Cervical Spine

Question 1

Vertebral segment

Answer 1

Two adjacent vertebrae with their associated intervertebral disk, arthrodial, ligamentous, muscular, vascular, lymphatic and neural elements

Question 2

Naming vertebral segments

Answer 2

Convention – named for superior vertebra in pair

Question 3

Vertebral joint

Answer 3

inferior facets of superior vertebra on superior facets of inferior vertebra

Question 4

reference point for motion of a vertebral segment

Answer 4

superior anterior aspect of superior vertebra

Question 5

The cervical vertebrae

Answer 5

7 Cervical Vertebrae

2 atypical: Atlas (C1) – no body; Axis (C2) – odontoid process (the dens)

4 typical C3-C6

-Uncovertebral joints present

1 semi-atypical: C7 –Cervical and thoracic mechanics, Vertebrae Prominens

Question 6

cervical spine biomechanics

Answer 6

Fryette’s first 2 laws do NOT apply to the cervical spine

Guided by unique anatomy

Fryette’s 3rd law Motion in one plane will affect motion in all planes This is because of tensegrity and that doesn’t change

Question 7

C spine rules: OA

Answer 7

Sidebends and rotates to OPPOSITE sides (i.e. OA F SLRR)

Question 8

C spine rules: AA

Answer 8

Only significant motion (for dysfunction) is ROTATION (i.e. AA RL)

Question 9

C spine rules: typical cervical joints (C2-C7)

Answer 9

Sidebend and rotate to SAME side (i.e. C3 E RSL)

Question 10

Anterior “column” of c spine

Answer 10

Functions: weight bearing, shock absorption, flexibility Example structures: Vertebral body, lognitudinal ligaments, IV discs

Question 11

Posterior “elements” of c spine

Answer 11

Functions: protect the neural elements, act as fulcrum for motion, guide movement of the spine as a functional unit Example structures: osseous canal, zygopophyseal joints, erector spinae muscles

Question 12

Atlas (C1)

Answer 12

1. No vertebral body 2. No true spinous process. Instead, it has a “posterior tubercle”. 3. Articulates in a “third” joint with the odontoid[1] process of the axis. 4. Prominent, palpable transverse processes. 5. There is no disc between the occiput and atlas (C1).

Question 13

OA joint

Answer 13

Occipital condyles articulating with the superior facets of the atlas (C1)

Condyles are convex and fit into the concave facets of C1 like a cup in a saucer

Allows for the nodding action of the head (flexion and extension)

Designed for both weight bearing and mobility

Question 14

OA joint motions

Answer 14

Major Motions Flexion/Extension Motion at both condyles in the same direction

Minor Motions Side-bending & Rotation Always in OPPOSITE directions

Always occurs in relative flexion or extension Ex. OA F RRSL; OA F RLSR

Motions that typically are the source of the somatic dysfunction

One condyle will create a pivot point

Question 15

Axis

Answer 15

1. It has the odontoid process. 2. There is no disc between the atlas (C1) and the axis (C2).

Question 16

Atlantoaxial joint- discuss connection to the skull

Answer 16

The superior crus of the transverse ligaments attaches from the odontoid to the anterior rim of the foramen magnum

Question 17

Motions of the atlanto-axial joint

Answer 17

Major Motion – Rotation Accounts for 50% of rotation of the cervical spine Minor motions are flex/ext and sidebending Typically not the planes of motion where the dysfunction is found so not commonly diagnosed or documented Ex. C1 RR or AA RR

Question 18

ligaments of the AA joint

Answer 18

Alar Ligament- Attaches dens to occipital condyles

Cruciform Ligament

Transverse ligament with superior and inferior crus- Attaches C1 to C2

Question 19

typical cervical vertebrae characteristics

Answer 19

Uncinate processes form the uncovertebral joints

Saddle-shaped vertebrae

Short transverse processes that are modified to contain a transverse foramen (Allows passage of the vertebral artery)

Large vertebral foramen

Facets oriented in the coronal plane

Short bifid spinous processes

Question 20

Motion of the typical cervical joints

Answer 20

Dictated by the zygophophyseal joints - Intervertebral facet joint - On a 45⁰ angle toward the eye - Synovial joint Rotation and Sidebending are always coupled motions Ex. C3 FRSL, C7 ERSR

Question 21

Uncovertebral Joints– aka Joints of Luschka

Answer 21

Uncinate processes –Lateral margins for C3-C7 Exist due to lack of full intervertebral disc coverage between the bodies Limits side-slipping during flexion/extension –Act as guiderails –Helps to prevent herniation in the cervical spine

Question 22

Gross motion of the cervical spine

Answer 22

Flexion 90⁰ Limited by the posterior longitudinal ligament

Extension 70⁰ Limited by direct contact of vertebral lamina, zygapophyseal joints (facets), spinous processes

