Cervical and thoracic vertebrae Flashcards
How many cervical vertebrae?
7
How many thoracic vertebrae?
12
Size and movement cervical?
Smallest (VERY MOBILE)
Movement thoracic?
Not very mobile (articulate with ribs)
Typical cervical vertebrae numbers
C3-C6
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)
Function of transverse foramen
Vertebral artery, vein and sympathetic nerve plexus (C1-C6)
What is different about transverse foramen of C7?
Transmits vertebral vein only
Atypical vertebrae?
C1 (atlas)
C2 (axis)
C7
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)
Arches on C1
Anterior arch - attachment for anterior longitudinal ligament
Posterior arch - attachment for ligamentum nuchae
C1 masses?
Large Superior - to support head weight
Atypical C2 vertebrae (Axis)
Odontoid process/Dens forms body of C1
Broadest spinous process (of cervical)
What prevents horizontal displacement of Atlas?
Odontoid process and transverse ligament
C1 ans C2 articulation
Pivot allows rotation
Problem C1 and C2
Atlantoaxial instability (from ligament weakness)
C1 can move forward over C2 (separate movement and compress cord)
C7 atypical vertabrae structural differences
Longest spinous process (Vertebrae Prominens)
NOT BIFID spinous process
Transverse process large, foramen is small (only transmits vertebral vein)
Facet joints cervical
Superior articular facet: faces upward and backward
Inferior articular facet: faces down and forward
45° angle
Cervical nerve roots
Exit more horizontally (than lumbar)
Nerve roots exit above vertebrae (until C7-T1)
Nerve root vs vertebrae cervical
7 cervical vertebrae
8 spinal roots = C8 exits below C7
C1 does not exit via foramen `
Ligaments of cervical
Same as lumbar Anterior to posterior: Anterior LL Posterior LL Ligamentum Flavum Interspinous Supraspinous
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
