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Vertebral Column > Vertebral Column of the Neck > Flashcards

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

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2
Q

Why is the vertebral foramen of C3-C6 large and triangular?

A

For the cervical enlargement

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3
Q

What direction are the transverse processes of C3-C6 directed?

A

Anterolaterally

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4
Q

What is the purpose of the foramen transversarium of C3-C6?

A

Passage of:

  • Vertebral arteries
  • Vertebral veins
  • SNS plexus
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5
Q

What features of the transverse processes of C3-C6 create a groove for the spinal nerves?

A

Anterior and posterior tubercles

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6
Q

What is the shape of the spinous process of C3-C6?

A

Bifid

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7
Q

What direction do the articular facets for C3-C6 face?

A

Superior articular facets = Superoposteriorly

Inferior articular facets = Inferoanteriorly

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8
Q

What is the reference for C3-C6 articular facet directions?

A

Cunningham et al., 2016

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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

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10
Q

What splits the vertebral foramen of C1?

A

Transverse ligament of the atlas

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11
Q

What structures run through the two spaces of C1?

A

Odontoid process anterior to transverse ligament

Spinal cord posterior to transverse ligament

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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

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13
Q

Where does the vertebral artery pass after the foramen transversarium of C1?

A

Sulcus on posterior arch

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14
Q

What features are present on the arches of C1?

A

Tubercles

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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

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16
Q

What structures are the articular facets of the atlas located on?

A

Lateral masses

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17
Q

What do the superior articular facets of C1 articulate with?

A

Occipital epicondyles

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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)

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19
Q

What is the strongest cervical vertebra?

A

C2

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20
Q

Why does C2 overlap the anterior part of C3?

A

The vertebral body of C2 is projected inferiorly

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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)

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22
Q

How do the transverse processes of C2 compare to those of the other cervical vertebrae?

A

Very small

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23
Q

What direction do the articular facets of C2 face? (Reference?)

A

Superior facets = Superolaterally
Inferior facets = Inferoanteriorly
(Dalton, 2011)

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24
Q

Why is the inferior surface of the vertebral body of C7 flatter?

A

To accommodate T1

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25
Q

What are the differences in the transverse processes of C7 compared to C1-C6?

A

Less prominent anterior (vestigial) and posterior tubercles

Foramen transversarium does not transmit vertebral artery

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26
Q

How does the spinous process of C7 differ?

A

Longest of c-spine
Not bifid
More solid and horizontal

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27
Q

What is the alternate name for C7?

A

Vertebra prominens

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28
Q

What direction do the articular facets of C7 face?

A

Superior facets = Superoposteriorly

Inferior facets = Inferoanteriorly

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29
Q

Describe the IV disc as a joint between vertebral bodies? What are their functions?

A 
Symphysis joint:
- Secondary cartilaginous joints
Functions:
- Strength
- Weight bearing
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30
Q

Where does the annulus fibrosus of the IV discs attach?

A

Epiphyseal rim of articular surfaces of vertebral body

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31
Q

What ligaments stabilise the IV discs?

A

Anterior longitudinal ligament

Posterior longitudinal ligament

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32
Q

What spinal movements do the IV discs allow? (Reference?)

A

Flexion and extension
Lateral flexion
Rotation
(Swartz et al., 2005)

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33
Q

Why is the disc thicker in the c-spine?

A

Greater range of movement

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34
Q

Why is there more spinal movement when several discs combine motions?

A

Compression and tension simultaneously

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35
Q

What are the joints between the articular facets of the vertebrae?

A

Zygapophyseal joints = Synovial plane

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36
Q

What innervates the facet joints?

A

Articular branches from medial branches of posterior rami of spinal nerves

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37
Q

What structures stabilise the facet joints?

A 
Thin joint capsule
Ligamenta flava
Intertransverse ligaments
Supraspinous ligaments
Interspinous ligaments
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38
Q

What is the reference for stabilising structures of the facet joints?

A

Snell, 2012

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39
Q

What movements are possible at the facet joints?

A

Flexion
Abduction
Adduction
Rotation

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40
Q

Why do the facet joints allow increased movement of the c-spine?

A

Large articular surfaces
Horizontal plane
Loose joint capsule

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41
Q

Why are the uncovertebral joints of Luschka considered ‘pseudojoints’?

A

Have a synovial membrane

No joint capsule

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42
Q

What else can the uncovertebral joints be considered?

A

Diarthrodial joints

Degenerated spaces of IV discs filled with ECF

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43
Q

What are the articular surfaces of the uncovertebral joints?

A

Uncinate process of C3-C7 and the inferolateral uncus of superior vertebra

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44
Q

What is the function of the uncovertebral joints in regards to IV discs?

A

Reinforce IV discs posterolaterally

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45
Q

What are the range of movements possible at the uncovertebral joints?

