Vertebral Column of the Neck Flashcards
1
Q
What is the shape of the vertebral bodies of C3-C6?
A
Small and broad
Concave superior and inferior surfaces
Uncinate processes:
- Upward projections on lateral margins
2
Q
Why is the vertebral foramen of C3-C6 large and triangular?
A
For the cervical enlargement
3
Q
What direction are the transverse processes of C3-C6 directed?
A
Anterolaterally
4
Q
What is the purpose of the foramen transversarium of C3-C6?
A
Passage of:
- Vertebral arteries
- Vertebral veins
- SNS plexus
5
Q
What features of the transverse processes of C3-C6 create a groove for the spinal nerves?
A
Anterior and posterior tubercles
6
Q
What is the shape of the spinous process of C3-C6?
A
Bifid
7
Q
What direction do the articular facets for C3-C6 face?
A
Superior articular facets = Superoposteriorly
Inferior articular facets = Inferoanteriorly
8
Q
What is the reference for C3-C6 articular facet directions?
A
Cunningham et al., 2016
9
Q
The vertebral bodies of C3-C6 are described as ‘saddle-like’ due to the uncinate processes. What study describes them as such?
A
Swartz et al., 2005
10
Q
What splits the vertebral foramen of C1?
A
Transverse ligament of the atlas
11
Q
What structures run through the two spaces of C1?
A
Odontoid process anterior to transverse ligament
Spinal cord posterior to transverse ligament
12
Q
What is the reference for the dens running anterior in the vertebral foramen of C1?
A
Rawls and Fisher, 2010
Atlanto-axial joint
13
Q
Where does the vertebral artery pass after the foramen transversarium of C1?
A
Sulcus on posterior arch
14
Q
What features are present on the arches of C1?
A
Tubercles
15
Q
What feature of the atlas is on the posterior side of the anterior arch of C1? (Reference?)
A
Articular surface for dens
Combalia, 2013
16
Q
What structures are the articular facets of the atlas located on?
A
Lateral masses
17
Q
What do the superior articular facets of C1 articulate with?
A
Occipital epicondyles
18
Q
What are the functions of the tubercles on the medial aspects of the lateral masses of C1? (Reference?)
A
Prevent forward movement relative to C2
Attachments for transverse ligament
(Bogduk, 2016)
19
Q
What is the strongest cervical vertebra?
A
C2
20
Q
Why does C2 overlap the anterior part of C3?
A
The vertebral body of C2 is projected inferiorly
21
Q
What do the two articular surfaces on the dens articulate with? (Reference?)
A
Anteriorly - Anterior arch of C1
Posteriorly - Transverse ligament
(Lippert, 2006)
22
Q
How do the transverse processes of C2 compare to those of the other cervical vertebrae?
A
Very small
23
Q
What direction do the articular facets of C2 face? (Reference?)
A
Superior facets = Superolaterally
Inferior facets = Inferoanteriorly
(Dalton, 2011)
24
Q
Why is the inferior surface of the vertebral body of C7 flatter?
A
To accommodate T1
25
What are the differences in the transverse processes of C7 compared to C1-C6?
Less prominent anterior (vestigial) and posterior tubercles
| Foramen transversarium does not transmit vertebral artery
26
How does the spinous process of C7 differ?
Longest of c-spine
Not bifid
More solid and horizontal
27
What is the alternate name for C7?
Vertebra prominens
28
What direction do the articular facets of C7 face?
Superior facets = Superoposteriorly
| Inferior facets = Inferoanteriorly
29
Describe the IV disc as a joint between vertebral bodies? What are their functions?
```
Symphysis joint:
- Secondary cartilaginous joints
Functions:
- Strength
- Weight bearing
```
30
Where does the annulus fibrosus of the IV discs attach?
Epiphyseal rim of articular surfaces of vertebral body
31
What ligaments stabilise the IV discs?
Anterior longitudinal ligament
| Posterior longitudinal ligament
32
What spinal movements do the IV discs allow? (Reference?)
Flexion and extension
Lateral flexion
Rotation
(Swartz et al., 2005)
33
Why is the disc thicker in the c-spine?
Greater range of movement
34
Why is there more spinal movement when several discs combine motions?
Compression and tension simultaneously
35
What are the joints between the articular facets of the vertebrae?
Zygapophyseal joints = Synovial plane
36
What innervates the facet joints?
Articular branches from medial branches of posterior rami of spinal nerves
37
What structures stabilise the facet joints?
```
Thin joint capsule
Ligamenta flava
Intertransverse ligaments
Supraspinous ligaments
Interspinous ligaments
```
38
What is the reference for stabilising structures of the facet joints?
Snell, 2012
39
What movements are possible at the facet joints?
Flexion
Abduction
Adduction
Rotation
40
Why do the facet joints allow increased movement of the c-spine?
