Part 1 (bone, lig disc) Flashcards
What unique functions does the cervical spine have?
- most mobile area of the spine
- Provides protection for vital structures such as spinal cord, sympathetic nerves, esophagus, trachea, arteries
- Supports and balances the head
- Extensive sensory function in support of positioning for eyes, ears and nose
- Upper cervical spine has the capacity to move independent of the rest of the spine
What anatomical features of the cervical spine are similar to the rest of the spine?
- body
- pedicales
- transverse processes
- neural foramina
- articular facets
- meniscoids
- lamina
- spinous processes
How are the neural foramina oriented in the cervical spine?
oriented anteriorly and inferiorly 10-15 degrees
How do the foraminal openings in the cervical spine vary?
- C1 adn C2 don’t have them
- C3 is the largest
- C7 is the smallest
What are the variations in the cervical vertebrae anatomy from the rest of the spine?
- foramen transversarium
- uncinate process
- bifid spinous process
- smaller vertebral bodies
- triangular vertebral canal
- short transverse process with foraminal gutter
- C1 and C2 are completely different
What is in the foramen transversarium?
- vertebral artery
- plexus of veins
- sympathetic nerve fibers
What is the foramen traversarium?
- Foramen through the transverse process in all cervical bodies except C7
- formed by an isthmus of bone extending from the body to the anterior tubercle
- located 3-6 mm from uncinate process and 2-3 mm from the facet
What are the characteristics of the cervical TPs?
- Shorter
- have a foraminal gutter
- have an anterior orientation pf about 1-=15 degrees
- Anterior and posterior tubercles
- anterior is actually a rudimentary rib
- Posterior is actually the true transverse process
How do the vertebrae differ as you transition into the thoracic spine from the cervical spine?
- Uncovertebrals disappear
- ribs appear
- body and pedicales become thicker
- spinous processes lengthen
- spinous process angle inferiorly
- transverse processes are longer and thicker
- facets become more vertically oriented
What does the articulating surface of the occiput look like?
- condyles- kidney pattern, but can be wasp shaped or have separate anterior and posterior facets
-Convex laterally, oriented inferior and lateral with long axes converging anteriomedially - condylar fossa located behind the condyle
accommodating the posterior margin of the super facet of the the atlas
How is the atlas different?
- No vertebral body
- No vertebral foramen
- Odontoid of C2 serves as its body
- Slim anterior and posterior arch
- Facet on the posterior part of the anterior arch for the articulation with the dens
- Wedge shaped lateral masses resembling a meniscus
- Biconcave superior articular surfaces above the lateral mass with shape patters like condyle
- foramen transversarium is loacated lateral to the articulating surface
- No pedicales
- No spinous process or Nutrient foramen
- Inferior articulating surface is biconvex
How is the axis different?
- small body with the dens on it
- Articular surface on the anterior part of the den with C1 anterior arch
- Lateral mass are wing shaped
- Superior articulating surface sits on the lateral mass
- Bi convex superior articulating surface
- Inferior articulating facet is located behind superior and is the first “normal” cervical facet
- No intervertebal foramen so nerve sits in sulcus behind lateral masses
- Largest spinous process of cervical spine
What are the attachments of the ALL?
1Basilar aspect of occipital bone 2anterior tubercle of C1 3anterior C2 body 4skips boney rim 5disc 6continues down to the sacrum
What are the different parts of the ALL?
- Superficial layer- cross several segments to attach to the body
- intermediate layer- cross only one segment to attach only half way up or down the body
- deep layer- one segment from superior to inferior margin
- fourth layer- travels inferior and lateral like the alars
What are the attachments of the AAOM?
base of the occiput to the anterior arch of the atlas covering the anterior margin of the
What does the AAOM blend with?
- laterally with capsular ligaments
2. anteriorly with the ALL
What are the attachments of the apical ligament?
tip of the dens to the base of the occiput
What does the apical ligament blend with
- AAOM
2. cruciform ligament
How is the apical ligament oriented and how long is it?
- 20 degrees anterior tilt
2. about 23.5 mm
What are the attachments of the alar ligament?
odontoid to the occiput as well as lateral masses of C1
How is are the alar ligaments oriented?
- They run down and in and their angle can vary depending on the height of the dens
- Panjabi indicates they are angulated about 70 degrees in the transverse plane and there is considerable variation
What are the standard types or variations in alar ligament attachments?
type 1- the two alars are separated at the dens
type 2- partially connected
type 3- totally connected with a covered dens tip
type 4- totally connected without a covered dens tip
type 5- type 3 covering a type 1
The alar ligament resists which motions?
contalateral rotation of the upper cervical spine
what are the attachments of the ALL?
- continusous with the ALL
- anterior inferior surface atlas
- body of axis
What are the attachments of the transverse ligament?
medial tubercles of the lateral masses of the atlas
What is the shape and size of the transverse ligament?
- Centrally it is broader than its laterally
- about 19-5 to 22 mm in length
- ascending and descending fibers form the cruciform ligament
What makes up the cruciform ligament?
