L4 Cervical Spine Flashcards
prevalance of cervical pain
25-70% experience pain at some point
30% chronic neck pain
increased mobility of cervical spine
characteristics of cervical vertebrae
small
large vertebral canal
short, bifid spinous process
each transverse process has a foramen for the vertebral artery, only C7 doesn’t
considerations of the vertebral artery
runs in the cervical vertabrae C6 and above
there is slack so head can move
supplies 15% blood to head
can be occluded and cause dizziness or fainting, especially in combined motion ext/rot/lat flexion
enters skull through foramen magnum
upper vs lower cervical
upper - C1-2, 50% rotation and head nod
lower - C3-C7, function as a unit
characteristics of C1
atlas
ring shape with no body or spinous process
2 large lateral masses for occipital condyles
anterior and posterior arches
large transverse process for muscle attachments
characteristics of C2
axis
vertical projection/dens from anterior portion of the body
dens articulates with the anterior arch of atlas and transverse ligament posteriorly
function of the alar and transverse ligaments
limit rotation of the head
function of the axis
axial motion
transmit combined load of head and atlas
What cervical joint does the most rotation?
AA, 50% rotation cervical
head and atlas move on the axis for rotation
What craniovertebral ligaments limit flexion?
posterior atlanto occpital membrane
posterior atlantoaxial ligament
nuchal ligament
function of cruciate ligament
hold dens in place
function of nuchal ligament
stabilize head and neck
function of posterior atlanto occipital ligament
support OA joint
posterior atlanto axial ligament
reinforce AA joint
limit flexion
dens fracture
40% of axis fractures are at the dens because the transverse ligament is stronger than the dens
if dens completely fractures the transverse ligament can go below it and cut it off from the body causing necrosis
rupture of transverse ligament
spinal cord compression - quadriplegia
if dens is fractured, there will be less compression because the spinal cord will push the dens forward to make more room
What joint are those with down syndrome at risk for instability at?
AA
10-20%
more in cervical flexion which puts more tension on the ligament
often asymptomatic
can fuse C1-2
precaution to avoid neck injury
characteristics of a typical cervical vertebrae
C3-6
uncinate processes preventing lateral flexion
small rectangular body
not as flat
short pedicle
thin lamina
ant/post tubercles on transverse processes
larger triangle shaped vertebral canal
how do cervical osteophytes form?
if disc deteriorates, more stress put on the uncovertebral joint and osteophytes can form
carotid tubercle
on C6
landmark for brachial plexus block
characteristics of C7
+possible bony abnormality
most prominent cervical vertebrae
large transverse processes, single pointed spinous process like thoracic
could accomodate cervical ribs impinging brachial plexus
function of the sub occipitals
extend, rotate head at AA
(capital extension)
sub occipital muscles
innervation and blood supply
innervation: post. ramus 1st cervical nerve
vascular: vertebral and occipital arteries
What can be found in the sub occipital triangle
vertebral artery
suboccipital nerve
rectus capitis posterior major
origin: C2 spinous process
insertion: occiput below inferior nuchal line
action: extend head, rotate
rectus capitis posterior minor
origin: C1 post tubercle
insertion: medial occiput below inferior nuchal line + dura mater (allow CSF flow)
action: extend head
obliquus capitis superior
origin: transverse process C1
insertion: occipital between superior/inferior line
action: extend/bend head
obliquus capitis inferior
origin: spinous process C2
insertion: transverse process C1
action: rotation
