Cervical And Thoracic Spine

Question 1

What are the 2 types of cervical vertebra? Which vertebrae are in each type?

Answer 1

Atypical: C1, C2, C7
Typical: C3-6

Question 2

For a typical cervical vertebra, describe the;

1. Size and shape of vertebral body
2. Vertebral foramen
3. Spinous process
4. Transverse processes and what structures pass through
5. Articular facets (in regards to coronal, axial planes)

Where do the inferior and superior articular facets face

Answer 2

1. Small and broad from side to side
2. Large triangular vertebral foramen
3. Bifid spinous process (All except C1 and C7)
4. Contain transverse foramina, artery/ vein/ nerve passing through
5. In coronal plane, at 45 degrees to axial plane

SAF: Faces upwards and backwards
IAF: Faces downwards and forwards

Question 3

Describe C1, the atlas

Describe its vertebral body, spinous process and width (Width in reference to other cervical vertebra)

Answer 3

A bony ring, consisting of an anterior and posterior arch, connected by 2 lateral masses

No Vertebral body
No Spinous Process
Widest cervical vertebra

Question 4

What 2 ligaments attach to the arches of C1 and where?

How much of the circumference of C1 is taken up by each arch

Answer 4

Anterior Longitudinal Ligament- Anterior arch- 20%

Ligamentum Nuchae - Posterior arch- 40%

Question 5

On C1, where are the articular facets

What are the articulations of the superior and inferior articular facets

Answer 5

On the lateral mass

Superior- Occiptal condyles of skull
Inferior- Superior articular facets of C2 vertebra

Question 6

On an X-ray, what is mistakenly recognised to be a spinous process on C1

Answer 6

The posterior arch

Question 7

What is the strongest cervical vertebra

In this structure, what projects vertically upwards

Answer 7

C2, the Axis

Dens OR Odontoid peg/ process (Remnant of C1’s vertebral body)

Question 8

How is the Dens/ Odointoid process held in place?

Together with this structure, what is prevented

Answer 8

By transverse ligament of atlas

Prevents horizontal displacement of atlas on axis

Question 9

What do you call excessive movement between C1 and C2, suggest 3 causes

Answer 9

Atlantoaxial instability

• Congenital
• Trauma
• Degeneration

Question 10

Which vertebra has the longest Spinous Process, what is it also called

Is the spinous process bifid or not?

What structures pass through Transverse Foramina

Answer 10

C7, Vertebra prominens, not bifid

Vertebral veins (Small foramen)

Question 11

A groove for what? Runs across the superior aspect of pedicle and between Ant./ Post. tubercles of transverse process

Answer 11

Groove for spinal nerve (Cervical region)

Question 12

In cervial and lumbar disc herniations, which nerve roots are at risk

Answer 12

Cervical: Exiting nerve root
Lumbar: Traversing nerve root

Question 13

What is the ligamentum nuchae, where does it extend to and from where?

What are its 3 functions

Answer 13

A thickening of the supraspinous ligament, from External Occipital Protuberance to Spinous process of C7

• Maintain secondary curvature of cervical spine
• Supporting weight of head
• Site of attachment for muscles in neck and trunk

Question 14

Regarding Flexion and Extension of the head, in which 2 joints does this take place?

How much in each joint

Regarding Rotation of the head, in which 2 joints does this take place?

How much in each joint

Answer 14

Atlanto-occipital joint= 50%
Facet joints between cervical vertebrae= 50%

Altlanto-axial joint= 50%
Facet joints between cervical vertebrae= 50%

Question 15

How much Lateral Flexion of the head can occur, and at what joint

Answer 15

45 degrees, at facet joints between vertebrae

Question 16

For a Thoracic vertebra, describe the;

1. Size and shape of vertebral body
2. Vertebral foramen
3. Transverse processes
4. Costal Facets on side of vertebral bodies
5. Spinous process
6. Articular facets (in regards to coronal, axial planes)

Answer 16

1. Medium sized, heart shaped vertebral bodies
2. Small, circular vertebral foramen
3. Large transverse processes, with transverse costal facets (Except T11 and T12)
4. Demi-facets (T2-T8) or Whole facets (T9-T10 only have superior)( T11 and T12 have wholefacets on pedicles) (T1 has wholefacet and demifacet)
5. Long spinous processes angled Inferiorly
6. Articular facets orientated 20 degrees to coronal plane, 60 degrees to axial plane

Question 17

In thoracic vertebrae, where do the Articular facets face

Answer 17

Superior: Face posterolaterally
Inferior: Face anteriomedially

Question 18

Describe the attachment of the ribs to the sternum/ costal cartilage

Answer 18

Ribs 1-7: Attach to sternum directly via costal cartilage

Ribs 8-10: costal cartilages attack to the CCs of the rib above them (Unite at CC7)

Ribs 11-12: Do not attach to sternum, but have a tip of Costal Cartilage at ends

Question 19

As you go from T1 to T12, how do the spinous processes change

Answer 19

Shorter, less oblique

Question 20

Where does the tubercle of the rib articulate

Answer 20

Transverse costal facet

Question 21

What movements are permitted and not permitted by facet joints of thoracic vertebra

Answer 21

Permit lateral flexion and rotation

Don’t permit flexion or extension

Question 22

In a C5/C6 Paracentral prolapse, which spinal nerve root is affected?

Answer 22

C6, as there is no traversing root in the cervical spine