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Vertebral Column > The neck > Flashcards

The neck Flashcards

1
Q

Illustrate the main features of a typical cervical vertebrae

A
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2
Q

Features of the body of a typical cervical vertebra

A
  • Small
  • Broad
  • Concave superiorly and inferiorly
  • Uncinate process
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3
Q

What shape is the vertebral foramen of the cervical vertebrae and why?

A
  • Large and triangular
  • To accommodate the cervical enlargement of the spinal cord
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4
Q

Dscribe the orientation of the articular facets of a typical cervical vertebra

A

Generally, superior articular facets face posteriorly

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5
Q

Describe the transverse process of a typical cervical vertebra

A
  • Directed anterior and lateral
  • Have foramen transversarium for passage of vertebral arteries and veins
  • Anterior and posterior tubercles have a groove for spinal nerves
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6
Q

Describe the spinous process of a typical cervical vertebra

A

Bifid

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7
Q

Describe the orientation of the articular facets of a typical cervical vertebra

A
  • Superior - face superiorly and posteriorly
  • Inferior - face inferiorly and anteriorly
    • Cunningham et al. (2016)
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8
Q

Describe the atlas (C1)

A
  • No body or spinous process
  • Vertebral foramen split into 2 spaces
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9
Q

What splits the vertebral foramen of the atlas and why?

A

Split into 2 spaces by the transverse ligament for passage of the odontoid process anteriorly and the spinal cord posteriorly.

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10
Q

What does the anterior part of the vertebral foramen accept and what does this form?

A

Anterior part accepts the dens from C2 to form the atlantoaxial joint.

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11
Q

Describe the transverse processes of C1 (atlas)

A
  • Same as typical cervical but shorter
  • Has foramen transversarium for vertebral arteries and veins
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12
Q

Describe the morphology of C1 (Atlas)

A
  • Formed of anterior and posterior arches
  • Small bump on each arch - tubercle
  • Sulcus on the posterior arch where the vertebral artery passes
  • Sulcus on the posterior arch where the vertebral artery passes
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13
Q

Illustrate the main features of C1 (atlas)

A
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14
Q

What do the superior articular facets of C1 articulate with?

A

Occipital epicondyles

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15
Q

What do the inferior articular facets of C1 articulate with?

A

C2 (axis)

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16
Q

Why are there tubercles on the medial aspect of the atlas (C1)?

A
  • To prevent forward movement relative to C2 (axis)
  • Attachment site for the transverse ligament
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17
Q

Illustrate the main feature of the axis (C2)

A
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18
Q

Describe the body of the axis (C2)

A
  • Projected inferiorly overlapping the anterior part of C3
  • Major upward projection - odontoid process / dens
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19
Q

Describe the odontoid process

A
  • 2 articular surfaces
    • 1 pointed anteriorly making contact with the anterior arch of 1
    • 1 pointed posteriorly connecting the dens and the transverse ligament
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20
Q

What size is the vertebral foramen of the axis relative to te atlas?

A

Axis vertebral foramen is smaller than atlas foramen

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21
Q

What holds the dens in place?

A

Transverse ligament of the atlas

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22
Q

Describe the transverse and spinous processes of the axis

A
  • Transverse - Very small compared to typical cervical vertebrae
  • Spinous - bifid
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23
Q

Describe the orientation of the superior articular facets of the axis (C2)

A

Face superiorly and laterally

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24
Q

Describe the orientation of the inferior articular facets of the axis (C2)

A

Face inferiorly and anteriorly

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25
Q

Illustrate the features of C7

A
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26
Q

Describe the body of C7 (vertebrae prominens)

A

Inferior surface is flatter than typical to accommodate upper surface of T1

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27
Q

Describe the vertebral foramen of C7

A

Similar to typical - large and triangular

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28
Q

Describe the transverse processes of C7

A
  • Show less prominent anterior and posterior tubercles
  • Foramen does not transmit vertebral artery
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29
Q

