Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Orthopedics > Cervical Spine > Flashcards

Cervical Spine Flashcards

1
Q

How and when does a person develop their cervical curve?

A

It develops a lordotic curve secondary to upright posture, which begins when a child lifts head at 3-4 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the benefit of having a lordotic curve?

A

It allows for the head and eyes to be oriented forwards. It also provides a shock absorption mechanism to counteract axial compression produced from the weight of the head.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is so special about the Atlanto-axial join C0-C1?

A

This part of the cervical spine possesses no disk and has contra lateral coupling.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is different from the lower cervical vertebrae C2-C7?

A

There are disks segments and they work as an ipsilateral coupling mechanism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the craniovertebral junction?

A

A collective term that refers to the occiput, atlas, axis, and supporting ligaments.
It accounts for approx. 25% of vertical height of total cervical spine.
Injuries to this region may involve the brain, brain stem, and spinal court.
Symptoms range from headache and vertigo to cognitive and sympathetic system dysfunction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Atypical cervical vertebrae (C1-C2-C7)

C1

A

Functions to support head
It has no body, pedicle, lamina, or spinous process
It has an anterior arch (anterior tubercle serves to attach anterior longitudinal ligament)
Posterior arch which marks nearly half of the circumference of the Atlantal ring with the posterior tubercle to mark midline.
It has CONCAVE superior articulate facet facing cranially to accept the convex occipital condyles.
It has inferior articulating facets facing 20 horizontal from midline.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

C2 atypical cervical vertebrae

A

Large and tall body that serves as the base for the dens (odontoid process).
Dens provides a rigid vertical axis of rotation for the atlas and head.
FIRST SPINOUS PROCESS THAT ONE CAN PALPATE AT MIDLINE.
Superior articulating processes project laterally from the body. They are slightly convex and oriented 20 degrees from horizontal plane.
Inferior articulating process projects anterior and inferior.
It has a Bifid and broad spinous process that serves for attachment for many muscles.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Cervical vertebrae characteristics

A

Predominantly trabecular bone

It has a transverse foramen FOR VERTEBRAL ARTERY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Typical cervical vertebrae C3-C6

A

Lower cervical spine
Have small rectangular bodies
Wider from the side than from the back
Superior surface are concave with uncinate processes.
Inferior surface is also concave anterior to posterior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Typical vertebrae

A

Spinous process are short and some Bifid
Transverse process are short lateral extensions that terminate as anterior and posterior tubercles(serves as attachments for muscles)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Typical vertebrae

A

Consecutive superior and inferior articulating processes form a continuous articulate pillar.
Facets are smooth and flat oriented midway between the frontal and horizontal planes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Intervertebral foramen

A

Between all vertebrae except the upper cervical spine
4-5mm long and 8-9mm high
Extends obliquely anterior-inferior from the spinal canal at an angle of 45 degrees in the coronal plane
Boundaries:
Anterior: IVD and both vertebrae
Posterior: ZAJ
Superior/inferior: pedicles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Intervertebral foramen

A

Entry and exit for the neuromuscular system to and from the vertebral canal

This region is VULNERABLE TO NARROWING with certain motions, or with osteophyte growth (they might even compress the nerve root and cervical cord posteriorly).
Motions to reduce intervertebral foramen: full extension and ipsilateral side bending.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Intervertebral disk

A

5 disks total
They are named from the vertebrae above: c4-c5 joint=c4 disk.
IVD height to vertebral height =2:5
Anterior margin of the IVD is attached to the anterior longitudinal ligament.
Nucleus pulposus sits in, or near, the center of the dis lying slightly more posteriorly.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Cervical spine vs. lumbar intervertebral discs

A

Anteriorly, the cervical annulus fibrous consists of interwoven alar fibers. No region of the AF exhibits alternating orientations with secessive lamellae.
Posteriorly, the AF lacks oblique fibers and consists exclusively of vertical oriented fibers.
Cervical AF has the structure of a dense anterior interosseous ligament, with few fibers containing the NP posteriorly.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Cervical vs. lumbar intervertebral discs.

