Week 1- Cervical Spine Anatomy & Pathology Flashcards
Compare the relevance of anatomy in acute vs chronic neck pain
Acute - Could be significant source of nociception and very relevant to treat - Requires exceptional knowledge Chronic - Becomes less relevant to pain - Knowledge is needed to test and help reassure BEFORE pain science
Characteristics of the cervical spine that make it challenging to treat
- Extreme mobility
- Complex series of joints
- Different functions of the IVD and ZPJ
- Vertebral and Carotid arteries
- Seven vertebrae and 8 nerve roots
- Close approximation to the shoulder
Upper cervical spine
C0-C2
Lower cervical spine
C3-C7
Unique characteristics of C1
- No vertebral body
- Anterior and posterior
arches - Lateral masses contain
superior and inferior
articulating facets,
both are concave
Unique characteristics of C2
- Small vertebral body
- Large bifid spinous
process
(easy to palpate) - Dens is superior
projection off
the body
Characteristics of the lower cervical vertebrae
- Small vertebral body
- Uncinate processes located on superior surface of vertebral body
What is formed by the uncinate processes?
Joints of Luschka
Where are the uncinate processes located?
C3-C7
Functions of uncinate processes
- Limit sidebending protecting cervical nerve roots
- Support intervertebral discs from protruding
- Form medial wall of the
intervertebral foramen/ canal - Become weight-bearing with age and disc dehydration
What do the uncovertebral joints combine with the ZPJs to do?
Stability, protecting the IVD from severe torsion strain
Do the ZPJs in the C spine or L spine protect the IVDs more?
ZPJs in the L spine
What categories of cervical pathology do we examine?
Pathology due to:
- Aging
- Trauma
What pathologies due to aging do we examine?
- Uncovertebral joints
- Disc changes
- Facet joint degeneration
Uncovertebral Joint Symptoms
- Very little pain – vague discomfort - Stiffness > pain - NO referred or neurological symptoms - Morning stiffness
Are uncovertebral joints potential pain generators in the cervical spine?
Yes
Uncovertebral Joint Signs
- Loss of extension
- Neck in forward flexed position
- Limited side bend in flexion,
neutral and extension - Decreased rotation
- Crepitus/”grinding”
Describe the progression of the uncus at 8 years old
Uncus grows upwards from the lateral edge of the vertebral body
When do the uncovertebral cleft appear?
By 12 years
When do fine fissures extend across the discs?
Late 20s/early 30s
Describe the progression of the disc fissuring at 35-40 years old
- Nucleus and posterior annulus usually completely fissured
- Anterior annulus and longitudinal ligaments remain intact
Describe the progression of the disc fissuring in the 50s and 60s
Disc thinning and resorption frequently seen at C5-6 or C6-7
Describe the progression of the disc fissuring in the 70s and 80s
Spontaneous fusion is common in the lower cervical levels
What happens as a result of decreasing disc height as we age?
Formation of uncovertebral osteophytes and hard posterior disc protrusions
What do these formations do to the spaces in the spine
Encroach on the intervertebral and
spinal canals
What are the implications of no nucleus in the IVD?
- No inflammatory and immune mediated chemicals to irritate the nerve roots - Lower incidence of upper cervical disc injury and radiculopathy
What are the implications of a present nucleus in the IVD?
- Contains inflammatory and immune mediated chemicals to irritate the nerve roots - Higher incidence of lower cervical disc injury and radiculopathy
Due to the disc changes from aging, what structures experience compressive effects?
- Nerve roots
- Vertebral arteries
- Spinal cord
Between the lumbar and cervical spine, where are disc lesions more common?
Cervical
Discogenic clinical presentation
- Cervical spine relatively pain- free/stiff/sore
- Deep burning, toothache pain around
the scapular border, supraspinous
fossa and scapula - Referral to the shoulder
What innervates facet joints?
- Medial branch
- Dorsal ramus
Facet Joint Symptoms
- Sharp, localized pain
- Unilateral
- Spasms
- Referral into the
UE
Facet Joint Signs
- Extension
- Rotation to the same side
- Lateral flexion to the same
side
What can cause “stuck neck” or Acute Wry Neck?
Prolonged lateral flexion to one side, characterized by sharp catching pain on one side
