7) Cervical Spine

Question 1

Typical cervical vertebrae

Answer 1

C3-6

Small kidney shaped VB

Short pedicels pass pesterolaterally

Long narrow laminae pass posteromedially

Short bifid Spinous process

Large 🔺 vertebral foreman

Stout transverse process arising from the lateral aspect of the body of pedicel

Foreman Transversium= for the vertebral artery in each transverse process

Question 2

Articular surfaces Cx

Answer 2

Large inferior and superior articular processes which have articular facets

Direction of facets:

Superior: superoposterially

Inferior: inferoanteriorlly

Question 3

Typical thoracic vertebrae

Answer 3

T2-8

❤️ shaped VB

Short pedicels project posteriorly

Laminae project towards midline

Long spinous process slopes downwards : middle Tx spins almost vertical

Small circular vertical foreman- no need to form a plexus for peripheral nerves

Question 4

Articular surfaces Tx

Answer 4

1) Inferior Costal facets- sides of VB
2) Long thick rounded transverse process project posterolaterally and slightly upwards: costal facet on anterior surface near the tip facing anterolaterally for the tubercle of the rib

***Articular processes project almost vertically and have articular facets ⬇️

3) Superior facets are concave transversely facing posteriorly superolaterally
4) Inferior facets are convex transversely facing Anteriorly and inferomedially

Question 5

Atypical Tx

Answer 5

1

9

10

11

12

Question 6

Classification of typical Cx and Tx joints

Answer 6

Anteriorly = 2nd cartilaginous

Posteriorly= zygoapophyseal

Question 7

Static stabilisers

Answer 7

IV disc 
Anterior longitudinal ligament 
Posterior longitudinal ligament 
Intertransverse ligament
ligamentum flava 
Interspinous ligament 
Supraspinous ligament =Cx LIGAMENTUM NUCHAE

Question 8

Ligamentum nuchae

Answer 8

Midline 🔺 fibroelastic septum

= large SA for muscle attachment doesn’t limit extension = larger range

External occipital protuberance - - - - C1-7 spinous processes

Question 9

Atypical Cx vertebrae

Answer 9

C1= ATLAS: Bears very little resemblance to any other vertebra: no body or spinous process

C2 = AXIS : strongest of the cervical vertebrae has most of the features of a typical CX vertebrae

C7 = very long non-bifid process has similarities to TX vertebrae possessing a larger body and a smaller vertebral foreman

Transition point

Question 10

C1 Atlas

Answer 10

Slender anterior and posterior arches joined on each sides by a lateral mass and has articular surfaces

Superiorly + Inferiorly= articular surfaces

Transverse processes laterally= Foreman transversearium

Posterior tubercle= quite like spinous process

Large vertebral foreman for spinal cord or pass through

See file

Question 11

What’s in the Foreman transversearium

Answer 11

Vertebral vesselesnans sympathetic nerves go up to brain

Question 12

C2 Axis

Answer 12

Dens of axis= c1 c2 articulations

Small round transverse process

Bifid spinous process

See file

Question 13

Atlanto Occipital joint

Answer 13

2 Separate multiple joints

C0+C1

Synovial joint between occipital condyle on inferior aspect of skull - - - facet on superior surface of lateral mass of atlas

2 joints = single ellipsoid joint

Question 14

Atlanto Occipital joint

Static stabilisers

Answer 14

Anterior Atlanto occipital membrane

Posterior Atlanto occipital membrane

Ligamentum nuchae

Other ligaments and membranous structures passing between C2 and occipital bone of skull

Question 15

Anterior occipital membrane

Answer 15

Densely woven fibres

Thicker centrally by upward prolongation of ALL

Blends laterally with anteromedial capsule

*Anterior arch of atlas to in front of anterior margin of foreman magnum on base of skull

Question 16

Posterior atlanto occipital membrane

Answer 16

Posterior margin of foreman magnum and below ——— upper boarder of posterior arch of atlas

Blends posteriormedial joint capsule

Lateral attachment to atlas it arches over the vertebreal artery and 1st cervical nerves

Lower arch part is thickened and may ossify

1st cervical never passes posterior to atlanto occipital joint

Question 17

Ligamentum nuchae

Answer 17

🔺 midline fibroelastic septum extending upwards

Spinous process 7th cervical vertebrae attaches to ———- external occipital protuberance and crest

Deep part= posterior tub if atlas and spinous processes of all cervical vertebrae

Neck muscle attatchment without limiting extensions

Question 18

Movements at atlanto occipital joint

Answer 18

Flexion: Retraction = double chin

Extension: protraction= piking chin

20°

Lateral flexion: 8°

Question 19

Atlanto Axail joints

Answer 19

Articulation between C1 -2

Atlas and Axis

3 joints:

2 lateral= synovial plane

1 Median= synovial pivot

All produce rotation

Question 20

Static stabilisers

Answer 20

Transverse ligament

Apical ligament of Dens

Membrane rector is

Alar ligament

ALL

Anterior antlanto axail membrane

Posterior ntlanto axail membrane

Ligamentum nuchae

Ligamentum flava

Question 21

Anterior antlanto axail member

Answer 21

Lower boarder if anterior arch of C1 and upper boarder of C2

Reinforced centrally by ALL as it comes up to attatch to anterior tubercle of anterior arch of atlas

Question 22

Posterior antlanto axail membrane

Answer 22

Lower boarder of posterior arch of C1 —— upper boarder of laminae of C2

Fills gap men loses segmental level

Question 23

Transverse ligament

Answer 23

Thick strong band acting behind The dens keeps it against against anterior arch of atlas

Covered fibrocartilage

From the middle of the ligament Small tubercle
Atlas

Superior band= middle of transverse ligament ascending to attatch to the anterior edge of foreman magnum

Inferior band= lower boarder middle transverse ligament passes downwards attatch es to posterior aspect of the body of C2

2 longitudinal bands together with the transverse ligament constitute the cruciform ❌ligament of the the atlas

Question 24

Alar ligament

Answer 24

Passes obliquely superolaterally from each side of apex of dens to medial side of occipital condyle

Short strong rounded band

Rotation side flexion

Question 25

Apical ligament

Answer 25

Slender band lying immediately in front of the upper longitudinal band of the cruciform ligament stretching from the apex of the dens to the anterior edge of foreman magnum in between the diverging alar ligaments

Question 26

Tectorial membrane

Answer 26

Broad sheet fascia continuous with posterior longitudinal ligament Extends from back of the body of axis to the occupital bone within the anterior edge of the foreman Magnum as far laterally as the hypoglosdens cruciform and alar ligaments Synovial bursa Between membrane and median part of the transverse ligament of atlas Blends spinal dura matter

Question 27

What pushes dens against anterior arch

Answer 27

X

Question 28

Atlanto-Axial joint

Answer 28

ROTATION 15° each side Combination of gliding and rotational movement of the head and C1 simultaneously C2 Anterior arch of C1 and transverse ligament pivot around the stationary dens of C2 Inferior facets of the lateral masses of C1 glide over the superior facets of C2 one gliding forward and the other backwards

Question 29

Rotation + Alar ligament

Answer 29

Rotation is accompanied by slight vertical descent of the head on C to approximately 1 mm Due to orientation of the articular surfaces of the lateral atlantoaxial joints the alar ligament slacken therefore delaying their action in limiting rotation at this segmental level

Question 30

Boundaries of intervertebral foreman

Answer 30

Oval shape Pedicels of successive vertebrae above and below Vertebral bodies and discs Anteriorly Articular processes and facet joints between processes posteriorly Exciting nerve roots from each level which combine and form the brachial plexus