Cervical Vertebrae

Question 1

Name two ways in which cervical vertebrae can be divided

Answer 1

• upper cervical spine =axial (C0-2) /&lower cervical spine = subaxial (C3-7)
• atypical (atlas/ axis) & typical (C3-7)

Question 2

What is the name for C1?

Answer 2

atlas

Question 3

What are the key features of C1?

Answer 3

• no spinous process of body
• consists of 2 lateral masses connected by anterior and posterior arches
• large vertebral foramen

Question 4

What feature does the posterior arch have?

Answer 4

groove for vertebral artery and C1 spinal nerve

Question 5

What does each lateral mass have?

Answer 5

superior articular facet - articulates with occipital condyles
inferior articular facet - articulates with C2

Question 6

What fills the large vertebral foramen of C1?

Answer 6

(Steel’s rule of thirds)
1/3 dens
1/3 cord
1/3 space

Question 7

What are the key ligaments of the atlas?

Answer 7

cruciform ligament consisting of transverse ligament of atlas (holds odontoid process in place) and superior/ inferior longitudinal ligaments

Question 8

What is the name of C2?

Answer 8

axis

Question 9

What are the key features of C2?

Answer 9

• dens (odontoid process) - pivot around which head rotates

- bifid spinous process

Question 10

What is the name of the ligament which stretches from the dens to the margin of the foramen magnum?

Answer 10

alar ligament

Question 11

What joint is formed from the articulation of the dens with articular facet of C1? - what type of joint is this?

Answer 11

median atlanto-axial joint

=pivot type synovial joint

Question 12

What joint is formed from the articulation of the inferior facets of the lateral masses and superior facets of C2? - what type of joints are these?

Answer 12

lateral atlanto-axial joint

= plane type synovial joint

Question 13

What is the function of the atlanto-occipital joint? Where is it formed and what type of joint is it?

Answer 13

permits nodding

• formed from articulation of superior facets of the lateral masses with occipital condyles of the cranium
• condyloid type synovial joint

Question 14

Where is the nuchal ligament found and what is its role?

Answer 14

attaches to tips of spinous processes (continuation of supraspinous ligament)
- proximal attachment for rhomboids and trapezius

Question 15

Describe a typical vertebra

Answer 15

• anterior: body

- posterior: vertebral arch - spinous process, 2 transverse processes, 2 pedicles, 2 laminae & vertebral foramen

Question 16

What makes typical cervical vertebrae distinct?

Answer 16

• vertebral foramen - large & triangular
• spinous process - bifid
• transverse processes - contain vertebral arteries & plexus C3-6 but C7 contains vertebral vein & fat

Question 17

What structures are found at the vertebral level of C1 ?

Answer 17

• spinal root of accessory nerve crossing transverse process of atlas
• open mouth & dens

Question 18

What structures are found at the vertebral level of C2?

Answer 18

superior cervical ganglion

Question 19

What structures are found at the vertebral level of C3?

Answer 19

body of hyoid bone

Question 20

What structures are found at the vertebral level of C4?

Answer 20

• upper border of thyroid cartilage

- bifurcation of common carotid arteries

Question 21

What structures are found at the vertebral level of C6? (7 elements)

Answer 21

• cricoid cartilage
• larynx becomes trachea
• pharnyx becomes oesophagus
• middle cervical ganglion
• vertebral artery enters transverse foramen
• carotid tubercle of chassaignac
• inferior thyroid artery crosses thyroid & passes behind sympathetic chain

Question 22

What is significant about chassaignac’s tubercle?

Answer 22

the carotid artery can be massaged against it to relieve symptoms of SVT

Question 23

What structures are found at the vertebral level of C7?

Answer 23

vertebra prominens

inferior (stellate) cervical ganglion

Question 24

What is C0?

Answer 24

occiput

Question 25

What is found at each level of the spine?

Answer 25

tripod - disc at front and 2 facet joints at back with spinal canal beyerrn

Question 26

Where is the uncinate process found, what does it articulate with and what is its function?

Answer 26

found bilaterally on superolateral margin of C3-C7 bodies

• articulaes with inferolateral portion of verterbral bodies - forming uncovertebral joints (aka joints of Lushka)
• function: limit lateral flexion & maintain position of IV discs during axial rotation

Question 27

What is the jefferson fracture of atlas?

Answer 27

fracture caused by vertical fall on extended neck - leads to compression of lateral masses and fracture in arches
- can rupture the transverse ligament of atlas

Question 28

What is the effect of fracture of dens?

Answer 28

avascular necrosis

note this fracture can be caused by traffic collisions & falls

Question 29

What is Hangman’s fracture?

Answer 29

fracture to pars interarticularis - fragments likely to rupture spinal cord

Question 30

What are the effects of whiplash from minor to most severe?

Answer 30

minor: damage to anterior longitudinal ligament
severe: fractures of cervical vertebrae due to compression by sudden deceleration
worst: dislocation/ subluxation - most commonly at C6-7 - most likely to involve spinal cord leading to quadriplegia or death

Question 31

Describe primary ossification of vertebrae

Answer 31

• centrum (body) & 2 halves of arches form from mesoderm in utero by 14th week
  = fuse at age 6-8

Question 32

Describe secondary ossification of vertebrae

Answer 32

• epiphyseal ring apophyses
• ossification of the tips of spinous, transverse, articular and lumbar mamillary processes
  = fuse at age 25

Question 33

Describe horizontal growth of vertebrae

Answer 33

• occurs by periosteal ossification during 1st 7 years

- AP 5-10x, lateral 3-5x

Question 34

Describe vertical growth of vertebrae

Answer 34

• occurs by superior & inferior growth plates during 1st 5 years
• 2-4x height