C & T Spine Flashcards
Defining features of the c-spine
- 2 projections on spinous process
- 2 projections of TV process
- TV foramen
- Small
Where are the lamina and pedicle
- Pedicle attached to body
- Lamina near the spine
Joints of the C-spine
- Atlanto-occipital
- 2 Lateral atlantoaxial
- Medial atlantoaxial
- Uncovertebral joint
- Facets
- Intervertebral joint
How the facets of the c-spine face
- Superior: post sup/med
- Inferior: ant inf lat
When looking sideways, ~45 degree orientation
Describe the special “Intervertebral joints” of the c-spine
- Uncinate joints
- The vertebral bodies superiorly have a raised lip
The uncovertebral joints serve to:
- Guide flex/ext
- Reduce side bending
Prevent post translation of neighbouring vertebrae - Reinforce the vertebral disk
Defining features of C1
- Atlas
- An anterior and posterior arch, connected by lateral masses
- Has a TV foramen
- Posterior side of superior articular facets have a grove for the vertebral artery
Defining features of C2
- The dens, which has the anterior articular facet
Describe the C0/1 joint
- Atlanto-occipital
- Between the superior articular facets of C1 and the occipital condyles of the skull
- Synovial joints
Has a fibroadipose meniscoid between the joints - Has translation/gliding like the knee and shoulder
- 50-60% flex/ext occurs here
Describe the C1/C2 joint
Lateral(s)
- At a slight angle allowing for lots of rotation
Medial
- Between dens and anterior arch of C1
- Pivot joint
Movement at the atlanto-axial joint
- 50-60% of total rotation of c-spine
- Limited amount of flex/ext and lateral bending
Movement of the c-spine below C2
- flex/ext, most at C4/5
- Lateral flexion, most between C2-5
- Axial rotation throughout
Anterior longitudinal lig (describe + attachments)
- Broad fibrous band
- Occipital bone to sacrum
- Most developed in lordotic areas
- Taut in ext.
Post. longitudinal ligament (describe, thickness)
- Posterior of vertebral bodies, anterior canal
- Narrow fibrous band
- Well developed in kyphotic regions
- Taut in flexion
The 3 ligaments of the spinous processes
Ant -> post
- Ligamenta flava (between lamina)
- Interspinous lig (between spinous processes)
- Supraspinous ligament (on top of spinous processes
Ligament between lamina
Ligamentum flava
Describe the ligament between TVP
- Intertransverse ligament
- Increase in size as you move inferiorly
- Blends with surrounding musculature
- Taut when bending away
Special ligament of the post. neck
Nuchal ligament
- A cervical extension of the supraspinous ligament
- Attached to EOP
- Limits flexion, also a point of attachment for muscles
Ligaments of C0-C2
- Alar ligaments
- TV ligament of atlas
- Tectorial membrane
- Posterior atlantooccipital membrane
- Apical ligament of dens
Alar ligaments
- Runs from lateral dens to occipital condyle
- About 1 cm long, about the width of a pencil
- Taut during front and side flexion, rotation
- Along with TV ligament of atlas, serves to prevent separation of C1/C2
TV ligament of atlas
- Along with alar ligaments, serves to prevent separation of C1/C2
Extension of post longitudinal lig
Tectorial membrane
Extension of ligamenta flava
posterior atlanto-occipital membrane
4 parts of the vertebral artery
- Proximal
- Transverse
- Suboccipital
- Intracranial
Proximal aspect of vertebral artery
- Runs vertically, and slightly medially/posteriorly to entry point
- Along it’s course, it lies between the longus colli and the anterior scalene
- Typically enters the TV foramen at C6, but this can vary from C3-7, and can vary side to side on an individual
Transverse aspect of the vertebral artery
- Runs through TV foramen
- Surrounded by periosteal sheath attached to canal boundaries
- At C2, the artery must run slightly laterally as the TV foramen of C1 is lateral to C2
Suboccipital aspect of the vertebral artery
- Once outside of C1 TVP, wraps around groove on superior facet, then runs ant/med/sup to enter foramen magnum
Intracranial
Now becomes the intercranial vertebral artery, then meets to form the singular basillar artery at the base of the medulla oblongata
Where the vertebral artery is susceptible to damage
- C1/2 due to amount of rotation, how it needs to wrap around sup. facet
- Extension
- Stenosis or narrowing, where a flap-like tear can develop in the arterial wall, leading to the formation of a hematoma
Where the head of the rib meets the body of spine
Costovertebral joint
Where the neck of the rib articulates with the spine
Costotransverse joint
Z-joints of the T-spine
- Increase in angle as you go down (45/60 at top - 90 at bottom)
- Superior facets of T-spine are directed posteriorly and slightly laterally, inferior is the opposite
Movement of the T-spine
- flexion/ext greater in lower t-spine due to coronal orientation in upper spine
- Lateral flexion and rotation limited due to rib cage