A

Flexion
Extension
Limited lateral flexion

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46
Q

What movements do the uncovertebral joints guide? (Reference?)

A

Couple rotation and lateral flexion

Hartman, 2014

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47
Q

What can degeneration of the uncovertebral joints compress? (Reference?)

A

Spinal nerve root
Vertebral artery
(Hartman, 2014)

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48
Q

What can the uncovertebral joints precipitate when oedematous?

A

Torticollis

49
Q

What type of joint is the atlanto-occipital joint?

A

Synovial condyloid

50
Q

What is the atlanto-occipital joint between?

A

The two occipital condyles superiorly

The superior articular processes of C1 inferiorly

51
Q

What is the range of movement at the atlanto-occipital joint? (Reference?)

A

Flexion/Extension (25 degrees)
Lateral flexion and rotation (5 degrees rotation)
(White and Panjabi, 1990)

52
Q

What is the course of the nuchal ligament?

A

From external occipital protuberance

To C7 spinous process

53
Q

Where does the anterior atlanto-occipital membrane run?

A

Anterior to alar ligament
From anterior margin of foramen magnum
To superior border of anterior arch of atlas

54
Q

Where does the posterior atlanto-occipital membrane run?

A

From posterior foramen magnum

To superior border of posterior arch of atlas

55
Q

What does the opening in the posterior atlanto-occipital membrane permit the passage of?

A

Vertebral artery

Suboccipital nerve

56
Q

What are the synovial plane joints of the atlantoaxial joint?

A

The 2 lateral atlanto-axial joints between inferior articular facets of C1 and superior articular facets of C2

57
Q

What is the synovial pivot joint of the atlantoaxial joint? (Reference?)

A

The medial atlantoaxial joint between dens of C2 and posterior aspect of anterior arch of C1
(Yang et al., 2014)

58
Q

What range of movement is possible at the atlantoaxial joint? (Reference)

A

Rotation (~40-50% of cervical rotation)
Flexion/Extension (20 degrees)
(White and Panjabi, 1990)

59
Q

What are the two bands of the cruciate ligament at the atlantoaxial joint and where do they run?

A

Longitudinal:
- Body of C2 to foramen magnum
Transverse:
- C1 lateral masses to inner margin C1

60
Q

What is the key band of the cruciate ligament?

A

Transverse band

61
Q

Where does the apical ligament run to and from?

A

Tip of dens to centre of anterior rim of framen magnum

62
Q

What does Tubbs (2000) state about the apical ligament?

A

It can be absent

63
Q

Where does the alar ligament run from and to?

A

From lateral side of dens to foramen magnum

64
Q

What is the function of the alar ligament?

A

Attaches cranium to C1/C2 to prevent excessive rotation

65
Q

What is the tectorial membrane continuous with?

A

Posterior longitudinal ligament

66
Q

Where does the tectorial membrane attach?

A

Posterior surface of body of C2

Basilar groove of occiput

67
Q

What movements does the tectorial membrane limit? (Reference?)

A

Flexion
Extension
(Tubbs, 2011)

68
Q

What is the course of the accessory atlantoaxial ligament?

A

From posterior body of C2 to lateral mass of C1

69
Q

What is the suggested function of the accessory atlantoaxial ligament?

A

Involved in craniocervical stability

70
Q

What is the course of the anterior longitudinal ligament?

A

From occiput to sacrum on anterior vertebral bodies

71
Q

What is the function of the ALL?

A

Increases spinal strength during flexion/extension

Prevents hyperextension

72
Q

What is the function of the PLL?

A

Increases spinal strength during flexion/extension

Prevents hyperflexion

73
Q

What is the reference for functions of ALL and PLL?

A

Reith, 2016

74
Q

What does the ligamentum flavum connect? (Reference?)

A

Laminae of C2-S1

Sayit et al., 2013

75
Q

What is the range of flexion of the c-spine?

A

80-90 degrees

76
Q

What is the range of extension of the c-spine?

A

70 degrees

77
Q

What is the range of lateral flexion of the c-spine?

A

20-45 degrees (both sides)

78
Q

What is the range of rotation of the c-spine?

A

90 degrees (both sides)

79
Q

Why are rotation and lateral flexion not possible at the atlanto-occipital joint?

A

Due to depth of sockets

80
Q

What are the primary movements at the atlanto-occipital joint?

A

Flexion/Extension of 15-20 degrees

81
Q

What other movements occurs with rotation at the atlantoaxial joint?

A

Lateral shift of dens carrying C1 laterally too

82
Q

Where is flexion and extension max in the remainder of the c-spine?

A

C5-C6

83
Q

What movements of the mid to lower c-spine are always combined? (Reference?)

A

Lateral flexion and rotation

Penning, 1978

84
Q

How do the occipital condyles move during head flexion?

A

Glide posteriorly

Roll anteriorly

85
Q

How do the occipital condyles move during head extension?

