Cervical Spine Flashcards
Cervical Spine Regions
Upper Cervical: Occiput, C1, C2
Midcervical: C2-C7
Cervicothoracic: C7-T3ish
Upper Cervical Articulations
Occiput-C1: facet (Convex) surfaces of occiput articulate with atlas (Concave) (C1)
C1-C2: Dens of C2 articulated with anterior arch of C1. Also articulation with facet joints of C1 and C2.
Occiput-C1 Motion
Shake head Yes
Flexion and Extension
C1-C2 Motion
Rotate head No
Rotation
What four ligaments keep the upper cervical stable?
- Anterior Atlanto-Occipital membrane
- Posterior Atlanto-Occipital membrane
- Alar ligaments
- Transverse ligament
What vertebrae does not have a spinous process?
C1
Mid Cervical Articulations
- Vertebral bodies with intervertebral discs
- Uncovertebral joints: uncinate process articulates with the inferior body of the vertebra above; help guide motion, not much movement occurs here
- Facet joints: formed by the inferior articulate facet of the vertebrae above and the superior articulate facet of the vertebrae below; 45 degree angle; F/E/R/SB
- Articular pillar: line of consecutive facet joints of the cervical spine (between the line of the mastoid and the occipital protuberance
Makeup - Intervertebral Disc
- End Plate (Superior bony layer of the body and cartilaginous layer of the disc; blends with the annulus fibrosis)
- Annulus fibrosis (Annular layers of collagen); Different orientations of collagen allow for multiple directions of force.
- Nucleus pulposus (Gelatinous inner structure); Exerts force in all directions on the nucleus pulposus
Intervertebral Disc
- Allos for compressive, tension and rotational motion
- Largest avascular structure in the body
- Nutrients come from loading and unloading of vertebral end plate
- Motions allowed: F/E/R/SB
Mid Cervical Facet Joints
- Oriented at 45 degrees between the frontal and horizontal plane
- Freedom of movement in all 3 planes
- During motion, facets slide on each other
What ligaments provide stability around the mid cervical spine?
- Disc
- Anterior longitudional ligament
- Posterior longitudional ligament
- Ligament nuchae
- Interspinous and intertransverse ligaments
- Ligamentum flavum
- Facet joint capsule
What makes the cervicothoracic different?
- As the spine transitions from cervical to thoracic the angle changes from 45 to 60 degrees. Thus, moving inferior moving the facest to transition into more frontal plane alignment.
- Less movement due to attachments to the ribs
Posterior Upper Cervical Musculature - Why are they important?
- Suboccipital muscles (Palpate along the based of the occiput)
- People often develop cervicogenic headaches due to these muscles
- Involved in Flexion, Extension, Rotation, Side bending
Posterior Cervical Musculature
Superficial: Upper trapezius and SCM
Deep: Erector Spinae muscles
Antero-Lateral Cervical Musculature
- SCM
- Scalenes
- Longus colli
- Longus capitus
- Suprahyoid
- Infrahyoid
- Suboccipitals (Rectus Capitus anterior and lateralis)
Central Foramen- What passes through it?
Spinal Cord (Red arrow pointing to location)
What passes through the intervertebral foramen?
- Spinal nerve root of the body BELOW passes through
- Ex: C4-C5 = C5 nerve root passing through
- Ex: C7-T1 = C8 nerve root
How many cervical nerves are there?
8
What are the primary arteries of the cervical region and where do they ascend?
Vertebral A.
- Ascend through the transverse process of C1-C6
- Takes a 90 degree turn posteriorly after C1 and forms Basilar A
Common Carotid
- Adcends anterior to the transverse process of C-spine
- Bifurcates to internal and external carotid at C4
What cervical artery is most likely to be damaged and why?
- Vertebral A.
- Most at risk as it runs through the TP of C1-C6 so if the vertebrae are damaged so is the artery.
What are the 3 Primary Veins of the Cervical Region
- External Jugular
- Internal Jugular
- Anterior Jugular
Cervical Sagittal Plane of Motion:
Flexion/Extension
Occiput on C1: Condyles slide and glide on C1
C1-C2: little motion
C2-T3: R and L inferior articular facet slides on superior articular facet
- Flexion: Facets “open” on both R and L side
- Extension: Facets “close” on both R and L side
Norms for Flexion and Extension cervical spine
Flexion: 45-60 degrees
Extension: 70-90 degrees
Cervical Horizontal/Transverse Plane Motion
Rotation
Occiput-C1: little motion
C1-C2: 50% of motion occurs here. C1 rotates around the dens. Facets slide on each other
C2-T3: other 50% of motion occurs here
- Inferior articular facets slide on superior articular facets
- Rotate R: facets on the Right “close” and on left “open”
- Rotate L: facets on the left “close” and on the right “open”
Cervical Frontal Plane Motion
Sidebending
Occiput-C1: little motion
C1-C2: “coupled motion” in OPPOSITE DIRECTION
- Mid Cervical SBR: C1-C2 rotates left
- Mid Cervical SBL: C1-C2 rotates right
C2-T3: majority of motion
- Inferior articular facets slides on superior articular facet
- SB R: facets on the right “close” and on left “open”
- SB L: factes on the left “close” and on the right “open”
How does coupling motion occur in the cervical spine during sidebending?
C2-C7:
- Due to the 45 degree inclination of the facets mechanical coupling exists in the frontal and horizontal planes. AKA cervical rotation and side bending occur simultaneously
- “ipsilateral coupling”: side bending of mid cervical spine to R occurs with rotation to the R
C1-C2:
- Due to the passive tension on the alar ligaments, during side bending of cervical spine, a contralateral rotation occurs at C1-C2
- “Contralateral coupling”: side bending of mid cervical to the R occurs with rotation of upper cervical to the L