- transverso-occipital ligament of the transerve ligament that attaches to base of the occipital bone between AL and TM
- transverso-axial ligament of the transverse ligament that attaches to the posterior body of axis
What are the attachments of the tectorial membrane?
- upper surface of the basilar occipital bone
- posterior body of atlas
- continues on as the PLL
What are the attachments of the PLL?
- discs
- pedicale
- adjacent margins of the vertebral body, but NOT the entire body
How many layers does the PLL have and what do they look like?
- superficial- longitudinal travelling several segments
- intermediate- longitudinal traveling one segment
- deep- short fibers traveling over the disc and angulated like the alars
What are the attachments of the POAM?
- posterior margin of the foramen magnum
2. superior posterior surface of the Atlas posterior arch
What anatomical structure travels through the PAOM?
vertebral artery travels through the PAOM before entering the Foramen magnum
What are the attachments of the PAAL?
- inferior posterior arch of atlas
2. superior posterior arch of axis
What anatomical structure travels through the PAAL?
second cervical nerve
what are the attachments of the LF?
- Lamina to lamina of adjoining vertebrae
- travel anterior to posterior from the superior to inferior vertebrae
- facet capsule
Why don’t the two LF unite centrally?
the space between the two ligaments allows the venous plexus to pass through
What unique function does the LF?
In addition to checking motion like other ligaments it also serves to pull the meniscoid free of the facet in order to prevent entrapments
What are the attachments of LN?
They are paired and running posterior to the LF
What are the attachments of the PCL?
- occiput
2. spinous process down to C7
What minor ligaments are specific to the upper cervical spine?
- lateral atlanto-occipital ligament supporting the OA joint
- capsular ligament of the occipital-axial joint that is deep to “a”
- capsular ligament of the OA joint
What cervical ligaments are continuous through the spine and how do they vary cervical versus lumbar?
- ALL- Thin in the cervical spine and thick in the lumbar spine
- PLL- (1) cervical spine it is uniform and broad, but in lumbar spine it narrows over bodies and widens at discs (2) three time five times thicker in the cervical spine
- Ligamentum Flavum- cervical spine they are thin broad and long and in lumbar they are thickest
What is the difference between a ligament and a membrane?
a significant difference is fibrin content with membranes having less, as a result are weaker and more permeable
How are the cervical disc and lumbar disc similar?
- they absorb shock
- the greater the height the greater the ROM
- they control shear forces
- wedge shaped
How are cervical discs and lumbar discs different?
- no disc between OA and AA
- they do not extend to the edge of the vertebral bodies due to the uncinate
- relatively thicker and higher allowing for more ROM
- there is a different degenerative process
- annulus does not form a complete rings or lamina
- fibrocartiliagenous core
- divided by clefts extending out from the core
How does cervical intradisc pressure change with movement?
- increases with extension more than flexion
2. decreases with traction and as the disc degenerates
What does the annulus of the cervical disc look look?
- It does not perform a complete ring around the nucleus
- it tapers down as it approaches the uncinate
- it is formed by three layers anteriorly
- there are no annular fibers superoposterior to the uncinate
- the posterior is a only a thin layers about 1 mm thick
What are the layers of the cervical annulus?
- transitional- fibers match the deep ALL orientation, but travel from body to body not the edges
- superficial- fibers run up and medial from the uncinate and travel towards the midline where the mesh with the contralateral superficial fibers
- deep- fibers are embedded in the fibrocartilagenous core and are more central
What does the posterior annulus look like?
- about 1 mm thick
- fibers travel vertically connecting vertebral bodies
- covers the fibrocartilagenous core
What is the cleft of the cervical disc?
- as the uncinate process develops a clefts forms into the disc from the posterior lateral margins
- at the uncinate process the cleft opens up to cover the uncinate in periosteofacial tissue
- the cleft extends from the posterior margins to travel medially to meet the contralateral side and then can extend anteriorly to bifurcate the disc
How do the variations in cervical disc structure effect its pathologies?
the uncinate process and fibrocartilagenous core decrease the risk of prolapse and herniation
What does the periosteofascial tissue look like?
- it is continues with the periosteum with the posteriolateral surface of the vertebral bodies
- composed of unorganized fibrous connective tissue embedded in fat and and blood vessels
- travels into the cleft and blends with the tissue of the core
What are the most common types of cervical pathology
whiplash ligament injuries bruising and hemorrhage in uncinate region rim lesions where annulus is puled away from the body and end plate degenerative changes collapse of disc annular bulging osteophytic formation foraminal stenosis
How does a cervical disc bulge effect the nerve roots?
- bulging disc will effect the ventral root (motor) first because the spinal nerve does not form until it exits the foramina
- you might still have some sensory changes because there are a few sensory fibers in the ventral root
How would you differentiate a cervical disc pathology?
- active and passive ROM pain provocation in the same direction
- nerve root encroachment with EXT and ipsalateral SB and ROT
- posterior disc tensioning or stretching with flexion and contralateral SB and ROT
- pain with compression greatest in extension, but also in neutral and flexion
- Positive disc shearing