Describe the spinous process of C7

A
  • Longest of the cervical vertebrae
  • Shows signs of transition to thoracic vertebrae
  • Not bifid
  • Much more solid and horizontally orientated (Moulton et al., 2009)
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30
Q

Describe the orientation of the superior articular surfaces of C7

A

Face superiorly and posteriorly

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31
Q

Describe the orientation of the inferior articular processes of C7

A
  • Face inferiorly and anteriorly
  • Orientation is better matched for thoracic vertebrae
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32
Q

Draw a table to compare the morphology of the cervical vertebrae

A
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33
Q

Describe the symphysis joints of the vertebral body

A
  • Secondary cartilaginous joints
  • Composed of intervertebral discs and ligaments
  • Designed for strength and weight-bearing
  • No IV disc between atlas and axis
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34
Q

What are the IV discs composed of?

A
  • Nucleus pulposus
  • Annulus fibrosis
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35
Q

What are the stabilising structures of the vertebral column?

A
  • IV discs
  • Epiphyseal rims of annulus fibrosis attach onto articular surface of adjacent vetebral body
  • ALL and PLL - primary stabilisers which run entire length of the spine and strengthen the discs to prevent herniation
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36
Q

What do the vertebral bodies carry?

A

2/3 of the vertebral load

Compresson and tension of the discs occurs simultaneously during movement

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37
Q

Describe the zygaphphyseal joints

A
  • Synovial plane
  • Between superior and inferior articular processes of adjacent vertebrae
  • Innervated by articular branches that arise from the medial branches of the posterior rami of the spinal nerves
38
Q

Describe the stabilising structures between the vertebral arches

A
  • Surrounded by thin joint capsule
  • Accessory ligaments help stabilise the joint and unite the:
    • Laminae - ligamenta flava
    • Transverse processes - intertransverse ligaments
    • Spinous processes - tip: supraspinous and base: interspinous ligaments
39
Q

What factors permit more movement in the cervical region than any other part of the vertebrae?

A
  • Large articular surfaces with a horizontal plane
  • Loose joint capsule
40
Q

What movements are possible in te cervical vertebrae?

A
  • Flexion
  • Abduction
  • Adduction
  • Rotation
  • Joints permit gliding movements
41
Q

What is the interspinous ligament like in the cervical region?

A

Small and inconspicuous

42
Q

What are uncovertebral joints (of Luschka)?

A

Pseudo joints with a synovial membrane and synovial fluid, but no joint capsule

43
Q

Where are uncovertebral joints (of Luschka) found?

A

Between the uncinate processes of cervical vertebrae 3-7 and the inferolateral uncus of the superior vertebra

44
Q

What is the function of the uncovertebral joints (of Luschka)?

A

Reinforce the IV disc posterolaterally

45
Q

What is the range of movement of the uncovertebral joints (of Luschka)?

A
  • Flexion
  • Extension
  • Limited lateral rotation
46
Q

What are the uncovertebral joints (of Luschka) considered as?

A
  • By some - true diarthrodial joints
  • By others - degenerative spaces of the IV discs filled with extracellular fluid and lined by a membrane
47
Q

Describe the atlanto-occipital joint

A
  • Synovial condyloid
  • Between occipital condyles and superior articular processes of C1
48
Q

What are the functions of the atlanto-occipital joint?

A
  • Designed to cradle occipit
  • Transmit forces from the head to the cervical spine
49
Q

Describe the movements of the atlanto-occipital joint

A
  • Flexion and extension of the head
  • Slight lateral flexion and rotation
  • 25° ROM in flexion and extension
  • 5° ROM in rotation
50
Q

Which joint is the red arrow pointing to?

A

Atlanto-occipital joint

51
Q

Which structure is the red arrow pointing to?

A

Dens (odontoid process)

52
Q

What are the stabilising factors of the atlanto-occipital joint?