A

Posterior Laterally, the NP is contained by the alar fibers of the posterior longitudinal ligament.
Absence of an AF over the uncovertebral region.
Collagen fibers are torn during the 1st 7-15 years of life leaving clefts that progressively extend across the back of the disc. (Enabling or resulting from rotatory movements).
Axial rotation of a typical revival vertebrae occurs around an oblique axis perpendicular to the facets.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Atlanta occipital joint

A

Anteriorly, the capsule of each joint blends with the anterior antlanto-occipital membrane.
Posteriorly, the capsule is covered by a thin, broad posterior Atlanto-occipital membrane.
THE VERTEBRAL ARTERY PIERCES THE POSTERIOR ATLANTO-OCCIPITAL MEMBRANE IN ORDER TO ENTER THE FORAMEN MAGNUM.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Atlantoaxial joint C1-C2

A

It is a pivot joint
It has 2 articulating components:
Medial joint: dens of the axis, Osseous-ligamentous ring of the atlas and transverse ligament…
Pair of laterally positioned apophyseal joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Atlantoaxial joint:

Medial joint

A

Two synovial cavities:

Smaller, anterior cavity between anterior Side of the dens and the posterior side of the anterior arch of the atlas.

Larger, posterior cavity separates the posterior side of the dens and a cartilage-lined section of the transverse ligament of the atlas.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Apophyseal joint of the atlantoaxial joint

A

Formed by the inferior articulating process of the atlas with the superior facets of the axis.
Articulating surfaces are generally flat but with cartilage convert to convex on convex and are oriented to the horizontal plane.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How many joints does the cervical spine consist of?

A

It consists of 37 joints which allow for more motion than any other region in the spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Anthology. Of the cervical spine

A

There are large excursions of motion at the cervical spine mainly due to the structure of the vertebrae and the orientation of the zygaaphophyseal joint (facet joints)

Small changes of the canal or foramen can result in significant compression of the spinal cord or spinal nerve.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Zygaaphophyseal joints of the cervical spine

A

14 total from occiput to thoracic vertebrae C1-C7
They are considered synovial joints covered with hyaline cartilage.
Superior facets face inferior posterior.
Inferior facets face inferior-anterior
C5-c6 have the greatest mobility
Greatest constrain & stability comes from ligaments no disc
vascular, fat filled, synovial intra-articulating inclusion may be present (pain generator)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Angles of the ZAJ of the cervical spine

A

Upper segments=35 degrees
Middle segments=45 degrees
Lower segments=65 degrees
ZAJ planes can be imaged as passing through the nose (angle)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Uncovertebral joints of cervical spine

A

Formed between the uncinate process and the inferolateral superior vertebrae.
10 saddle shape joints (2 per level)
C3-T1
Maintains a synovial compartment.
They are developed due to the loading of the head.
They start appearing at 12 and complete by 33 years of age.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Function of the uncovertebral joints

A

Guide flex and extension, reduce side bending of cervical spine, prevent posterior translation of neighboring vertebrae.
Helps reinforce the posterior lateral aspect of the disc!!!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Alar ligaments

A

Tough fibrous cord about 1cm in length
Passes laterally and slightly upwards from the apex of the dens to the medial sides of the occipital condyles.
It helps resist flexion, contra lateral side bending, and contra lateral atlanto-occipital rotation.
Resists anterior/posterior translation of the occiput on C1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Transverse portion of the cruciform ligaments ( transverse ligament of atlas)

A

Stretches on the medial aspect of the lateral masses of atlas.
Connects atlas with dens.
Composed almost entirely of collagen
Counteracts anterior translation of C1-C2 (atlas on axis).
Limits the amount of flexion of C1 on C2.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Anterior longitudinal ligament coverage

A

It is narrower in the upper cervical but is wider in the lower cervical than in the thoracic region. It is less developed in the cervical spine than the lumbar spine.
It travels from occiput to sacrum.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Posterior longitudinal ligament

A

Broader and thicker in cervical region than thoracic and lumbar regions.
C3-sacrum
Can cause neck pain with disc pathology. Predilection to irritation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Nuchal ligament bilaminar fibroblast of inter muscular septum that spans the entire cervical region.

