Cervical and thoracic vertebrae Flashcards by Rebekah Agunede

How many cervical vertebrae?

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How many thoracic vertebrae?

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Size and movement cervical?

Smallest (VERY MOBILE)

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Movement thoracic?

Not very mobile (articulate with ribs)

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Typical cervical vertebrae numbers

C3-C6

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Typical cervical vertebrae structure

Same as lumbar spine (lamina, pedicle, articular processes, body and foramen)

BUT BIFID spinous process
Transverse Foramen (holes in transverse process)

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Function of transverse foramen

Vertebral artery, vein and sympathetic nerve plexus (C1-C6)

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What is different about transverse foramen of C7?

Transmits vertebral vein only

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Atypical vertebrae?

C1 (atlas)
C2 (axis)
C7

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Atypical C1 (Atlas) structure

No vertebral body (odontoid process makes)
No spinous process
Widest
Largest transverse process (not usually symptomatic if problem as lots of space)

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Arches on C1

Anterior arch - attachment for anterior longitudinal ligament
Posterior arch - attachment for ligamentum nuchae

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C1 masses?

Large Superior - to support head weight

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Atypical C2 vertebrae (Axis)

Odontoid process/Dens forms body of C1

Broadest spinous process (of cervical)

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What prevents horizontal displacement of Atlas?

Odontoid process and transverse ligament

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C1 ans C2 articulation

Pivot allows rotation

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Problem C1 and C2

Atlantoaxial instability (from ligament weakness)

C1 can move forward over C2 (separate movement and compress cord)

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C7 atypical vertabrae structural differences

Longest spinous process (Vertebrae Prominens)
NOT BIFID spinous process

Transverse process large, foramen is small (only transmits vertebral vein)

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Facet joints cervical

Superior articular facet: faces upward and backward
Inferior articular facet: faces down and forward

45° angle

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Cervical nerve roots

Exit more horizontally (than lumbar)

Nerve roots exit above vertebrae (until C7-T1)

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Nerve root vs vertebrae cervical

7 cervical vertebrae
8 spinal roots = C8 exits below C7
C1 does not exit via foramen `

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Ligaments of cervical

Same as lumbar 
Anterior to posterior:
Anterior LL
Posterior LL
Ligamentum Flavum
Interspinous 
Supraspinous

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Additional ligament cervical

Ligamentum nuchae (thickening of supraspinous ligament)

Ligamentum nuchae attach

Septa splits muscles

Attach:
External occipital bone
Spinous processes of all cervical vertebrae

Function of ligamentum nuchae (3)

Maintains secondary curvature of spine

Helps cervical spine support head (running)

Site of attachment for neck and trunk muscles (eg Trapezius and Rhomboids)

Movements of cervical spine

Multiplanar | flexion and rotation 80, extension 70, lateral flexion 40

Movements of cervical spine contributions

Atlanto-occiptal joint = 50% of flexion, extension and rotation of head Other 50% is rest of cervical spine (C2/3 --> C7/T1)

Thoracic vertebrae structure (3)

Heart shaped vertebral body Demi facets (T2-T8)/ Whole facets (T9-T10) to articulate with head of rib Vertebral foramen is small and circular

Problems with small foramen?

If problem with spinal canal, more likely to be symptomatic as suppressed spinal cord likely

Where does rib articulate with thoracic vertebrae (costal articulations)?

The head of rib with vertebral body | The neck of rib with transverse process/facets (except T11/T12)

Where does neurovascular bundle lie?

Within Costal groove on rib

Facet joint orientation thoracic vertebrae

Coronal (60 degrees) | permits rotation but LIMITS flexion

What is Cervical spondylosis?

Osteoarthritis | Age related changes

Cervical spondylosis triad

Loss of disc height (loss of water) Osteophytes Facet joint arthritis

Consequences of cervical spondylosis

Radiculopathy (osteophyte in foramen) | Myelopathy (osteophyte in vertebral canal)

Symptoms of cervical radiculopathy

Sensory: dermatome parathesia/numbness, pain Motor: myotome weakness

Cervical prolapsed intervertebral disc presentation

30-50 year olds No history of injury Wake up with stiff neck

Why does Cervical prolapsed intervertebral disc occur?

Tear of annulus fibrosis | Nucleus pulposus migrates through into spinal canal

Which nerve root affected in C5/C6 disc prolapse?

C6 Always the nerve root below usually (exiting nerve roots only in cervical spine) Pain in neck and dermatome areas Weakness in myotome Numbness/parathesia in dermatome

What happens if prolapse of C7/T1 disc?

C8 nerve root affected

Cervical myelopathy presentation

Older (50-80 year olds) | Compression usually as a result of spondylosis

Anatomy change in cervical myelopathy

Thickening ligamentum flavum Osteophyte (can lead to spinal cord signal change)

Cervical myelopathy symptoms

Progressive Clumsiness Loss of fine movements (buttoning shirt, writing) Loss of balance

C4 myelopathy problems?

Neck pain Motor weakness in all distant myotomes Numbness from shoulders distally (latter spinal cord is disrupted)

What is a Jefferson fracture?

Burst fracture C1 (fracture of anterior and posterior arch of Atlas) Usually caused by axial load (diving into shallow water and hitting head)

What is a Hangman's fracture?

Hyperextension of head on neck Forward displacement of C1 and C2 over C3 Fracture through pars interarticularis (joins facet joints)

Odontoid peg fracture

Hyperextension injury | Happens in elderly (slower reflexes do not put out hands to protect as they fall)

Visualising odontoid peg fracture

Open mouth AP x ray | CT scan?

Thoracic cord compression causes

Tumour or fracture | Most likely to give issues as vertebral foramen is narrowest

Thoracic cord compression at T10?

Lower thoracic pain Weakness of all muscles distally (in legs) Loss of sphincter control Numbness/paraesthesia below umbilicus

T5 compression?

Weakness legs and INTERCOSTALS Loss of sphincter control Numbess/paraesthesia distal from nipples

What is infection of spine called?

Spondylodiscitis

How does spondylodiscitis occur?

Bacteria enters spine via vertebral body nutrient artery Migrates to end plate Extends towards disc (not many cells to fight infection here so suitable environment)

What can spondylodiscitis lead do?

Abscess in epidural space | Vertebral osteomyelitis

Whiplash injury

Hyperextension then hyperflexion injury of cervical spine | head rotates back and then forward