Large articular surfaces
Horizontal plane
Loose joint capsule
41
Why are the uncovertebral joints of Luschka considered 'pseudojoints'?
Have a synovial membrane
| No joint capsule
42
What else can the uncovertebral joints be considered?
Diarthrodial joints
| Degenerated spaces of IV discs filled with ECF
43
What are the articular surfaces of the uncovertebral joints?
Uncinate process of C3-C7 and the inferolateral uncus of superior vertebra
44
What is the function of the uncovertebral joints in regards to IV discs?
Reinforce IV discs posterolaterally
45
What are the range of movements possible at the uncovertebral joints?
Flexion
Extension
Limited lateral flexion
46
What movements do the uncovertebral joints guide? (Reference?)
Couple rotation and lateral flexion
| Hartman, 2014
47
What can degeneration of the uncovertebral joints compress? (Reference?)
Spinal nerve root
Vertebral artery
(Hartman, 2014)
48
What can the uncovertebral joints precipitate when oedematous?
Torticollis
49
What type of joint is the atlanto-occipital joint?
Synovial condyloid
50
What is the atlanto-occipital joint between?
The two occipital condyles superiorly
| The superior articular processes of C1 inferiorly
51
What is the range of movement at the atlanto-occipital joint? (Reference?)
Flexion/Extension (25 degrees)
Lateral flexion and rotation (5 degrees rotation)
(White and Panjabi, 1990)
52
What is the course of the nuchal ligament?
From external occipital protuberance
| To C7 spinous process
53
Where does the anterior atlanto-occipital membrane run?
Anterior to alar ligament
From anterior margin of foramen magnum
To superior border of anterior arch of atlas
54
Where does the posterior atlanto-occipital membrane run?
From posterior foramen magnum
| To superior border of posterior arch of atlas
55
What does the opening in the posterior atlanto-occipital membrane permit the passage of?
Vertebral artery
| Suboccipital nerve
56
What are the synovial plane joints of the atlantoaxial joint?
The 2 lateral atlanto-axial joints between inferior articular facets of C1 and superior articular facets of C2
57
What is the synovial pivot joint of the atlantoaxial joint? (Reference?)
The medial atlantoaxial joint between dens of C2 and posterior aspect of anterior arch of C1
(Yang et al., 2014)
58
What range of movement is possible at the atlantoaxial joint? (Reference)
Rotation (~40-50% of cervical rotation)
Flexion/Extension (20 degrees)
(White and Panjabi, 1990)
59
What are the two bands of the cruciate ligament at the atlantoaxial joint and where do they run?
Longitudinal:
- Body of C2 to foramen magnum
Transverse:
- C1 lateral masses to inner margin C1
60
What is the key band of the cruciate ligament?
Transverse band
61
Where does the apical ligament run to and from?
Tip of dens to centre of anterior rim of framen magnum
62
What does Tubbs (2000) state about the apical ligament?
It can be absent
63
Where does the alar ligament run from and to?
From lateral side of dens to foramen magnum
64
What is the function of the alar ligament?
Attaches cranium to C1/C2 to prevent excessive rotation
65
What is the tectorial membrane continuous with?
Posterior longitudinal ligament
66
Where does the tectorial membrane attach?
Posterior surface of body of C2
| Basilar groove of occiput
67
What movements does the tectorial membrane limit? (Reference?)
Flexion
Extension
(Tubbs, 2011)
68
What is the course of the accessory atlantoaxial ligament?
From posterior body of C2 to lateral mass of C1
69
What is the suggested function of the accessory atlantoaxial ligament?
Involved in craniocervical stability
70
What is the course of the anterior longitudinal ligament?
From occiput to sacrum on anterior vertebral bodies
71
What is the function of the ALL?
Increases spinal strength during flexion/extension
| Prevents hyperextension
72
What is the function of the PLL?
Increases spinal strength during flexion/extension
| Prevents hyperflexion
73
What is the reference for functions of ALL and PLL?
Reith, 2016
74
What does the ligamentum flavum connect? (Reference?)
Laminae of C2-S1
| Sayit et al., 2013
75
What is the range of flexion of the c-spine?
80-90 degrees
76
What is the range of extension of the c-spine?
70 degrees
77
What is the range of lateral flexion of the c-spine?
20-45 degrees (both sides)
78
What is the range of rotation of the c-spine?
90 degrees (both sides)
79
Why are rotation and lateral flexion not possible at the atlanto-occipital joint?
Due to depth of sockets
80
What are the primary movements at the atlanto-occipital joint?
Flexion/Extension of 15-20 degrees
81
What other movements occurs with rotation at the atlantoaxial joint?
Lateral shift of dens carrying C1 laterally too
82
Where is flexion and extension max in the remainder of the c-spine?
C5-C6
83
What movements of the mid to lower c-spine are always combined? (Reference?)