A

Glide anteriorly

Roll posteriorly

86
Q

How do the occipital condyles move during head rotation?

A

Ipsilateral glide of occipital condyles

87
Q

How do the occipital condyles move during head lateral flexion?

A

Ipsilateral glide of occipital condyles

88
Q

How do the inferior articular surfaces of C1 move during head flexion?

A

Glide posteriorly

Roll anteriorly

89
Q

How do the inferior articular surfaces of C1 move during head extension?

A

Glide anteriorly

Roll posteriorly

90
Q

How do the inferior articular surfaces of C1 move during head rotation?

A

Ipsilateral inf. articular surface slides posteriorly

Contralateral inf. articular surface slides anteriorly

91
Q

Regarding movements from C2-C7, how does the superior vertebra at each intervertebral joint move during flexion?

A

Upper vertebra glides and rolls anteriorly

92
Q

Regarding movements from C2-C7, how does the superior vertebra at each intervertebral joint move during extension?

A

Upper vertebra glides and rolls posteriorly

93
Q

Regarding movements from C2-C7, how does the superior vertebra at each intervertebral joint move during lateral flexion?

A

Rotates ipsilaterally
Ipsilateral inf. articular surface glides posteroinferiorly
Contralateral inf. articular surface glides anterosuperiorly

94
Q

What are the movements involved in the type of injury that results in occipitocervical dissociation? What type of accident causes these movements?

A

Pedestrian hit by car:

  • Hyperflexion
  • Hyperextension
  • Lateral flexion
95
Q

What are the types of occipitocervical dissociation? (Reference?)

A

Type 1 = Anterior occiput dislocation
Type 2 = Longitudinal dislocation
Type 3 = Posterior occiput dislocation
(Kasliwal et al., 2016)

96
Q

In what percentage of c-spine traumas are occipital condyle fractures seen?

A

3-15%

97
Q

What are the types of occipital condyle fractures?

A

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
Q

What is the reference for occipital condyle fractures?

A

Alcelik et al., 2006

99
Q

What percentage of cervical fractures are atlas fractures?

A

Up to 10%

100
Q

What movements/forces cause atlas fractures?

A

Hyperextension
Lateral compression
Axial compression

101
Q

What does the stability of an atlas fracture depend on?

A

Degree of injury

Damage to transverse ligament of atlas

102
Q

What are the types of atlas fractures?

A

Posterior arch fracture
Burst/Jefferson fracture (ant. and post. arches)
Lateral mass fracture

103
Q

What is the reference or atlas fractures?

A

Mead et al., 2016

104
Q

What percentage of cervical fractures are odontoid fractures?

A

Up to 20%

105
Q

What are the types of odontoid fractures?

A

Type 1 = Tip of dens (least common)
Type 2 = Junction of dens and VB (most common)
Type 3 = Fracturing extending into C2 VB

106
Q

What is the reference for odontoid fractures?

A

Julien et al., 2000

107
Q

What movements/forces can result in traumatic spondylolisthesis of the axis?

A

Hyperextension

Axial loading

108
Q

What does a Hangman’s fracture/spondylolisthesis of axis typically involve? (Reference?)

A

Fracture of pars interarticularis on both sides of C2

Schwartz and Reisdorff. 2000

109
Q

What are the types of traumatic spondylolisthesis of the axis?

A

Type 1 = <3mm AP deviation
Type 2 = >3mm AP deviation
Type 3 = Type 1 plus bilateral facet dislocation

110
Q

What is the reference for types of traumatic spondylolisthesis of the axis?

A

Govender and Charles, 1987

111
Q

Where are flexion-compression injuries most common in the subaxial c-spine?

A

C5-C6

112
Q

When are flexion-compression injuries to the subaxial c-spine deemed stable?

A

If posterior ligaments, ALL and PLL are all intact

113
Q

What are the complications of flexion-compression injuries and fractures of the subaxial c-spine?

A

Anterior cord syndrome

Quadriplegia

114
Q

What flexion-distraction injuries are somewhat common in the subaxial c-spine?

A

Facet subluxation with posterior ligamentous sprains
Unilateral facet dislocations and facet fracture dislocations
Bilateral facet dislocations

115
Q

Where are flexion-distraction injuries of the subaxial c-spine most common? (Reference?)

A

C6-C7

Sengupta and Torretti, 2007

116
Q

What is stage 1 of subaxial c-spine extension injuries?

A

Disruption of ALL and IV disc

Abnormal disc widening

117
Q

What is stage 2 of subaxial c-spine extension injuries?

A

Posterior ligamentous disruption

Vertebral displacement into spinal canal

118
Q

How does central cord syndrome present?

A 
Weak upper limb (motor)
Sensory impairment (cape like)
119
Q

What causes the presentation of extension injuries in the subaxial c-spine region?

A

IV disc or vertebral protrusion into spinal canal

Vertebral Column (14 decks)

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