A

Bilaminar fibroblast of inter muscular septum that spans the entire cervical region.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Segmental ligaments

A

Interspinous ligament and ligamentum flavum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Anterior suboccipital muscles

A

Rectus capitis anterior

Rectus capitis lateralis

34
Q

Posterior suboccipital muscles

A

Rectus capitis posterior major
Rectus capitis posterior minor
Obliques capitis inferior
Obliques capitis superior

35
Q

Anterior lateral craniocervical musculature

A 
Sternocleidomastoid
Scalenes: anterior, medius, posterior ( might cause brachial plexus impingement )
Longus coli
Longus capitis
Rectus capitis anterior
Rectus capitis lateralis
36
Q

Muscles of the posterior craniocervical region

A 
Splenius capitis & cervicis
Rectus capitis posterior major
Rectus capitis posterior minor
Obliques capitis superior and inferior
Trapezius
Levator scapulae
Sternocleidomastoid
37
Q

Sternpcleidomastoid function

A

Ipsilateral side bending and contra lateral rotation

Main flexor and extensor due to origin and insertion

38
Q

Global muscle of the neck

A 
Sternocleidomastoid
Semispanialis capitis
Splenius capitis
Capable of producing great amount of force
Work over two joints or several levels
39
Q

Stabilizer muscles of neck (local)

A 
Longus capitis & coli
Semispinalis cervicis
Multifidus
Located at a single segment
Series of deep muscles that have insertions or origins near each other 
Responsible for segmental stability
40
Q

Neurology of cervical spine

posterior Ramus of C1

A

Exits spinal canal by passing posterior between the posterior arch of atlas and rim of foramen magnum with vertebral artery. It then enters the suboccipital triangle.
Supplies most muscles of triangle
Usually NO cutaneous distribution.

41
Q

Posterior (dorsal) Ramus of C2 (occipital nerve)

A

Exits vertebral canal by passing through the slit between the posterior arch of the atlas and the lamina of the axis.
Supplies MOST of the aspect of the scalp. Runs from one external auditory meatus to the other.
Very large dorsal root ganglion that is located in a vulnerable location between posterior arch of C1 and lamina of C2 (specially with extension).
IMPLICATED AS PRIMARY NOCICEPTORS IN CERVICOGENIC HEADACHE.

42
Q

Nerve roots of cervical spine

A

Only region that has more nerve roots than vertebral levels. 8 nerve roots, 7 cervical vertebrae.
In general, structures of the upper three nerve roots can cause pain in neck and head while mid and lower cervical nerves can refer symptoms to the shoulder, anterior chest, upper limb and scapula

43
Q

Cervical proprioception

A

Considerable influence on posture through the tonic neck reflex and on eye movement and accommodation through the cervico-ocular and vestibulo-ocular reflexes.

44
Q

Medial branches of cervical posterior rami from C2-C8 and the recurrent meningeal nerve

A

ZAJ, anterior dural sac, posterior annulus fibrosus, posterior longitudinal ligament

45
Q

What nerve innervates the cervical disc?

A

Sinuvertebral nerve, formed by recurrent branches from the ventral Ramus containing sympathetic fibers. Can cause pain

46
Q

Mid cervical level nerve roots are Predisposed to more osteophytic compression.. Why?

A

Higher uncinate processes
Smaller anterior posterior diameter of the intervertebral foramina
Longer course of nerve root in close proximity to uncovertebral joint C4-C6.
Greatest mobility at c5-c6

47
Q

Cause for cervical nerve root compression

A

Lower cervical nerves are large in diameter and take up most of the foramina. These nerves are vulnerable to encroaching by osteophyte growth and certain motions (extension, ipsilateral side bending and rotation).
They are also in close proximity with ZAJ, and ligamentum flavum. ZAJ arthritis and ligamentum flavum hypertrophy may cause posterior impingement in nerves (sensory)

48
Q

Extradural vertebral artery

A

Supplies middle cervical segments by its radicular branches

49
Q

Common Carotid artery

A

Bifurcated at the middle of the cervical levels into the internal carotid and external carotid.

50
Q

Vertebral artery supplies…

A

Most of the upper cervical segments
It appears during 5-6 of intra-uterine development
It can be viewed from proximal, transverse, suboccipital, intracranial.

51
Q

Proximal portion of the vertical artery

A

Originates from posterior surface of subclavian artery but can also originate from aortic arch and common carotid artery.
Runs slightly medial posterior, lateral to the longus coli and medial to the anterior scalene to reach the transverse foramen of the cervical spine. At the level of c6
Compression of this artery is common (muscular, congenital, age related degeneration).

52
Q

Transverse section of vertebral artery.

A

From entry of the spinal column to the transverse foramen of C2.
Has muscle all around it. (Intertransverse muscles, scaleni, longus coli muscles )

53
Q

Suboccipital portion of vertebral artery

A

From exit at the axis to its point of penetration into the spinal canal.
THE VERTEBRAL ARTERY IS MOST VULNERABLE TO COMPRESSION AND TENSION AND C1-C2 LEVEL DUE TO THE AMOUNT OF CERVICAL ROTATION THAT CAN OCCUR AT THE ATLANTOAXIAL JOINT.

