Cervical Spine

Question 1

In the cervical spine, _______ has been sacrificed for ______.

Answer 1

Stability has been sacrificed for mobility.

Question 2

The cervical spine is divided into what two areas?

Answer 2

Cervicoencephalic (C0-2)
and
Cervicobrachial (C3-7)

Question 3

Injuries to cervicocephalic

Answer 3

Often cause headache, fatigue, vertigo, poor concentration, increased SNS and irritability.

May involve brainstem, brain, spinal cord.

Question 4

Atlas

Answer 4

C1

Question 5

Axis

Answer 5

C2

Question 6

Atlanto-occipital joints

Answer 6

C0-C1
Ellipsoid.

Principle motion: flexion/extension (15-20°)

Some side flexion (10°) hardly any rotation.

Question 7

Vertebral body of C1

Answer 7

Doesn’t exist. Develops into odontoid process of C2.

Question 8

Anterior Atlantic-occipital membrane

Answer 8

The fibrous layer that extends from the anterior arch of the atlas to the anterior margin of the foramen magnum of the occipital bone.

Strengthened by anterior longitudinal ligament.

Question 9

Posterior Atlanto-occipital membrane

Answer 9

Replaces ligamentum flavum between atlas and occiput

Question 10

Tectorial membrane

Answer 10

Broad band covering dens and its ligament

Within vertebral canal

Continuation of posterior longitudinal ligament

Question 11

What ligament is the cervical continuation of the PLL?

Answer 11

Tectorial membrane

Question 12

Which ligament is the cervical continuation of the ligamentum flavum?

Answer 12

Posterior Atlanto-occipital membrane.

Question 13

Alar ligaments

Answer 13

Two strong cords found on each side of the upper dens

Pass upward and lateral to attach to medial sides of occipital condyles

Major role in stabilizing C1 and C2, especially in rotation.

Question 14

What movements are limited by alar ligaments?

Answer 14

Flexion and rotation

Question 15

The most mobile articulation in the spine.

Answer 15

C1-C2

Question 16

Atlanto-axial movements

Answer 16

Flex/extend 10°
Side flexion 5°
Rotation 50° (primary movement)

Question 17

Atlanto-axial joints

Answer 17

2 facet joints (plane joints)

Centre pivot joint around odontoid process

Question 18

Main supporting ligament of C1-C2.

Answer 18

Transverse ligament of the atlas

Question 19

Transverse ligament of the atlas

Answer 19

Holds dens of axis against anterior arch of atlas.

Weakens in rheumatoid arthritis.

Question 20

Cruciform ligament

Answer 20

Transverse ligament of atlas
Superior crus
Inferior crus

Question 21

Cervical spine: resting position

Answer 21

Midway between flexion and extension

Question 22

Cervical spine: close packed position

Answer 22

Full extension

Question 23

Cervical spine: capsular pattern

Answer 23

Side flexion = rotation, then extension

Question 24

Which major blood vessel travels through the TVPs of the Cspine?

Answer 24

Vertebral artery

Enters at C6 (sometimes as high as C4)

Question 25

How many pairs of joints in the cervical spine?

Answer 25

Seven

Question 26

How many cervical intervertebral discs?

Answer 26

Six. No disc between C0/C1 or C1/C2

Question 27

How many cervical spinal nerves?

Answer 27

Eight. Even though only 7 cervical segments (the nerves exit above segments).

Question 28

MFR on acute torticollis?

Answer 28

No! (Spasm -- don't passively stretch -- Swedish, contract release stretch).

Question 29

Vertebral and internal carotid arteries are stressed mostly by what cervical movements?

Answer 29

Rotation Extension Traction Vertebral blood flow can be diminished by as little as 20° of rotation and extension.

Question 30

The greatest stresses on the vertebral artery are in what four places?

Answer 30

Where it enters TVP at C6 Within bony canals of vertebral TVP Between C1 and C2 Between C1 and entry of arteries into the skull.

Question 31

Vertebral artery Sx

Answer 31

``` Vertigo Nausea Tinnitus "Drop attacks" Visual disturbances ```

Question 32

Pain in cervicobrachial referred:

Answer 32

Into upper extremity

Question 33

How many apology seal joints in C spine?

Answer 33

14.

Question 34

Superior facets in cervical spine face:

Answer 34

Backwards Up Medial

Question 35

Cervical facet angle facilitates what moves?

Answer 35

Flexion Extension (Prevents simple rotation or side flexion)

Question 36

Cervical coupled movements

Answer 36

Rotation and side flexing. At C0-C2 and between C7-T1 rotation and flexion contralateral Rest of c-spine ipsilateral

Question 37

Cervical: most flexion-extension

Answer 37

C5-C6 (Followed closely by C4-5 and C6-7) --> most common location of degeneration.

Question 38

Recurrent meningeal nerve

Answer 38

AKA sinuvertebral nerve Innervates anterior dura, posterior annulus fibrosis, and PLL

Question 39

Joints of Luschka

Answer 39

AKA uncinate joints Costal or uncovertebral processes (inferior) to échancrure/notch (superior) Limit side flexion

Question 40

IVD make up how much of C-spine height?

Answer 40

25%

Question 41

Cervical lordosis results from the shape of:

Answer 41

The intervertebral discs

Question 42

Even minimal weight bearing by cervical facet joints can lead to

Answer 42

Spondylitic changes

Question 43

Whiplash Grading

Answer 43

0. No Sx 1. No physical signs. Pain, stiffness, tenderness. Nothing neurological 2. Neck symptoms, musculoskeletal signs. No neuro. 3. Neck symptoms. Neurological signs. Sensory deficits. Neg X-ray. 4. Neck symptoms. Fracture, dislocation, objective neuro signs, possible SC signs.

Question 44

Normal lordotic curvature

Answer 44

30-40°

Question 45

Facet joints are what type of joints?

Answer 45

Plane joints

Question 46

Which vertebra has the largest TVPs?

Answer 46

C1

Question 47

Which SPs can be bifid?

Answer 47

C3-5

Question 48

What level is the hyoid?

Answer 48

C3

Question 49

What level is the thyroid cartilage?

Answer 49

C4-5

Question 50

What level is the first cricoid ring?

Answer 50

C6

Question 51

To stretch anterior scalene, place the head and neck:

Answer 51

CL side flexion | IL rotation