Side-bending

Rotation 50% of rotation in AA joint 50% rest of the cervical spine

Question 23

Anterior longitudinal ligament

Answer 23

Anterior aspect of the vertebral bodies from the occiput to the sacrum

Superiorly becomes the anterior occipito-atlantal ligament

Connects the foramen magnum to the anterior arch of the atlas

Question 24

Posterior longitudinal ligament

Answer 24

Posterior aspect of the vertebral bodies from the occiput to the coccyx

Extends to become the tectorial membrane

Question 25

Ligamentum flavum

Answer 25

Posterior of the spinal cord overlying the vertebra Extends superiorly to become the posterior atlanto-occipital membrane Connects the foramen magnum to the posterior arch of the atlas

Question 26

Nuchal ligament

Answer 26

–Connects the posterior aspects of the cervical vertebrae to the occiput –Broad and thick, providing a broad area of attachment for cervical muscles –Limits flexion

Question 27

three ligaments of the cervical spine that we don't go into any extra detail on

Answer 27

Interspinal ligament Intertransverse ligament Supraspinal ligament

Question 28

cervical fascia

Answer 28

Investing fascia Infrahyoid fascia Pre-tracheal fascia Buccopharyngeal fascia Alar fascia Pre-vertebral fascia – includes Sibson’s Carotid sheath

Question 29

what do anterior strap muscles do?

Answer 29

coordinate the hyoid bone to assist in stages of swallowing

Question 30

Prevertebral musculature

Answer 30

Rectus capitis lateralis Rectus capitis anterior Longus Capitis Longus Coli - All are primary flexors of the neck - The rectus muscles also add slight sidebending

Question 31

Posterior deep musculature

Answer 31

muscles of the sub-occipital triangle and short restrictors of the spine

Question 32

Posterior musculature of the neck

Answer 32

Erector Spinae - Iliocostalis - Longissimus cervicis and capitis - Spinales cervicis Extensors and the longissimus induce some sidebending Semispinalis Splenius Cervicis and capitis

Question 33

Lateral neck musculature

Answer 33

Anterior, Middle and Posterior Scalene When contracting b/l they raise ribs 1 and 2 in order to assist in respiration (During respiratory insufficiency or distress) Act u/l to sidebend the neck towards that side Levator Scapulae B/l contraction causes the medial upper borders of the scapula to rise and the cervical spine to extend

Question 34

Superficial muscles

Answer 34

SCM - Extends from the mastoid process of the temporal bone to the clavicle and sternum via two separate attachments - Sidebends and rotates head in opposite directions with u/l contraction - Flexes the head when bilaterally contracted Trapezius - Extends from the occiput to the spine of T12 - Attaches to every spinous process and to the shoulder as well - Stabilizes the shoulder girdle and elevates the scapula - U/l contraction causes extension of the head with sidebending to the same side and rotation away

Question 35

Sympathetic innervation to the head and neck

Answer 35

Superior cervical ganglia: Anterior to C1-2 Sympathetics to the eye, nose and throat Middle cervical ganglia: Anterior to C6 Sympathetics to the cardiac plexus Inferior (stellate) ganglia: Anterior to C7 May fuse with T1

Question 36

parasympathetic innervation to most of the body

Answer 36

Vagus nerve (CN X) Affected by OA and C1 somatic dysfunction

Question 37

Phrenic nerve

Answer 37

Phrenic Nerve From cervical plexus (3, 4, and 5) Exits neck between clavicular and sternal heads of SCM

Question 38

Greater occipital nerve

Answer 38

Greater Occipital Nerve From C2 Can cause tension HA due to course through descending traps C3 may also contribute through lesser occipital nerve

Question 39

clinical correlation: torticollis

Answer 39

The head is side-bent towards and rotated away from the affected side Often spontaneous and idiopathic in children Unilateral sternocleidomastoid contracture is the most common cause

Question 40

Injury to the dens

Answer 40

People at risk: Down syndrome - May have congenital absence of stabilizing ligaments (cruciform, alar) - Must obtain Xrays before participating in Special Olympics Rheumatoid arthritis - May have damage at the joint space Dens Fx - May result in avascular necrosis - Concomitant cruciate ligament rupture - Death or quadriplegia

Question 41

Whiplash

Answer 41

Damage to the anterior and posterior longitudinal ligaments - From hyperextension/hyperflexion Most commons: - Rear-end collisions - Front-seat passengers - 2x more likely in women - In tall/slender people The use of seatbelts slightly increases the incidence

Question 42

Hiccups

Answer 42

Can be caused by imbalance of the phrenic nerve Can be treated by balancing the anterior fascia of the neck = the best party trick!

Question 43

Neurologic injuries: erb's palsy, klumpke's palsy, winged scapula

Answer 43

Erb’s palsy (C5/C6) Waiter’s tip Klumpke’s palsy (C8/T1) Claw Hand Winged scapula Long thoracic nerve (C5/C6/C7)

Question 44

C5 neuologic level

Answer 44

Question 45

C6 neurologic level

Answer 45

Question 46

C7

Answer 46

Question 47

C8 neuological level

Answer 47

Question 48

The three rules of the C-Spine

Answer 48

•OA –Sidebends and rotates to OPPOSITE sides (i.e. OA F SLRR) •AA –Only significant motion (for dysfunction) is ROTATION (i.e. AA RL) •Typical cervical joints (C2-C7) –Sidebend and rotate to SAME side (i.e. C3 E RSL)