A
  • Nuchal ligament
  • Anterior atlanto-occipital membrane
  • Posterior atlanto-occipital membrane
53
Q

Describe the nuchal ligament

A
  • Continuous with supraspinous ligament
  • Extends from the external occipital protuberance to the spinous process of C7
54
Q

Describe the anterior atlanto-occipital ligament

A
  • Posterior to the alar ligament
  • Composed of densely packed fibres that run between the anterior margin of the foramen magnum and the superior border of the anterior arch of the atlas
55
Q

Describe the posterior atlanto-occipital joint

A
  • Broad, thin fibrous sheet
  • Between the posterior margin of the foramen magnum and superior border of the posterior arch of the atlas
  • Lateral borders blend with the posterior atlanto-occipital joint capsule
  • Opening for the vertebral artery and suboccipital nerve
56
Q

What is the atlanto-axial joint comrpised of?

A
  • 2 synovial plane joints
    • Lateral atlanto-axial between inferior facets of lateral masses of C1 and superior facets of C2
  • 1 synovial pivot joint
    • Medial atlanto-axial - pivot joint between dens of C2 and posterior aspect of anterior arch of atlas
57
Q

Describe the movement of the atlanto-axial joint

A
  • Allows head to be turned side to side.
  • Cranium and C1 use C2 as a pivot point
  • Accounts for 40-50% of cervical rotation
  • Contributes 20° of to the flexion/extension ROM
58
Q

What are the stabilisers of the atlanto-axial joint?

A
  • Cruciate ligament
  • Apical ligament
  • Alar ligament
  • Tectorial membrane
  • Accessory atlanto-axial ligament
59
Q

Describe the cruciate ligament

A
  • Made up of 2 bands - longitudinal and transverse
  • Longitudinal band - body of C2 → foramen magnum
  • Transverse band - joins C1 lateral masses and inner margin of C1
60
Q

Describe the apical ligament

A
  • Tip of the dens → Centre of the anterior rim of the foramen magnum
  • No significant added stability
  • Sometimes not present
  • TUBBS, 2011
61
Q

Describe the alar ligament

A
  • Side of the dens → foramen magnum
  • Responsible for attaching the cranium to C1 and preventing excessive rotation
62
Q

Describe the tectorial membrane

A
  • Continuous with PLL
  • Covers the dens
  • Attached at the posterior surface of the axis body and the basilar groove of the occipital bone
  • Limits flexion and rotation
  • Tubbs, 2011
63
Q

Describe the accessory atlanto-axial ligament

A
  • From posterior body of C2 to lateral mass of C1
  • Thought to be involved in craniocervical stability
64
Q

List the stabilisers of the cervical spine

A
  • Interspinous ligament
  • Anterior longitudinal ligament
  • Posterior longitudinal ligament
  • Nuchal ligament
  • Ligamentum flavum
65
Q

What does the interspinous ligament connect?

A

Adjacent spinous processes

66
Q

Where does the ALL run and what is its function?

A
  • Runs from occipital bone on the anterior side of the vertebral body to the sacrum
  • Increases the strength of the spine during flexion and extension
  • Limits hyperextension
67
Q

Where does the PLL run and what is its function?

A
  • Continuation of tectorial membrane
  • Passes down the posterior surface of the vertebral body
  • Increases strength of spine during flexion and extension
  • Limits flexion
  • Reith, 2016
68
Q

Where does the nuchal ligament run and what is its function?

A
  • Continuous with the supraspinous ligament
  • Extends from the external occipital protuberance to the spinous process of C7
69
Q

What does the ligamentum flavum connect?

A

The laminae of vertebrae C2-S1

70
Q

What is the range of flexion in the cervical spine?

A

80-90°

71
Q

What is the range of extension in the cervical spine?

A

70°

72
Q

What is the range of lateral flexion in the cervical spine?

A

20-45° on both sides

73
Q

What is the range of rotation in the cervical spine?