Lateral flexion and rotation
| Penning, 1978
84
How do the occipital condyles move during head flexion?
Glide posteriorly
| Roll anteriorly
85
How do the occipital condyles move during head extension?
Glide anteriorly
| Roll posteriorly
86
How do the occipital condyles move during head rotation?
Ipsilateral glide of occipital condyles
87
How do the occipital condyles move during head lateral flexion?
Ipsilateral glide of occipital condyles
88
How do the inferior articular surfaces of C1 move during head flexion?
Glide posteriorly
| Roll anteriorly
89
How do the inferior articular surfaces of C1 move during head extension?
Glide anteriorly
| Roll posteriorly
90
How do the inferior articular surfaces of C1 move during head rotation?
Ipsilateral inf. articular surface slides posteriorly
| Contralateral inf. articular surface slides anteriorly
91
Regarding movements from C2-C7, how does the superior vertebra at each intervertebral joint move during flexion?
Upper vertebra glides and rolls anteriorly
92
Regarding movements from C2-C7, how does the superior vertebra at each intervertebral joint move during extension?
Upper vertebra glides and rolls posteriorly
93
Regarding movements from C2-C7, how does the superior vertebra at each intervertebral joint move during lateral flexion?
Rotates ipsilaterally
Ipsilateral inf. articular surface glides posteroinferiorly
Contralateral inf. articular surface glides anterosuperiorly
94
What are the movements involved in the type of injury that results in occipitocervical dissociation? What type of accident causes these movements?
Pedestrian hit by car:
- Hyperflexion
- Hyperextension
- Lateral flexion
95
What are the types of occipitocervical dissociation? (Reference?)
Type 1 = Anterior occiput dislocation
Type 2 = Longitudinal dislocation
Type 3 = Posterior occiput dislocation
(Kasliwal et al., 2016)
96
In what percentage of c-spine traumas are occipital condyle fractures seen?
3-15%
97
What are the types of occipital condyle fractures?
Type 1 = Impaction fracture (compression)
Type 2 = Basilar fracture extending to condyle (direct blow to skull)
Type 3 = Avulsion by alar ligament due to forced lateral flexion and rotation
98
What is the reference for occipital condyle fractures?
Alcelik et al., 2006
99
What percentage of cervical fractures are atlas fractures?
Up to 10%
100
What movements/forces cause atlas fractures?
Hyperextension
Lateral compression
Axial compression
101
What does the stability of an atlas fracture depend on?
Degree of injury
| Damage to transverse ligament of atlas
102
What are the types of atlas fractures?
Posterior arch fracture
Burst/Jefferson fracture (ant. and post. arches)
Lateral mass fracture
103
What is the reference or atlas fractures?
Mead et al., 2016
104
What percentage of cervical fractures are odontoid fractures?
Up to 20%
105
What are the types of odontoid fractures?
Type 1 = Tip of dens (least common)
Type 2 = Junction of dens and VB (most common)
Type 3 = Fracturing extending into C2 VB
106
What is the reference for odontoid fractures?
Julien et al., 2000
107
What movements/forces can result in traumatic spondylolisthesis of the axis?
Hyperextension
| Axial loading
108
What does a Hangman's fracture/spondylolisthesis of axis typically involve? (Reference?)
Fracture of pars interarticularis on both sides of C2
| Schwartz and Reisdorff. 2000
109
What are the types of traumatic spondylolisthesis of the axis?
Type 1 = <3mm AP deviation
Type 2 = >3mm AP deviation
Type 3 = Type 1 plus bilateral facet dislocation
110
What is the reference for types of traumatic spondylolisthesis of the axis?
Govender and Charles, 1987
111
Where are flexion-compression injuries most common in the subaxial c-spine?
C5-C6
112
When are flexion-compression injuries to the subaxial c-spine deemed stable?
If posterior ligaments, ALL and PLL are all intact
113
What are the complications of flexion-compression injuries and fractures of the subaxial c-spine?
Anterior cord syndrome
| Quadriplegia
114
What flexion-distraction injuries are somewhat common in the subaxial c-spine?
Facet subluxation with posterior ligamentous sprains
Unilateral facet dislocations and facet fracture dislocations
Bilateral facet dislocations
115
Where are flexion-distraction injuries of the subaxial c-spine most common? (Reference?)
C6-C7
| Sengupta and Torretti, 2007
116
What is stage 1 of subaxial c-spine extension injuries?
Disruption of ALL and IV disc
| Abnormal disc widening
117
What is stage 2 of subaxial c-spine extension injuries?
Posterior ligamentous disruption
| Vertebral displacement into spinal canal
118
How does central cord syndrome present?
```
Weak upper limb (motor)
Sensory impairment (cape like)
```
119
What causes the presentation of extension injuries in the subaxial c-spine region?
IV disc or vertebral protrusion into spinal canal
