The cervical and thoracic spine

Question 1

Which are the atypical vertebrae

Answer 1

C1 C2 C7

Question 2

What is C1 also known as

Answer 2

Atlas

Question 3

Structure of C1

Answer 3

-Bony ring
-Anterior and posterior arch connected by 2 lateral masses
-widest cervical vertebrae
No vertebral body and no spinous processes

Question 4

What permits nodding

Answer 4

Atlanta-occipital joint- contributes 50% of the total range of flexion and extension of the head and neck

Question 5

What is C2 also known as

Answer 5

Axis

Question 6

What is responsible for 50% of total rotation of the head

Answer 6

Atlanta-axial joint

Question 7

What is the odontoid process

Answer 7

also known as the dens or odontoid peg, projects vertically upwards from the body of the axis.

This is the vestigial remnant of the body of C1.

Question 8

What prevents horizontal displacement of the atlas on the axis

Answer 8

The odontoid process and transverse ligament together p

Question 9

Features of C7

Answer 9

• vertebra prominens
• longest spinous process
• not bifid
• large transverse process
• small foramen transversarium which only transmits the accessory vetebral veins

Question 10

Where do each spinal nerve exit in the cervical spine

Answer 10

In the cervical region, however, each spinal nerve exits above its respectively- named vertebral body until the C7/T1 junction, where the C8 nerve root is the ‘exiting nerve root’

Question 11

What is the ligamentum nuchae

Answer 11

Thickening of the supraspinous ligament

Extends from the external occipital protuberance of the skull and the median nuchal line to the spinous process of C7

Question 12

What is the role of ligaentum nuchae

Answer 12

• To maintain the secondary curvature of the cervical spine • To assist the cervical spine to support the weight of the head
• In continuity with the supraspinous ligament of the thoracic and lumbar
spine, to be a major site of attachment of the muscles in the neck and trunk
e.g. trapezius, rhomboids

Question 13

Features of the thoracic spine

Answer 13

• Medium-sized, heart-shaped vertebral bodies
• A vertebral foramen that is small and circular
• Prominent transverse processes with transverse costal facets that allow for
articulation with ribs (except T11 and T12)
• Either demi-facets (T2-T8) or whole facets (T9-T10) on the sides of the
vertebral bodies for articulation with the heads of the ribs. [T11-12 have
whole facets on the pedicles instead.
• Long, spinous processes, angulated inferiorly
• Articular facets that are orientated at 20° to the coronal plane and at 60° to
the axial plane. (The superior articular processes face
posterolaterally and inferior articular processes face anteromedially; this
orientation permits rotation and lateral flexion, but prevents flexion and
extension).

Question 14

Why does the thoracic spine have limited flexibility

Answer 14

The thoracic spine has limited flexibility compared with the cervical and lumbar spine because the rib cage is connected to each segment of the thoracic spine

Question 15

Which thoracic vertebra have hole facets

Answer 15

• T1: The superior costal facet is not a demi-facet, as this is the only vertebra
to articulate with the 1st rib (figure 7.18). The inferior costal facet is a demi- facet as per the typical thoracic vertebrae.
• T9 and T10: Whole costal facets articulate with the 9th and 10th rib
respectively. These facets extend from the vertebral body to the pedicle.
• T11 and T12: Whole costal facets are located on the pedicles

Question 16

How does the spinous process change from T1 Down to T12

Answer 16

The spinous process also becomes shorter and less oblique from T1 down to T12, so that the T12 spinous process more closely resembles that of a lumbar vertebra

Question 17

What is cervical spondylosis

Answer 17

chronic degenerative osteoarthritis affecting the intervertebral joints in the cervical spine.

age- related disc degeneration which is followed by marginal osteophytosis (osteophyte formation adjacent to the end plates of the vertebral bodies) and facet joint osteoarthritis.

Question 18

What is radiculopathy

Answer 18

The resultant narrowing of the intervertebral foramina can put pressure on the spinal nerves leading to radiculopathy. Symptoms of radiculopathy include dermatomal sensory symptoms (e.g. paraesthesia, pain), and myotomal motor weakness.

Question 19

Myelopathy

Answer 19

degenerative process leads to narrowing of the spinal canal, this may instead put pressure on the spinal cord

Question 20

What is a Jefferson’s fracture

Answer 20

Jefferson’s fracture is a fracture of the anterior and posterior arches of the atlas vertebra (C1). The mechanism of injury is axial loading

Question 21

Hangman’s fracture

Answer 21

In a Hangman’s fracture, the axis vertebra (C2) is fractured through the pars
interarticularis (the region between the superior and inferior articular processes).

Question 22

What causes a hangman’s fracture

Answer 22

The mechanism of injury is usually forcible hyperextension of the head on the neck; historically by ‘hanging’ and more recently in road traffic collisions.

Question 23

What causes fracture of the odontoid process

Answer 23

caused by either flexion or extension injuries. The most commonly seen mechanism is an elderly patient with osteoporosis falling forwards and impacting their forehead on the pavement.

Question 24

Why do Whiplash injuries occur

Answer 24

The head accounts for 7-10% of the total body weight. It is balanced on the cervical
spine, which has high mobility and therefore low stability (as mobility and stability
of joints are inversely related

Question 25

Myofasical pain syndrome

Answer 25

can sometimes develop as a secondary tissue response to disc or facet-joint injury. There is a surprisingly high prevalence of chronic pain that results from whiplash injury, although secondary gain

Question 26

What will be compressed in cervical disc prolapse

Answer 26

Exiting nerve root

Question 27

Cervical myelopathy

Answer 27

Cervical myelopathy is spinal cord dysfunction due to compression of the cord. It is caused by narrowing of the spinal (vertebral) canal.

Question 28

What caused cervica myelopathy

Answer 28

degenerative stenosis of the spinal canal caused by cervical spondylosis

Question 29

Hoffmans test

Answer 29

the doctor holds the patient’s middle finger at the middle phalanx and flicks the finger nail. If there is no movement in the index finger or thumb after this motion, the patient has a negative Hoffman’s sign (normal). If the index finger and thumb move, the patient has a positive Hoffman’s sign (abnormal).

Question 30

Babinski sign

Answer 30

the lateral side of the sole of the foot is stroked with a blunt instrument from the heel towards the toes. Normally in children over the age of approximately 2-3 years and adults, the response is flexor in that the toes flex downwards towards the sole (plantarflex). In a positive (abnormal) Babinski sign, the hallux dorsiflexes and the toes fan out. This suggests damage to the long tracts of the spinal cord.

Question 31

Which nerve is damaged in a disc prolapse of Cx/ CX + 1

Answer 31

CX + 1