Cervical spine

Question 1

name 3 distinguishing features of the cervical spine

Answer 1

1. has a triangular vertebrae foramen
2. has transverse foramen - passing of vertebral artery, veins and nerves, apart from C7
3. has a bifid spinous process

Question 2

Name the joints that are unique to the cervical spine

Answer 2

lateral atlanto axial joint
medial atlanto axial joint
atlanto-occipital joint

Question 3

lateral atlanto-axial joint

Answer 3

articulation between inferior facet of lateral masses of C1 (atlas) and superior facet of lateral masses of C2 (axis)
plane type synovial joint

Question 4

medial atlanto-axial joint

Answer 4

articulation between dens of C2 (odontoid process of axis) and anterior facet of C1 (atlas)
(dens in between articulating surface and transverse ligament running opposite)

Question 5

atlanto-occipital joint

Answer 5

between atlas (C1) and occipital (head)
superior facet (top) of the lateral masses (sides) of the atlas and occipital condyles (base of cranium)
synovial joint - flexion of head (e.g. nodding)

Question 6

Name the 2 cervical ligaments unique to the cervical spine

Answer 6

1. transverse ligament of the atlas (C1)

2. Nuchal ligament

Question 7

Transverse ligament

Answer 7

attaches from 1 lateral mass of the atlas to the other lateral mass of the atlas (C1)

Question 8

Nuchal ligament

Answer 8

A superior continuation of the supraspinous ligament, attaching to the tips of the spinous process, allowing attachment for rhomboid and trapezius muscles

Question 9

what is contained within the transverse foramina of which cervical vertebrae? How are they different in the other vertebrae?

Answer 9

vertebral artery, vein and sympathetic nerves
excluding C1 (atlas) and C7
C7: vertebral artery runs around the vertebral instead of within it, vertebral vein and sympathetic nerve still within foramina
C1 (atlas): vertebral artery runs along grooves for the artery (on lamina) instead of within the foramina

Question 10

where do the spinal nerve appear on the cervical vertebrae?

Answer 10

for C1-C7, above the associated cervical vertebrae through the intervertebral foramen
C8 between C7 and T1 (so appearing below C7 through intervertebral foramen - gap between 2 vertebrae)
there are 7 vertebrae, and 8 spinal nerves

Question 11

Jefferson fracture of the atlas

Answer 11

vertical fall on extended neck e.g. diving into shallow water
compress lateral mass of atlas (C1) between occipital condyles (articulating surface of head) with axis (C2)
causing the lateral masses to drive apart (superior and inferior), leading to fracture of the anterior / posterior arches (joining the lateral masses)

Question 12

Hyperextension injury (whiplash)

Answer 12

head whipped back to shoulders e.g. rear end car accident

minor: anterior longitudinal ligament of spine damaged (prevents hyperextension)
severe: cervical vertebrae fracture - sudden compression by rapid deceleration (after neck whipped backwards, suddenly stopped)

Question 13

what’s the worse case scenario for hyperextension injury?

Answer 13

dislocation (surfaces no longer articulating) / subluxation (surfaces still articulating) of cervical vertebrae
normally C12 moves anterior to C3, can involve spinal cord –> quadriplegia (paralysis of all 4 limbs) –> death can occur
more commonly, subluxation at C6/C7

Question 14

how come most cervical vertebrae injuries don’t involve the spinal cord?

Answer 14

the vertebrae foramen is large, so unlikely damage to spinal cord

Question 15

How many cervical spine vertebrae are there?

Answer 15

7
C1 - atlas
C2 - axis

Question 16

hangman’s fracture

Answer 16

fracture of pars interarticularis (isthmus - between superior & interior articulating facets) has low blood supply - easy fracture
fractured fragments / force involved can rupture the spinal cord –> deep unconsciousness, respiratory & cardiac failure –> death

Question 17

Fracture of the Dens

Answer 17

about 40% fractures of axis (C2)
area of low blood supply(isolation of distal fragment), so takes a long time to heal and can easily develop avascular necrosis
slight risk of spinal cord involvement