C & T Spine

Question 1

Defining features of the c-spine

Answer 1

• 2 projections on spinous process
• 2 projections of TV process
• TV foramen
• Small

Question 2

Where are the lamina and pedicle

Answer 2

• Pedicle attached to body

- Lamina near the spine

Question 3

Joints of the C-spine

Answer 3

• Atlanto-occipital
• 2 Lateral atlantoaxial
• Medial atlantoaxial
• Uncovertebral joint
• Facets
• Intervertebral joint

Question 4

How the facets of the c-spine face

Answer 4

• Superior: post sup/med
• Inferior: ant inf lat

When looking sideways, ~45 degree orientation

Question 5

Describe the special “Intervertebral joints” of the c-spine

Answer 5

• Uncinate joints

- The vertebral bodies superiorly have a raised lip

Question 6

The uncovertebral joints serve to:

Answer 6

• Guide flex/ext
• Reduce side bending
  Prevent post translation of neighbouring vertebrae
• Reinforce the vertebral disk

Question 7

Defining features of C1

Answer 7

• Atlas
• An anterior and posterior arch, connected by lateral masses
• Has a TV foramen
• Posterior side of superior articular facets have a grove for the vertebral artery

Question 8

Defining features of C2

Answer 8

• The dens, which has the anterior articular facet

Question 9

Describe the C0/1 joint

Answer 9

• Atlanto-occipital
• Between the superior articular facets of C1 and the occipital condyles of the skull
• Synovial joints
  Has a fibroadipose meniscoid between the joints
• Has translation/gliding like the knee and shoulder
• 50-60% flex/ext occurs here

Question 10

Describe the C1/C2 joint

Answer 10

Lateral(s)
- At a slight angle allowing for lots of rotation

Medial

• Between dens and anterior arch of C1
• Pivot joint

Question 11

Movement at the atlanto-axial joint

Answer 11

• 50-60% of total rotation of c-spine

- Limited amount of flex/ext and lateral bending

Question 12

Movement of the c-spine below C2

Answer 12

• flex/ext, most at C4/5
• Lateral flexion, most between C2-5
• Axial rotation throughout

Question 13

Anterior longitudinal lig (describe + attachments)

Answer 13

• Broad fibrous band
• Occipital bone to sacrum
• Most developed in lordotic areas
• Taut in ext.

Question 14

Post. longitudinal ligament (describe, thickness)

Answer 14

• Posterior of vertebral bodies, anterior canal
• Narrow fibrous band
• Well developed in kyphotic regions
• Taut in flexion

Question 15

The 3 ligaments of the spinous processes

Answer 15

Ant -> post

• Ligamenta flava (between lamina)
• Interspinous lig (between spinous processes)
• Supraspinous ligament (on top of spinous processes

Question 16

Ligament between lamina

Answer 16

Ligamentum flava

Question 17

Describe the ligament between TVP

Answer 17

• Intertransverse ligament
• Increase in size as you move inferiorly
• Blends with surrounding musculature
• Taut when bending away

Question 18

Special ligament of the post. neck

Answer 18

Nuchal ligament

• A cervical extension of the supraspinous ligament
• Attached to EOP
• Limits flexion, also a point of attachment for muscles

Question 19

Ligaments of C0-C2

Answer 19

• Alar ligaments
• TV ligament of atlas
• Tectorial membrane
• Posterior atlantooccipital membrane
• Apical ligament of dens

Question 20

Alar ligaments

Answer 20

• Runs from lateral dens to occipital condyle
• About 1 cm long, about the width of a pencil
• Taut during front and side flexion, rotation
• Along with TV ligament of atlas, serves to prevent separation of C1/C2

Question 21

TV ligament of atlas

Answer 21

• Along with alar ligaments, serves to prevent separation of C1/C2

Question 22

Extension of post longitudinal lig

Answer 22

Tectorial membrane

Question 23

Extension of ligamenta flava

Answer 23

posterior atlanto-occipital membrane

Question 24

4 parts of the vertebral artery

Answer 24

• Proximal
• Transverse
• Suboccipital
• Intracranial

Question 25

Proximal aspect of vertebral artery

Answer 25

- Runs vertically, and slightly medially/posteriorly to entry point - Along it's course, it lies between the longus colli and the anterior scalene - Typically enters the TV foramen at C6, but this can vary from C3-7, and can vary side to side on an individual

Question 26

Transverse aspect of the vertebral artery

Answer 26

- Runs through TV foramen - Surrounded by periosteal sheath attached to canal boundaries - At C2, the artery must run slightly laterally as the TV foramen of C1 is lateral to C2

Question 27

Suboccipital aspect of the vertebral artery

Answer 27

- Once outside of C1 TVP, wraps around groove on superior facet, then runs ant/med/sup to enter foramen magnum

Question 28

Intracranial

Answer 28

Now becomes the intercranial vertebral artery, then meets to form the singular basillar artery at the base of the medulla oblongata

Question 29

Where the vertebral artery is susceptible to damage

Answer 29

- C1/2 due to amount of rotation, how it needs to wrap around sup. facet - Extension - Stenosis or narrowing, where a flap-like tear can develop in the arterial wall, leading to the formation of a hematoma

Question 30

Where the head of the rib meets the body of spine

Answer 30

Costovertebral joint

Question 31

Where the neck of the rib articulates with the spine

Answer 31

Costotransverse joint

Question 32

Z-joints of the T-spine

Answer 32

- Increase in angle as you go down (45/60 at top - 90 at bottom) - Superior facets of T-spine are directed posteriorly and slightly laterally, inferior is the opposite

Question 33

Movement of the T-spine

Answer 33

- flexion/ext greater in lower t-spine due to coronal orientation in upper spine - Lateral flexion and rotation limited due to rib cage