Cervical Spine Flashcards
In the cervical spine, _______ has been sacrificed for ______.
Stability has been sacrificed for mobility.
The cervical spine is divided into what two areas?
Cervicoencephalic (C0-2)
and
Cervicobrachial (C3-7)
Injuries to cervicocephalic
Often cause headache, fatigue, vertigo, poor concentration, increased SNS and irritability.
May involve brainstem, brain, spinal cord.
Atlas
C1
Axis
C2
Atlanto-occipital joints
C0-C1
Ellipsoid.
Principle motion: flexion/extension (15-20°)
Some side flexion (10°) hardly any rotation.
Vertebral body of C1
Doesn’t exist. Develops into odontoid process of C2.
Anterior Atlantic-occipital membrane
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.
Posterior Atlanto-occipital membrane
Replaces ligamentum flavum between atlas and occiput
Tectorial membrane
Broad band covering dens and its ligament
Within vertebral canal
Continuation of posterior longitudinal ligament
What ligament is the cervical continuation of the PLL?
Tectorial membrane
Which ligament is the cervical continuation of the ligamentum flavum?
Posterior Atlanto-occipital membrane.
Alar ligaments
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.
What movements are limited by alar ligaments?
Flexion and rotation
The most mobile articulation in the spine.
C1-C2
Atlanto-axial movements
Flex/extend 10°
Side flexion 5°
Rotation 50° (primary movement)
Atlanto-axial joints
2 facet joints (plane joints)
Centre pivot joint around odontoid process
Main supporting ligament of C1-C2.
Transverse ligament of the atlas
Transverse ligament of the atlas
Holds dens of axis against anterior arch of atlas.
Weakens in rheumatoid arthritis.
Cruciform ligament
Transverse ligament of atlas
Superior crus
Inferior crus
Cervical spine: resting position
Midway between flexion and extension
Cervical spine: close packed position
Full extension
Cervical spine: capsular pattern
Side flexion = rotation, then extension
Which major blood vessel travels through the TVPs of the Cspine?
Vertebral artery
Enters at C6 (sometimes as high as C4)
How many pairs of joints in the cervical spine?
Seven
How many cervical intervertebral discs?
Six. No disc between C0/C1 or C1/C2
How many cervical spinal nerves?
Eight.
Even though only 7 cervical segments (the nerves exit above segments).
MFR on acute torticollis?
No! (Spasm – don’t passively stretch – Swedish, contract release stretch).
Vertebral and internal carotid arteries are stressed mostly by what cervical movements?
Rotation
Extension
Traction
Vertebral blood flow can be diminished by as little as 20° of rotation and extension.
The greatest stresses on the vertebral artery are in what four places?
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.
Vertebral artery Sx
Vertigo Nausea Tinnitus "Drop attacks" Visual disturbances
Pain in cervicobrachial referred:
Into upper extremity
How many apology seal joints in C spine?
14.
Superior facets in cervical spine face:
Backwards
Up
Medial
Cervical facet angle facilitates what moves?
Flexion
Extension
(Prevents simple rotation or side flexion)
Cervical coupled movements
Rotation and side flexing.
At C0-C2 and between C7-T1 rotation and flexion contralateral
Rest of c-spine ipsilateral
Cervical: most flexion-extension
C5-C6
(Followed closely by C4-5 and C6-7)
–> most common location of degeneration.
Recurrent meningeal nerve
AKA sinuvertebral nerve
Innervates anterior dura, posterior annulus fibrosis, and PLL
Joints of Luschka
AKA uncinate joints
Costal or uncovertebral processes (inferior) to échancrure/notch (superior)
Limit side flexion
IVD make up how much of C-spine height?
25%
Cervical lordosis results from the shape of:
The intervertebral discs
Even minimal weight bearing by cervical facet joints can lead to
Spondylitic changes
Whiplash Grading
- No Sx
- No physical signs. Pain, stiffness, tenderness. Nothing neurological
- Neck symptoms, musculoskeletal signs. No neuro.
- Neck symptoms. Neurological signs. Sensory deficits. Neg X-ray.
- Neck symptoms. Fracture, dislocation, objective neuro signs, possible SC signs.
Normal lordotic curvature
30-40°
Facet joints are what type of joints?
Plane joints
Which vertebra has the largest TVPs?
C1
Which SPs can be bifid?
C3-5
What level is the hyoid?
C3
What level is the thyroid cartilage?
C4-5
What level is the first cricoid ring?
C6
To stretch anterior scalene, place the head and neck:
CL side flexion
IL rotation