A

90° on both sides

74
Q

Range of flexion/extension at the atlanto-occipital joint

A

15-20°

75
Q

Rotation at the atlanto-axial joint

A
  • 50° each side
  • 50% of rotation does not occur without a small degree of extension and lateral flexion
  • PENNING, 1978
76
Q

Arthrokinematics of the atlanto-occipital joint

A
  • During flexion - ocipital condyles glide posteriorly and roll (rotate) anteriorly
  • During extension - occipital condyles glide anteriorly and roll (rotate) posteriorly
  • During rotation - ipsilateral gliding of occiput condyles
  • During lateral flexion - ipsilateral gliding of occipital condyles
77
Q

What is the range of craniocervical flexion?

A

45-50°

78
Q

What is the range of craniocervical extension?

A

85°

79
Q

What is the range of craniocervical lateral flexion?

A

40°

80
Q

Arthrokinematics of the atlanto-axial joint

A
  • During flexion - atlas inferior articular surfaces glide posteriorly and roll anteriorly
  • During extension - atlas inferior articular surfaced glide anteriorly and roll posteriorly
  • During rotation - while dens remains static, the atlas rotates towards the side of rotation
    • The ipsilateral inferior articular surface slides posteriorly, while the contralateral slides anteriorly
81
Q

Arthrokinematics of the cervical spine - C2-C7

A
  • During flexion - upper vertebrae glides anteriorly and rolls anteriorly
  • During extension - upper vertebrae glides posteriorly and rolls posteriorly
  • During lateral flexion - always occurs with same side rotation; ipsilateral inferior articular surface of the vertebrae glides posteriorly and inferiorly, contralateral glides anteriorly and superiorly
  • During rotation - always occurs with same side lateral flexion, ipsilateral inferior articular surface of vertebrae glides posteriorly and inferiorly, contralateral glides anteriorly and superiorly
82
Q

What are the three types of occipitocervical dislocation?

A
  1. Anterior occiput dislocation
  2. Longitudinal dislocation
  3. Posterior occiput dislocation
  • Kasliwal et al. (2016)

AKA atlanto-occipital dislocation

83
Q

Occipitocervical Dislocation

A
  • Follows complete or near complete ligamentous disruption
  • Common cause - pedestrian hit by high speed vehicle
  • As a result of hyperlexion
84
Q

Occipital condyle fracture

A
  • Reported in 3-15% of cervical trauma patients
  • Type 1 - impaction fracture of the condyles, due to compression
  • Type 2 - Basilar fracture extending to the condyle, due to direct blow to skull
  • Type 3 - avulsion fracture at the site of the alar ligament attachment, due to forces lateral bending and rotation.
  • Alcelik et al. (2006)
85
Q

Atlas fractures

A
  • Due to hyperextension, lateral compression and axial compression.
86
Q

Odontoid fracture

A
  • Due to high energy trauma or low energy fall
  • Type 1 - tip of odontoid
  • Type 2 - junction of odontoid base and vertebral body
  • Type 3 - fracture extends into the body of C2
87
Q

Traumatic spondylolisthesis of the axis

A
  • High energy trauma involving hyperextension and axial loading
  • Known as HANGMAN’S FRACTURE
  • Several types
  • Generally involves fracture of pars interticularis on both sides of C2
88
Q

Where is the pars interticularis?

A

Anterior to the lamina, posterior to the pedicles

89
Q

Traumatic spondylolisthesis of the axis

A
  • HANGMAN’S FRACTURE
  • Type 1 - <3mm anterio-posterior deviation
  • Type 2 - >3mm antero-posterior deviation
  • Type 3 - type 1 with bilateral facet dislocation
  • Govender and Charles, 1987
90
Q

Subaxial cervical spine injuries

A
  • Flexion compression injuries - most common at C5-6
  • Flexion-distraction injuries - most common at C6-7

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