Lecture 1: Cervical Spine Functional Anatomy

Question 1

What are components of upper cervical spine?

Answer 1

occipito atlantal joint, atlanto axial joint

Question 2

What are primary motions of OA jt?

Answer 2

occipital condyles and C1 atlas

flexion and extension 25-30 degrees

SB 10 degrees

Question 3

What is arthrokinematics of OA jt?

Answer 3

flexion of head- occiput slides posterior

extension- occiput slides anterior

Question 4

What is primary motion of the AA joint?

Answer 4

rotation 45-60 degrees odontoid process of C2 acts as a pivot for rotation

Question 5

What is helpful radiographic view for AA joint?

Answer 5

odontoid view helpful to r/o fx

Question 6

What are two important ligaments in the upper cervical spine?

Answer 6

transverse ligament, alar ligament

Question 7

Where is the transverse ligament located?

Answer 7

between medial aspects of lateral masses of atlas

prevent anterior translation of c1 on c2

Question 8

What are two kinds of transverse ligament classification?

Answer 8

caused from trauma

type 1- disruption of the ligament without an osseous component
type 2- fracture or avulsion involving the tubercle for insertion of the ligament on the C1 lateral mass, without disruption of the substance of the ligament

Question 9

What are 3 types of causes of AA instability?

Answer 9

1. congenital- os odontoideum ( separation of dens from atlas)
2. arthritis- RA, psoriatic arthritis, Reiter syndrome, AS, SLE
3. acquired- trauma/fx, abcess, recurrent URI

Question 10

What is the Atlas Dens interval (ADI)?

Answer 10

is the horizontal distance between the anterior arch of the atlas and the dens of the axis,

should be no more than 2.5 mm

Question 11

What happens during anterior subluxation of C1 on C2?

Answer 11

spinal cord is compressed between the pannus anteriorly and posterior arch of atlas

common in pts with AS

Question 12

What are attachments of alar ligament?

Answer 12

connects odontoid process to occipital condyles

prevents excessive rotation and SB

Question 13

What are characteristics of vert of c2-t3?

Answer 13

contain articular pillar of facet joints, SC passes through vertebral arch

Question 14

What is midpoint of cervical lordosis?

Answer 14

c4-5 interspace

Question 15

What are the uncovertebral joints?

Answer 15

guide flexion and extension, limit SB, reinforce the intervertebral disc

Question 16

What are primary ligaments of cervical spine?

Answer 16

1. anterior longitudinal- taut in extension
2. posterior long.- taut in flexion
3. interspinous and supraspinous- taut in flexion
4. ligamentum flavum- continous with joint capsule

Question 17

What is mobile/functional unit of cervical spine?

Answer 17

2 adjacent vertebrase the IVD, facet joints and ligamentous structures

each mobile unit has 2 facet joints

ex: if its C6 it includes C7 named by superior vert.

Question 18

What is Fryette’s law?

Answer 18

movement patterns for the spine- if movement in one plane introduced to the spine, any motion in another direction is restricted

Question 19

What is an example of Fryette’s law?

Answer 19

if you fully flex it will be hard to side bend or rotate

however this is good as it can isolate AA joint

same with AO if you rotate and flex

Question 20

What is coupled cervical spinal motion for upper cervical spine (above c2)?

Answer 20

SB and rotation takes place to opposite sides regardless if vert are in flexion or ext.

Question 21

What is coupled cervical spinal motion for lower cervical spine (c2-t3)?

Answer 21

rotation and SB to same side

Question 22

What are two ways to document facet joint movement?

Answer 22

1. motion restriction- right facet cant downglide or close

2. positional fault- the right facet is flexed, rotated left or sidebent left