Cervical spine anatomy

Question 1

What is C3-C7 (lower cervical spine) called

Answer 1

Cervicobrachial area

Question 2

What is the principal motion of Atlanto-occipital joint

Answer 2

(C0 to C1) flexion-extension (15-20 degree) or nodding of the head. Side flexion is approximately 10, where as rotation is NEGLIGIBLE

Question 3

What is the region of C0 to C2 called and what kind of injuries involved in this region

Answer 3

Cervicoencephalic or cervicocranial

Brain, brainstem and spinal cord

Question 4

what are the ligaments stabilize atlantooccipital joint

Answer 4

ant-post: anterior longitudinal ligament and tectorial membrane (covering dens and its ligaments) in the vertebral canal is a continuation of the posterior longitudinal ligament

Question 5

what motion alar ligaments limit

Answer 5

flexion and rotation and play a major role in stabilizing C1 and C2, especially in rotation

Question 6

what is the major movement for atlanto-axial joint

Answer 6

(C1-C2) Rotation which is approximately 50 degree (primary movement). Flexion -extension is 10, side flexion is 5.

Question 7

C1-C2 median joint is classified as:

Lateral atlanto-axial joints are classified as

Answer 7

median: Pivot (trochoidal) joint, synovial, diarthrotic, uniaxial/monoaxial
lateral: Plane joints (synovial, plane/gliding, diarthrotic, uniaxial)

Question 8

Main stabilizing ligament of atlanto-axial:

main supporting ligament of atlanto-axial:

Answer 8

Stabilizing: alar ligament

Supporting ligament: transverse ligament of the atlas

Question 9

what condition weakens or ruptures transverse ligament

Answer 9

rheumatoid arthritis

Question 10

transverse ligament is a part of

Answer 10

cruciform ligament of atlas

Question 11

what are two arteries supply blood to brain and %

Answer 11

vertebral artery (20%)
internal carotid artery (80%)

Question 12

4 places vertebral arteries are stressed

Answer 12

transverse process of C6 (where the artery enters)
within bony canals of the vertebral transverse processes
between C1 and C2
Between C1 and entry of the arteries into the skull

Question 13

most common mechanism for non-penetrating injury to the vertebral artery is

Answer 13

neck extension with or without side flexion or rotation

Question 14

common injuries in cervicobrachial area referred into

Answer 14

upper extremity, neck pain, arm pain, headaches, restricted range of motion (ROM), paresthesia, altered myotomes and dermatomes and radicular signs. (Cognitive dysfunction and cranial nerve dysfunction are not common)

Question 15

how many facet joints in the cervical spine

Answer 15

14 facet (apophyseal) joint from C1 to C7

Question 16

The superior facets of the cervical spine face
of transitional vertebra
of the Thoracic spine face
of Lumber spine face

Answer 16

Cervical: Upward, backward and medially (PMS) or (BUM)
Transitional vertebra (T1): face up and back
Thoracic (T2-T11): face up and back and slightly laterally (BUL)
Transitional vertebra (T11 and T12): face up back and medially
Lumber: medially, backwards (BM)

Question 17

coupled movement of Cervical spine

Answer 17

rotation and side flexion

Question 18

greatest flexion-extension of the facet joint in cervical spine

Answer 18

between C5 and C6, there is almost as much movement at C4 to C5, C6 to C7.

Question 19

uncinate joints AKA….where do you find

Answer 19

Joints of Luschka, C3 to T1 (inferior vertebrae - uncus, superior vertebrae - echancrure) will not appear until age 6-9.

Question 20

Intervertebral discs make up approximately what % fo the height of the cervical spine

Answer 20

25% (no disc between C0 to C1, C1 to C2)

Question 21

Cervical Spinous process are at the level of the facet joints of:
Thoracic:
Lumber:

Answer 21

Cervical : same
Thoracic: Rule of 3
Lumber: same

Question 22

Cervical Nerve root is named
Thoracic nerve root is named
Lumber nerve root is named

Answer 22

Cervical Nerve root is named above

Thoracic and Lumber nerve roots are named below.

Question 23

Most common affected by cervical disc herniation

Answer 23

C5-C6

Question 24

injury to the nerve roots

Answer 24

Cervical radiculopathy
acute: disc herniations
chronic type: spondylosis

Question 25

injury to the spinal cord itself

Answer 25

Cervical myelopathy

Question 26

Quebec severity classification of whiplash associated disorders

Answer 26

0: no neck symptoms, no physical signs
1: No physical sign, neck pain, stiffness or tenderness only, normal ROM, normal reflexes, dermatomes, and myotomes
2: Neck symptoms (pain, stiffness) and musculoskeletal signs (decreased ROM, point tenderness, soft tissue complaints)
3: Neck symptoms and neurological signs
4: Neck symptoms with fracture or dislocation and objective neurological signs, possible spinal cord signs

Question 27

what is a drop attack?

Answer 27

Falling with no provocation while remaining conscious

Question 28

facet/zygapophyseal joint (what type)

Intervertebral joint

Answer 28

Zygapophyseal joint ( synovial, plane/gliding, diarthrotic, apophyseal)
Intervertebral joint (symphysis type amphiarthrosis)

Question 29

Bakody’s sign

Answer 29

AKA: shoulder abduction (relief) test. C4-C5 pain and referred symptoms are decreased or relieved by placing the hand or arm of the affected side on top of the head

Question 30

upper crossed syndrome

Answer 30

show poking chin posture of the mm
weak: deep neck flexors, rhomboids, serratus anterior and lower trapezius
Tight: pect maj and minor, upper trap and lavator scapulae

Question 31

Spurlings test is indicative of….

Reverse Spurling’s sign is indicative of….

Answer 31

Cervical radiculitis (nerve root)
Reverse: muscle spasm, tension myalgia and WADs

Question 32

Bikele’s sign

Answer 32

seated patient abducts the arm to 90 degree with the elbow fully flexed. The arm is extended at the shoulder and then the elbow is extended. If radicular pain results the test is positive. Bikele’s sign. Modification of ULNT4 done actively

Question 33

Lhermitte sign

Answer 33

The patient is in the long leg sitting position on the examining table, passively examiner flexes the patient’s head and one hip simultaneously with the leg kept straight. Positive test occurs if there is a sharp, electric shock like pain down the spine and into the upper or lower limbs, indicates dural or meningeal irritation in the spine or possible cervical myelopathy.

Question 34

Soto-Hall test

Answer 34

If the patient actively flexes the head to the chest while in the supine lying position

Question 35

Romberg test

Answer 35

patient is standing and is asked to close the eyes. Position is held for 20-30 seconds. If the body begins to sway excessively or the patient loses balance, the test is positive for an upper motor neuron lesion