Cervical Spine

Question 1

How does the cervical spine differ from infancy to adulthood?

Answer 1

in infancy = neck is kyphotic/primary curvature

in adulthood = lordotic/secondary curvature

Question 2

What are the distinguishing parts of the cervical vertebrae?

Answer 2

cervical vertebra have

• foramen transversarium - holes that allow blood supply to brain
• triangular vertebral canal
• spinous processes are short and bifid (except the 7th cervical vertebra- which is very long and not bifid)

Question 3

what are the joints between vertebrae?

Answer 3

intervertebral discs- secondary cartilaginous

superior articular facet/inferior articular facet = facet joints = synovial

Question 4

which cervical vertebrae are ‘typical’

Answer 4

C3,4,5,6 are typical

Question 5

Describe the first cervical vertebrae

Answer 5

C1 = ‘atlas’ which supports the ‘globe’ of the head - it doesn’t have a body at all, it has an anterior neural arch and a posterior tubercle - it has fairly substantial transverse parts - which articulate with the occipital condyle -

Question 6

Describe the 2nd cerivcal vertebrae

Answer 6

the ‘dens’ is actuallly acting as the ‘body’ of C1 but it is actually attached to the second cervical vertebrae - you also have foramina transversarium as well for the arteries - The den’s is held in position by ‘the most important ligament in the body’ which is the transverse ligament of atlas

Question 7

what is the transverse ligament of atlas (or cruciate ligament)

Answer 7

the most important ligament in the body

• it holds the ‘dens’ in the place, keeping it from sitting on the spinal cord -

if this ligament snaps (particularly in the elderly) - it could compress the cord and the lower part of the brain stem - this is fatal if it happens.

*note it’s actually cruciate in shape, but the vertical portion of it isn’t very important other than to restrict the motion of your head*

Question 8

what ligaments prevent your head movement from left to right?

Answer 8

the alar ligaments - the vertical portion of the ‘cruciate ligament’ which is combined with the transverse ligament of atlas

Question 9

describe the ligaments of the vertebral colummn

Answer 9

• anterior and posterior longitudinal ligaments (posterior does not attach to the body of the vertebra, but anterior does)
• ligamenta flava - elastic yellow ligament (not complete, it only attaches from between each of the vertebrae- it’s elastic so when you lift yourself back up, it helps to pull you back into upright
• interspinous ligament - between each spine
• supraspinous ligament - between each spine
• between supraspinous ligament and vertebrae in the cervical spine it thickens as the ligamentum nuchae - fills in the curvature of your neck

Question 10

Whey does the posterior longitudinal ligmament not attach tot he body of the vertebrae?

Answer 10

becuase the body of the vertebrae produces blood this needs to leave the body of the vertebrae through vessels - if the posterior was fused to the body, there would be no space for these vessels to exit the body

Question 11

what are the three layers of tissue that cover the nervous system?

Answer 11

meninge

• Dura, arachnoid, and Pia

Pia is directly adherent to the surface of the spinal cord - continues all the way down to the coxcyx

Question 12

where does the spinal cord end on an adult?

Answer 12

L1- L2

Question 13

Where does the spinal cord end on a child?

Answer 13

L3-L4

Question 14

where does the subarachanoid space end on an adult?

Answer 14

S2 - important if you’re sampling for fluid b/c there is no spinal cord at this level, but there is cerebral fluid. t

Note however that babies can get meningitus- and their spinal cord ends very low, so you have to be sure to go low enough

Question 15

there are how many cervical vertebrae? How many cervical nerves?

Answer 15

7 cervical vertebrae

8 cervical nerves

*the first cervical nerve comes out above the cervical vertebrae- 8th nerve comes out below C7)

Question 16

Where do the motor roots exit the cord?

How about the sensory roots?

Answer 16

motor root =anterior

sensory root= exits posteriorly

Question 17

what does the dorsal ramus supply?

Answer 17

the erector spinae muscle and the skin above it

Question 18

what is the epidural space?

Answer 18

space between the bone and the outer layers of meninges

Question 19

• what space contains the cerebrospinal fluid?

Answer 19

the subarachnoid space between the pia and the arachanoid layer

Question 20

What is the spinal cord’s blood supply?

Answer 20

vertebral arteries come up and give off ‘spinal arteries’=- these arteries run down the length of the spinal cord and supply it with blood -

segemental arteries - tends to waiver as you move inferiorly b/c presumably your upper neck is getting enough blood from the cervical arteries - but sometimes a spinal cord is entirely reliant on these segmental arteries and you could paralyze the patient by compromising these

the artery of adamkiewicz= booster artery- branch of the segmental spinal artery and supplies lower down the column

Question 21

Describe the veins in the spinal column

Question 22

what muscles maintain the neck’s ability to raise and turn?

Answer 22

the suboccipital muscles

innervation = posterior ramus of C1

Question 23

the dorsal ramus is usually very small - what is it like in C2?

Answer 23

the dorsal ramus of C2 is rather large actually - and it can be compressed in patient with a bit of arthritis- it supplies skin of back of head and scalp so it can cause lots of headaches

Question 24

what are the contraindications of a lumbar puncture?

Answer 24

contraindicated with raised intracranial pressure

Question 25

what are the layers before you can attain cerebrospinal fluid in a lumbar punctre?

Answer 25

•Layers passed – skin, subcutaneous tissue, muscle, supraspinous ligs, interspinous ligs,+/-ligamentum flavum, dura mater, arachnoid mater

Question 26

how many cranial nerves are there?

Answer 26

12 pairs - you have to learn them all

Question 27

in general with the sympathetic nervous system, what is the organization of fibers?

Answer 27

pre-gangiolic = very long

post ganglionic = very short

Question 28

what is the organization of parasympathetc fibers?

Answer 28

come from cranial nerves- short pre-ganglionic fibers and long post-ganglionic fibers

Question 29

the lateral horn forms what?

Answer 29

the pre-ganglionic sympathetic fibers

found from T1- L2

Question 30

the cervical part of the sympathetic trunk originates from where?

Answer 30

from T1 - it originates lower and must travel up the colum to the cervical region

Question 31

What sympathetic level dilates the eye?

Answer 31

T1-T2

which is why one of the first signs of a lung tumour is a dilated pupil - becuase it interferes with the sympathetic chain in that region