q

A patient with a large central disc protrusion in the cervical spine is likely to have what symptoms?

A

Central would be UMN symptoms (pressing on cord - Myelopathy)
bilateral
hyperreflexia
in UEs and/or LEs

48
Q

A patient with a large lateral disc protrusion in the cervical spine is likely to have what symptoms?

A

Lateral would be more s/s of nerve root irritation or compression
paresthesia
hard neuro signs
radiculopathy

MINCER - EXAM 3 (9 decks)

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