The Cervical And Thoracic Spine And Associated Disorders Flashcards
Which part of the spine is more mobile - cervical or thoracic
Cervical as the thoracic spine’s movement is limited by the ribs
What are the characteristics of typical cervical vertebrae?
- Smallest vertebrae of the spinal column
- Vertebral Body is small and broad from side to side
• Bifid Spinous Process (except C7)
- Transverse foramen in transverse process
- Transmits the vertebral artery
- C7 foramen transmits the accessory vertebral vein
- Large triangular vertebral foramen
- Superior articular facet faces upward and backward
- Inferior articular facet faces downward and forward
What is atlas
C1
• Atypical Vertebra
• No vertebral body (Body is fused with axis to form dens or odontoid process)
• No spinous process
• Widest cervical vertebra
• Vertebral arches are thick and strong to form a powerful lateral mass
What does atlas articulate with?
- Articulates with:
- Occiput of skull superiorly (Atlanto-occipital joint → 50% of total flexion and extension - “nodding”)
- Axis (C2) inferiorly (Atlanto-axial joint → 50% of total rotation –shaking the head)
What is axis?
C2 • Atypical Vertebra • The Odontoid Process or Dens • Characterised by: – Rugged lateral mass – Largest spinous process of Cervical Vertebra •Dens and transverse ligament prevent horizontal displacement of atlas •Atlantoaxial Instability
Describe c7
- Atypical Vertebra
- Longest spinous process – Vertebra prominens
- Spinous process is not bifid
- The transverse process is large, but the foramen transversarium is small and only transmits the accessory vertebral veins.
Where do the nerve roots exit in the cervical spine
• The nerve roots exit more horizontally (than in lumbar spine)
• Nerve Roots in cervical spine exit above their vertebral body (until the C7/T1 junction)
Spinal cord retracts proximally as bones grow faster - cauda equina vcervical- nerve roots exit above expect c8 which exits below c7 - then lumbar and thoracic exit below vertebra
What is the ligamentum nuchae?
• Nuchal ligament
• Thickening of the Supraspinous Ligament
• Attached to:
• External occipital protruberance
• Spinous processes of all cervical vertebrae
Spinous process of C7
What are the roles of he ligamentum nuchae?
- Maintains secondary curvature of cervical spine
- Helps the cervical spine support the head
- Major site of attachment of neck and trunk muscles (e.g. Trapezius, Rhomboids)
What are the roles of the ligaments of the vertebral column?
- Provide stability
- Major ligaments: anterior longitudinal and posterior longitudinal ligament (anterior and posterior to vertebral bodies)
- Anterior is stronger than posterior
Describe the thoracic vertebrae
- Typical Vertebra Except:
- Demi-facets on sides of body for articulation with head of rib (T2-T8); whole facets T9-10
- Costal facets on transverse processes for articulation with tubercle of rib (except T11 and T12)
- Vertebral foramen is small and circular
- Superior articular processes face posterolaterally
- Inferior articular processes face anteromedially
- Permits rotation, limits flexion
Describe x rays of the cervical spine
See sides
What is cervical spondylosis?
- Age-related changes of the cervical spine
- Triad:
- Loss of Disc Height
- Osteophytes
- Facet Joint Osteoarthritis
• Pressure on nerve roots leads to
Radiculopathy:
– Dermatomal sensory symptoms:
paraesthesia, pain – Myotomal motor weakness
• Pressure on the cord leads to Myelopathy (less common):
– Global weakness – Gait dysfunction, loss of balance – Loss of bladder and bowel control
What is hangman’s fracture
Fracture of c1
• Hangman’s fracture:
– Hyperextension of head on neck
– Axis fractures through the pars interarticularis
– Unstable fracture
– Forward displacement of C1 and body of C2 on C3
What is an odontoid fracture?
Fracture of th odontoid peg • Odontoid fracture • Hyperextension Injury • ‘Open mouth’ AP X-ray = ‘peg view’ • CT Scan – Trauma series or with head CT scan