54
Q

Intracranial portion of vertebral artery

A

From penetration of the dura mater into the arachnoid space at the level of the foramen magnum. It forms the BASILAR artery by the midline Union of the two arteries at the lower border of the pons.
This portion of the artery is prone to the mechanical obstruction of the artery as well as atherosclerotic plaque or stenosis.
It goes from EXTRACRANIAL TO INTRACRANIAL!!
Decrease in number of elastic fibers in tunica adventitita and media increase the distortion with cervical extension and rotation.

55
Q

Cervical retraction

A

Upper cervical flexion and lower cervical extension

56
Q

Protraction

A

Upper cervical extension and lower cervical flexion

57
Q

Atlanto-occipital joint (flexion & extension)

A 
Osteokinematics:
Plane: Sagittal
Axis: medial-lateral
Range: 15-20 degrees
Arthrokinematics: 
convex occipital condyles roll posterior slide anterior (extension)relative to the concave facets of C1.

Convex occipital condyles roll anterior and slide posterior (flexion)relative to the concave facets of C1

58
Q

Atlantoaxial-occipital joint lateral flexion

A

Osteokinematics:
Plane: frontal
Axis: anterior-posterior
Range: 9 degrees to both sides

Arthrokinematics:
Convex occipital condyles roll ipsilateral and slide contra lateral on concave facets of C1. (Lateral flexion)

59
Q

Atlanto-axial joint (flexion and extension)

A

Osteokinematics:
Plane: Sagittal
Axis: medial-lateral
Range: 10 degrees

Arthrokinematics:
The ring-shaped atlas tilts forwards on the axis (flexion)
The ring- shaped atlas tilts backwards on the axis ( extension)

60
Q

Atlantoaxial joint (axial rotation)

A

Osteokinematics:
Plane: Horizontal
Axis: Vertical
Range: 32 degrees to either side

Arthrokinematics:
The convex inferior facet of the superior vertebral body (atlas) slides on a curved path across the convex superior facets of the axis (axial rotation)
Ipsilateral side slides posterior
Contra lateral side slides anterior

61
Q

Upper cervical coupling (motion)

A

Craniovertebral region (C0, C1,C2,C3 the ligamentous structures and musculature) a thought to exhibit a CONTRALATERAL COUPLING due to the influence of the alar ligament!!!!
Side bending of head to the right :
Translation of C1 to the right
Right rotation of C2 (creating a relative left rotation of the C1 vertebrae)
Right rotation of C2-3(ipsilateral )

62
Q

Clinical findings that might suggest a craniovertebral fracture

A

Painful neck muscle splitting
Neck and occipital numbness
Pain and stiffness in the neck, with a reluctance to move the neck
Presence or absence of neurological sign and symptoms

63
Q

Fracture of the axis (hangman fracture)

Need more info

A

Anterior dislocation of the c2 vertebral body

64
Q

Odontoid fractures RARE

A

Type 1: avulsion of the tip of the odontoid, transverse ligament is spared
Type 2: fracture of the neck of the odontoid (most common)
Type 3: fracture extends into body of C2

65
Q

C1 vertebral fracture (Jeffersons fracture)

A

Type 1: single arch fracture (not both. Either anterior or posterior)
Type 2: Burst fracture of both anterior and posterior arches.
Type 3: lateral mass fracture

66
Q

Canadian cervical spine rules

A 
High risk (require X-rays)
Age > 65
Dangerous MOI (car accident of 60 mph or greater or expelled from car)
Paresthesia in extremities
---------------------------------
Low risk factor that allows safe assessment of ROM?( do not require X-rays)
Simple rear-end
Sitting position in ER
ambulatory
delayed onset of neck pain
Absence of midline C-spine tenderness
----------------------------------------
If they are yes to above, then can they rotate to 45 degrees L and R (yes? Then no X-ray)
67
Q

Nexus low risk criteria (must meet all criteria to not have X-rays)

A 
No posterior midline cspine tenderness
No evidence of intoxication
Normal alertness
No focal neurological deficits
No painful distracting injuries
68
Q

Cervical disk pathology

A

Pain can result from strain or tears of the anterior anulus fibrosis (mainly in hyperextension trauma), strain of the posterior longitudinal ligament such as being stretched by a bulging disc.

