C-spine iRA/tRA

Question 1

what are the typical cervical vertebrae?

Answer 1

C3-C7

Question 2

C3-C7 body: anterior is ____

Answer 2

convex

Question 3

C3-C7 body: posterior is ____

Answer 3

flat or slightly concave

Question 4

what part of C1 (atlas) articulates with the dens?

Answer 4

the posterior surface of the anterior arch

Question 5

the posterior arch of C1 has a groove for what artery on its superior surface?

Answer 5

vertebral artery

Question 6

the posterior tubercle on the posterior arch of C1 is an attachment for which ligament?

Answer 6

ligamenta flava

Question 7

the transverse processes of C1 are palpable between what 2 bony landmarks?

Answer 7

mastoid process and ramus of mandible

Question 8

the superior facets of C2 (axis) are oriented slightly ____

Answer 8

convex

Question 9

the inferior facets of C2 are oriented ____ and ____

Answer 9

inferiorly and anteriorly

Question 10

how is the odontoid process (dens) of C2 tilted?

Answer 10

• posteriorly: up to 14 deg

- laterally: 10 deg or less

Question 11

what ligaments stabilize the dens?

Answer 11

• transverse ligament
• apical ligament
• alar ligaments

Question 12

what 3 parts make up the IV discs?

Answer 12

• nucleus pulposus
• annulus fibrosis
• vertebral endplates

Question 13

describe what a vertebral endplate is

Answer 13

• cartilaginous disc affixed to the inferior and superior surface of the IV disc
• transition between disc and vertebra
• failure of this structure can be problematic

Question 14

T/F: there is no clear boundary between the nucleus and annulus in the c-spine

Answer 14

true

Question 15

what is the significance of the semifluid material of the nucleus?

Answer 15

it transmits pressure in all directions if deformed

Question 16

which part of the vertebral endplate is made of hyaline cartilage?

Answer 16

toward the vertebral body

Question 17

which part of the vertebral endplate is made of fibrocartilage?

Answer 17

toward the nucleus

Question 18

T/F: the vertebral endplate covers the entire nucleus and annulus

Answer 18

False! It covers the nucleus, but not the entire annulus

Question 19

the vertebral endplate is weakly attached to ____ and strongly attached to ____

Answer 19

• vertebral bodies

- IV disc

Question 20

are IV discs strongly or poorly vascularized?

Answer 20

poorly

Question 21

how do IV discs get nutrition?

Answer 21

• nutrition is accomplished with diffusion (compression and distraction)
• compression: fluid leaves
• distraction: fluid returns

Question 22

describe the anterior annulus of the c-spine disc

Answer 22

• thick and strong

- lambdoid orientation

Question 23

describe the posterior annulus of the c-spine disc

Answer 23

• thin
• longitudinal fibers
• transverse fissure

Question 24

what is the significance of the transverse fissure on the posterior annulus?

Answer 24

allows for swingng motion of cervical vertebral bodies

Question 25

what are the 3 primary functions of the c-spine disc?

Answer 25

- allow motion to occur - transmit forces - absorb energy/attenuate forces

Question 26

what type of joint are zygapophyseal joints?

Answer 26

synovial

Question 27

describe the fibro-adipose meniscoid found in z-joints

Answer 27

- leaf-like fold of synovium that encloses fat, collagen , and blood vessels - folds into the corners of the joint to fill space + protect joint surfaces in extremes of motion - projects up to 5mm into jt cavity - highly innervated

Question 28

what structure is innervated by the dorsal rami medial branch?

Answer 28

z-joint capsule

Question 29

describe the sinuvertebral nerve

Answer 29

- comes off ventral ramus - goes 1/3 of the way deep into the annulus - with disc degeneration, typically don't feel pain until it reaches the outer layers of the disc

Question 30

what are the joints of Luschka?

Answer 30

- synaovial jts that glide w c-spine movement - enclosed in a capsule that blends w the disc - can get stress concentrations here (with degeneration, osteophytes can cause nerve root impingement)

Question 31

what muscles are part of the spinotransverse group at the c-spine?

Answer 31

- multifidus | - semispinalis cervicis and capitis

Question 32

what is important about the spinotransverse muscles (especially the multifidus)?

Answer 32

they stabilize the c-spine

Question 33

what movements do the suboccipitals do?

Answer 33

- B/L: extend the upper c-spine | - Uni: ipsi rotation and/or lateral flexion

Question 34

what does the longus colli do?

Answer 34

- B/L: straighten cervical curvature and flex neck - Uni: flexion and ipsi flexion of neck - Plays a role in static positioning

Question 35

what are the attachments of the scalenes?

Answer 35

- ant: C3-C6 to rib 1 - middle: C2-C7 to rib 1 - post: C4-C6 to rib 2

Question 36

cervical flexion ROM

Answer 36

80-90 deg

Question 37

cervical extension ROM

Answer 37

70 deg

Question 38

cervical lateral flexion ROM

Answer 38

20-45 deg

Question 39

cervical rotation ROM

Answer 39

70-90 deg