PT3 - Cervical Spine

Question 1

What are the functions of the cervical spine?

Answer 1

• orientate the sense organs in space

Question 2

What are the specialisations of the cervical spine?

Answer 2

• most varied => different parts perform different functions
• upper cspine => supports head + cervical viscera + orientates sense organs = no disc @ o/a and a/a segments
• middle cspine => complex coordination movement + dampen torsion from above + varied movement from below
• lower cspine => integration into shoulder + thoracic = gliding + decreasing range to dampen forces from below

Question 3

What are the specialisations of the atlas?

Answer 3

• vertebra cradles occipital
• superior articular sockets shaped for occiput
• Atlanta-occipital joint = strong = only nodding
• head + atlas move + function as a unit

Question 4

What are the specialisations of the axis?

Answer 4

• head sits on atlas; atlas sits on axis
• lateral Atlanto-axis joints = weight baring
• cardinal function of a/a = axial rotation
• atlas = convex; axis = concave (in neutral)
• atlas rotation = atlas facets slide down slope of axis facet = atlas descends into axis
• reversing rotation = atlas rises back up

Question 5

What is another name for the c2/c3 junction?

Answer 5

• The root

Question 6

What are the specialisations of the root (C2/C3 junction)?

Answer 6

• anchors c1 + head into typical cspine vertebrae
• c3 superior articular surfaces face up + backwards + medially
• processes of both sides form a socket for inferior articular process of axis

Question 7

What are the specialisations of the cspine (the column)?

Answer 7

• coupled movement = rotation + lateral flexion
• horizontal rotation => inferior articular process ride up slope => vertebra must side bend

Question 8

What are the specialised movements of c0-c1

Answer 8

• flexion + extension

Question 9

What are the specialised movements of c2-c3?

Answer 9

• flexion + extension
• rotation

Question 10

What are the specialised movements of c4-c7

Answer 10

• flexion + extension
• less movement at move down spine
• more side bend at c4-c5

Question 11

What is coupled motion of the c-spine?

Answer 11

• type 1 spinal motion = rotation / side bending in opposite directions
• type 2 spinal motion = rotation / side bending in the same directions

Question 12

Where does type 1 c-spine coupling occur?

Answer 12

-c0-c2 = rotation / side bending in opposite directions

Question 13

Where does type 2 c-spine coupling occur?

Answer 13

• c2-7 = rotation / sidebending in the same directions

Question 14

What happens within the c-spine on movement regarding coupled motion?

Answer 14

• intervertebral foramen opens in flexion + narrowed in extension
• cspine canal lengthens in flexion + decreases in extension
• rotation in canal => narrows by dural action e.g. twisting action of camer shutter

Question 15

Where does spondyloarthrosis occur in the Cspine?

Answer 15

• c3-4
• c7-t1

Question 16

Where does Spondylosis occur in the cspine?

Answer 16

• c5-6
• c6-7

Question 17

What are the age related changes of the c-spine?

Answer 17

• several discs involved in general alterations
• anterior superior surface of bodies => rounded + loss of height in column + lordosis reduced/straightened
• posterior osteophytes common @ c6=7 => decrease in A/P diameter => pressure on spinal cord + nerve roots
• degeneration of facet joints => subluxation (spondylolysis) => advanced disc degeneration => encroachment on nerve root esp. w/ osteophytes
• compromised IVF => disc involvement => uncoverterbral joints + facets in 80% cases
• most narrowing associated @ apex of lordosis => c3/4, c4/5 + c5/6
• c-spine Spondylosis => reduction in a/p diameter => myelopathy
• acute c-spine disc herniation -> event associated
• chronic => nerve root + cord compression develop insidiously. Acute herniation => severe pain + voluntary immobilisation of neck
• chronic degeneration => wax and wane

Question 18

Mr Smith is a 46 year old salesman who spends 5-7 hours a day in the car. He has recently noticed some neck pain when looking over his right shoulder while driving.

Describe how the different regions of the cervical spine are adapted to facilitate successful orientation of the eyes towards their target

Answer 18

• c0-c1 = flexion + extension of the OA joint tilting the head up and down slightly to allow eyes to move to the horizon
• c1-c2 = pivot movement = head allow to rotation = large surface area of atlas provides support for occiput. Strong ligaments attach from OA/AA
• c2-c3 = c3 has articular surface superiorly, medially and posteriorly. Root => anchoring head.
• c4-c6 = lordosis of spine => flexion extension and side bend movements. Coupled movement = rotation + side bend ipsilaterally.
• c6-c7 = less movement => gliding and integrating with t-spine

Question 19

Mr Smith is a 46 year old salesman who spends 5-7 hours a day in the car. He has recently noticed some neck pain when looking over his right shoulder while driving.

Describe how these movement may be compromised if there is increased age related changes in his cervical spine

Answer 19

• osteophytes may occur (c6-c7), especially around facet joints, narrowing intervertebral foramen, potentially putting pressure on nerve roots
• Spondylosis may occur, where the intevertebral disc is squeezed and pushes into the spinal canal resulting in nerve suptoms
• Spondylitis may occur, with loss of height in the vertebral column, pressuring disc and pushing the annulus into the spinal canal
• anterior superior surface of VB => rounded + heigh of cspine reduced => normal lordosis decreased/straighten
• multiple disc involvement => general alternations in cspine
• acute disc herniation => particular event association