Anterior/posterior diameter of the cervical spinal canal tends to be narrower in patients with herniation a resulting in myelopathy.

69
Q

Cervical radiculopathy

A

A disorder of the cervical spinal nerve root and is most commonly caused by a cervical disc herniation or other space occupying lesion.

70
Q

Cervical disc prolapse

A 
Not the same as a lumbar disc herniation
Extremely Rare under age of 30
Peak Incidence between 45-54
Slightly less in 35-44 years
MEAN AGE 50 YEARS
May be more painful due to repetitive microtrauma, degenerative cascade, macrotrauma
71
Q

Cervical disc pathology

A

Most common cervical involvement:
C7(60%)->C6(25%)->c4-c5
Disc degeneration is believed to play a more important role than trauma in cervical disc herniation
Neurological deficits corresponding to the offending disc level in 80% of patients

72
Q

What is the presentation of a cervical disc pathology ?

A

Patients complain of neck pain before they complain of arm pain.
Pain is often insidious and can range from dull to severe burning
No comfortable position often
Spurling maneuver often aggravates patient (ext, rotation of side of pain)

73
Q

Diagnosis for cervical radiculopathy

A

Less than 60 degrees of cervical rotation towards involved side
+upper limb tension test (median nerve)
+ cervical distraction test (reduction of pain)
+ spurling compression test

3 or more will give you a moderate prediction that it is cervical radiculopathy

74
Q

Short term outcomes with cervical radiculopathy

A

Moderate shift in probability that patients with cervical radiculopathy who have 3 or more predictors will have a meaningful change in neck disability (improvement):

Less than 54 in age
Dominant arm not affected
Symptoms do not ^^^ with cervical flexion
Received multimodal treatment more than or equal to 50% of time
Received deep cervical neck flexor strengthening

75
Q

Predictor variables for cervical traction for neck pain w or wo arm pain. (5)

A 
Age >55
\+shoulder abduction test
\+upper limb tension test
Symptoms peripheralize with central posterior-anterior motion segment testing c4-c7
\+ neck distraction test.
at least 3 for large change in symptoms
76
Q

Surgical intervention for cervical disc pathology

A

When patient has significant extremity or myotonia like weakness, progressive neurological deficits, severe unremitting pain, or pain that continues beyond arbitrary conservative intervention treatment of 8-12 weeks.

77
Q

Cervical spondylosis

A

Chronic degenerative condition affecting the contents of the spinal canal (spinal cord or nerve roots) and the cervical vertebral bodies and IVD.
Degenerative joint disease
Degenerative disc disease
MOST COMMON CAUSE OF PROGRESSIVE SPINL CORD AND NERVE ROOT COMPRESSION.
Seen in 30 y/o but mainly in 60 y/o (90%)
Most common in c5-c6 and c6-c7

78
Q

Stages of cervical spondylosis (kirkaldy- Willis stages)

A

Dysfunctional: pt. complains of gradual onset of neck and arm symptoms (radicular) or both, that have increase in severity and frequency!!
Unstable: pain is worse when the patient is in certain positions, and can interfere with sleep. Morning stiffness of the neck, which gradually improves throughout the day is common finding.
Stabilization:
Lateral nerve root entrapment becomes More common. In some, the spinal cord or anterior vessels may be compressed result in in cervical myelopathy or vertebrobasilar insufficiency. The blood supply (radicular arteries of Dural sleeve) and the spinal cord and spinal canal are major factors.

79
Q

Clinical presentation of cervical spondylosis

A

Reduced Sagittal motion, with decrease in side bending in early stages
As it progresses, capsular pattern presents:
Extension>symmetrical rotation and side bending > flex
Cervical myelopathy may also be present and considered most serious consequence.

80
Q

Zyggapophyseal joint dysfunction

A

Entrapment of the meniscoid (synovial membrane) tissue by the zygapophyseal joint
Characterized by:
Onset of unilateral neck pain, “neck locking” following sudden backwards bending, side bending, or rotation of the neck, or pain that followed a sustained head position.
Clinical presentation:
Palpating just lateral o the midline indicates soft tissue changes
3-D testing is often most painful
Imaging is usually unremarkable.

81
Q

Predictor variables for thoracic Manipulation for mechanical neck pain (6)

A

Symptoms

Orthopedics (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions