CSpine Flashcards by Talia Holze

Describe three things about the atlas

no vertebral body

no IV disc

No IV foramen

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What does the transverse process run?

odontoid to the anterior arch of atlas

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How to palpate transverse process of C1

What attaches here

go to mastoid and angle of mandible and find in between

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Transverse foramen

only in the Cspine, for the vertebral artery to snake up

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IV foramen

Behind?
In front?

created by one vertebrae on top of another/two gutters (of transverse process) this is where spinal nerves sit in the gutter.

Behind: facet joints
In front: vertebral disc and bodies

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Vertebral foramen:

houses SC

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transverse ligament in relation to the SC

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Alar ligament contributes to what?

coupling behavior of C1 and C2

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What x-ray view would you look at if someone had trauma or you’re concerned about stability?

Why this view?

Lateral! this way you can see the interval between C1 and C2. If its widened (>2mm) this shows there was attenuation of the transverse ligament

C1 has slipped anteriorly causing a gap and possibly shearing the SC

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What attaches to the nuchal ligament?

trap and splenius capitis

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Where do the vertebral arteries travel?

through the transverse foramen

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Crappy vertebral artery test

end range rotation and a little extension, hold here for 20ish seconds and look fr symptoms or nystagmus.

probably poses more harm than good

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What structure is very susceptible to degenerative processes bc of its location?

the vertebral arteries traveling up the transverse foramen

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created by two gutters

IV foramen

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Where the spinal nerve actually lies

transverse process/gutter

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if the vertebral body was a rectangle what part would the articular pillar be?

posterior lateral corner

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What is a key thing that happens at the uncovertebral joint?

degenerative changes

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Unocovertebral joint is where on the uncinate process?

posterior lateral corner

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Where is the nerve in relation to the uncovertebral joint and the facet joint and pedicles?

posterior to the unocovertebral joint

anterior to the facet joint

above and below are pedicles

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Describe the location of the nerves sitting within the transverse processes

behind the uncovertebral joint

in front of the facet joints

above and below are the pedicles

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uncinate process limit what?

lateral bending

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canal narrowing is called what

stenosis

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C spine disc is mostly what in nature?

fibrous

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What part of the cspine discs are pain sensitive?

posterior 1/3

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When do cspine discs start loosing water?

20's

What are the two key functions of discs?

Stability and spacer function

What happens when you lose the spacer function of the IV disc?

you lose the vertical component to the vertebrae therefore making the IV foramen that the nerve is traveling through smaller. AND the ligaments are on slack (passive stabilizers of the system)

What is the wrinkles of the Cspine? where specifically is this most likely to occur?

transverse fissures most likely to occur/predictable feature in the posterior 1/2 of discs

Are the ligaments of the Cspine pain sensitive?

YES!

Ligamentum flavum travels where?

lamina to lamina

what travels from medial spinous process to spinous process?

interspinous ligament

Posterior spinous process to spinous process is what ligament?

Suraspinous ligament --> ligamentum nuchae

Thickening of what two structures can cause impingement of spinal nerves

Ligamentum flavum and facet capsules

Describe the predictable degenerative cascade of Cspine discs.

Dysfunction: starts in 20's Instability: 30-40's Restabilization: 50-70's

When are we most susceptible to instability in the Cspine? and why?

30-40's because there has been dysfunction due to disc changes but the body hasn't caught up to making osteophytes to try to stabilize it yet.

Before you start seeing degenerative changes what happens?

GAGS are lost

is isolated testing of the cspine musculature possible?

To assess length of the muscles how do you need to move? Why?

in 3D plane because muscles are obliquely oriented

Stretching the semispinalis

super close to midline so mostly just flexion but also a little rotation contralaterally

Stretch the SCM

chin tuck, opposite side lateral bend, ipsilateral rotation

What are like the mini splenius muscles in how you stretch them/their muscle action

Rectus capitus major and minor Flex, contralateral side bend and rotation

Action and origin and insertion of Oblique capitis inferior

rotation! Origin: spinous process of C2 , insertion is transverse process of C1

Action of oblique capitis superior

ipsilateral side bending

What are the triangular muscles critical for PT's to be thinking about?

cervicogenic HA! These are critical muscles of head posture

Where do we do the fine tuning of head positioning?

Upper C spine

Where does most rotation in the Cspine occur

50% occurs btwn C1 and C2

Where does rectus capitis major run to and from

From spinous process of C2 to occiput

Anterior border is the SCM and posterior border is upper trap are what muscles? What are their primeary action?

Scalenes Lateral bending

Where are longus coli and capitis muscles? Function?

anterior Cervical flexors but not a big moment arm, work to compress and stabilize

What are the active stabilizers of the Cspine?

muscles! just the osteoligamentous structure of Cspine will collapse under just 2.5 lbs.

Upper cervical motion is _____ relative to ____

head relative to neck

lower cspine motion is _____ relative to ______

neck relative to trunk

What moves first in flexion and extension upper or lower cspine

upper: think about nodding

True or false, the upper and lower cspine can move independently from one another as well as together?

true

Chin tuck Upper cspine Lower cspine

Upper: flexion Lower: extension

What movements have the most motion in the cspine. Where does it occur t/o? where does it peak?

flexion and extension motion is distributed t/o A lot in upper cspine as well as C4,5,6 (4,5,6 is the most common area for degeneration)

what actions does the least total motion happen with in the cspine What level does it happen the most at?

lateral bending Occurs at all levels but mostly middle of the c-spine

Where does the most rotation occur in the Cspine? Where does it minimally occur?

50% between C1 and C2 but happens at all levels Minimally at occiput and C1

Upper thoracic spine is an extension what?

lower cspine: however in thoracic flexion and extension is limited due to rib cage

what should you see with the lordosis of the spine when someone flexes their head?

curve reversal

When you flex, what happens to the inferior facet in comparison to the superior fact?

sliding up the hill

in flexion or extension is the INFERIOR facet sliding up the hill of the corresponding superior facet?

flexion

What is the motion that should be seen most at the cpspine if the individual is not unstable?

rotation rather than translation. Excessive translation is a sign of instability.

Biomechanics of flexion Upper segment rotates: anteriorly or posteriorly Slides: forward or back? IV foramen and spinal canal widen or collapse? Posterior elements compressed or tensed?

FLEXION upper segment rotates anteriorly and slides forward IV foramen and spinal canal widen Posterior elements are put on compression stress

Extension biomechanics upper segment in relation to lower segment Rotates: anteriorly, posterior? Slides: forward or back? IV foramen and spinal canal widen or collapse? Posterior elements compressed or tensed?

EXTENSION Upper segment rotates posteriorly and slides back IV foramen and spinal canal collapse Posterior elements have compression stress

What is the axis of motion in a normal neck? when does this change

posterior 1/3 of the disc this changes when there are degenerative changes

In flexion and extension as a posterior structure unit what is going on

muscles, nerves, ligaments etc are all going for the ride, its like an accordion flexion: tension extension: slack

In the LOWER cspine what motions are coupled?

lateral bending and rotation

What part of the cspine are rotation and lateral bending coupled?

Lower Cspine

Why are we able to keep our eyes facing forward when we side bend if rotation and lateral bending are coupled int he lower Cspine

upper cspine compensates and rotates the opposite direction

If a pt cannot rotate to the L what could you ask them to do to determine if its a limitation in upper or lower cspine?

have them side bend to the R, if they cannot keep their eyes forward then you know its the upper cspine limiting them because it should be compensating for the R sidebend and rotation being coupled in the lower cspine

Test to isolate the upper cspine:

flexion rotation test, maximally flex them then rotate

Vertebral body degeneration is called what?

spondylosis

At what age is spondylosis incredibly common

>age of 60

What should there be with compressive syndromes other than a radiograph that shows spondylosis we know doesn't correlate?

there should be neurologic symptoms! just pressure on a nerve doesn't hurt, it can cause numbness and parenthesia but not pain. Inflammation hurts

True or false: pain is evidence of nerve compression?

False! there need to be neurologic symptoms (parensthesia, anesthesia, loss of motor function or reflex, clonus)

What has decent correlation with degenerative changes on imaging?

someone experiencing neurological symptoms

Bright white margins on x ray you're looking at what?

subchondral sclerosis

no clear margins btwn uncovertebral bodies telling you what?

uncovertebral bodies are sclerotic

referred pain due to convergence or divergence in the dorsal or ventral gray?

Convergence in the dorsal gray matter!

Referred pain along border of scapula likely to be from what?

disc

referred pain in C5,6,7 likely to be from what?

interspinous ligaments

what is referred pain generally described as?

dull and achy, poorly localized, deep

upper cspine refers to what? lower cspine refers to what?

upper: head, neck, shoulder Lower: neck, shoulder, arm

True or false: referred pain means nerve root compression

NOOOOO. no need to focus on "decompressing" NR

You think you're on C6 and C7, what can you do to check

Ask the pt to extend, C6 should disappear with moderate extension, C7 should disappear after excessive extension.

Adams apple is what?

thyroid cartilage

+ Flexion rotation test

> 10 degrees of lost motion side to side OR | <35 degrees

What are the four classifications of neck pain

Neck pain w/ - mobility deficits - movement coordination impairment - HA - radiating pain