Ligaments that attach to the typical cervical spinous process
the interspinous ligament and ligamentum nuchae
What forms the anterior boundary of a typical cervical intervertebral foramen?
the lateral groove and vertebral body of the segment above, the uncinate process and vertebral body of the segment below, the intervertebral disc and the posterior longitudinal ligament
Posterior boundary of a typical cervical intervertebral foramen
the inferior articular process (post-zygapophysis), the superior articular process (pre-zygapophysis), the capsular ligament and the ligamentum flavum
Superior boundary of a typical cervical intervertebral foramen
inferior vertebral notch or inferior vertebral incisure
Inferior boundary of a typical cervical intervertebral foramen
the superior vertebral notch or superior vertebral incisure
The unique anterior boundary of the intervertebral foramen for the C4 spinal nerve
the lateral groove of C3 and uncinate process of C4 forming the joint of Luschka
Name of first cervical vertebra
atlas
Features missing on C1
vertebral body, pedicles, a spinous process and the intervertebral disc
Represents the pedicle at C1
anterior arch
Osseous modification on the front of the anterior arch of C1
anterior tubercle
muscle that attaches to the anterior arch of C1
longus colli
Ligaments that attach to the anterior arch of C1
anterior longitudinal, anterior atlanto-occipital and anterior atlanto-axial ligaments
Joint classifications found on anterior arch of C1
fibrous (amphiarthrosis) syndesmosis joint and synovial pivot (diarthrosis trochoid) joint
Morphology of the superior articular facet of C1
elliptical, closer together in front and often demonstrate an elevation subdividing the facet surface into two separate surfaces
orientation of the superior articular facet of C1
backward, upward, medial (BUM)
Joint classification of the atlanto-occipital zygapophysis
synovial (diarthrosis) ellipsoidal joint
morphological characteristics of the inferior articular facet of C1
backward, medial, downward (BMD)
joint classification of the atlanto-axial zygapophysis
synovial plane (diarthrosis arthrodia) joint
Muscles that attach to the lateral mass of C`
levator scapula, splenius cervicis and rectus capitis anterior
contribution of the posterior arch of the circumference of C1
about forty percent
Part of C1 that represents the spinous process
posterior tubercle of the posterior arch
Distance from the posterior tubercle of the posterior arch to the skin in each gender
Males: 50 millimeters
Females: 37 millimeters
What attaches to the posterior tubercle of the posterior arch of C1?
rectus capitis posterior minor muscle and ligamentum nuchae
Attachments to the arcuate rim of C1
posterior atlanto-occipital ligament
What atypical bone classification is ossification of the free margin of the posterior atlanto-occipital ligament?
accessory bone
earliest age of development where ossification of the anterior free margin of the posterior atlanto-occipital ligament was observed
about 7 years old
Based on the amount of ossification of the anterior free margin of the posterior atlanto-occipital ligament what structures will form?
an incomplete ponticulus posticus or a complete ponticulus posticus
Attachment sites of the ponticulus posticus
it is attached to the arcuate rim of the posterior arch of atlas and to the superior articular process of the lateral mass of atlas
Ethnic populations who have a ponticulus posticus
all ethnic populations studied thus far
Percentages of incidence of ponticulus posticus’
1-41%
Gender bias associated with ponticulus posticus
female
Incidence of a complete ponticulus posticus versus an incomplete ponticulus posticus
complete ponticulus posticus 15%;
incomplete ponticulus posticus as high as 41%
What is observed on the undersurface of the posterior arch of C1?
“Inferior vertebral notch” and an attachment site for the posterior atlanto-axial ligament
Location of the “zygapophysis” relative to the atlanto-occipital and atlanto-axial intervertebral foramina
forms part of the anterior boundary of the intervertebral foramen in both cases
Osseous parts of the transverse process of C1
Costal element, posterior tubercle, true transverse process
Osseous parts of the transverse process that are absent from C1
anterior tubercle and costotransverse bar
Suboccipital muscles known to have fascial projections attaching to the spinal dura
rectus capitis posterior minor, rectus capitis posterior major, obliquus capitis inferior
Connections between sub occipital muscles and the spinal dura
myodural bridges
what are the lateral bridges of atlas connected to?
the lateral mass and the transverse process of atlas
What forms of the lateral bridges are observed in the population
incomplete lateral bridges and complete lateral bridges
Opening identified when a complete lateral bridge is formed
the retrotransverse foramen
Possible contents of the retrotransverse foramen
Vertebral artery and a branch from the sub occipital nerve and veins communicating with the venous sinuses of the neck
Which of the ponticles (bridges) of atlas is most numerous
ponticulus posticus
Which of the ponticles (bridges) of atlas is only observed in humans?
lateral bridges
What is in the transverse foramen of C1
- Vertebral artery
- Vertebral venous plexus
- Postganglionic sympathetic motor nerve fibers
Gender variation of measurements of the transverse diameter of C1?
Males: 78 millimeters
Females: 72 millimeters
Distance from the posterior tubercle of the transverse process of C1 to the skin for each gender
a little over 30 millimeters for both males and females
Joint classifications observed at C1
fibrous (amphiarthrosis) syndesmosis joint, synovial (diarthrosis) ellipsoidal joint, synovial pivot (diarthrosis trochoid) joint and synovial plane (diarthrosis arthrodia) joint
How many synovial joint surfaces are observed at C1?
5
Synovial joint surfaces observed at C1?
two superior articular facets, two inferior articular facets and the fovea dentis
Names given to C2
Axis or epistropheus
Unique vertebral body modification on C2
dens or odontoid process
Number of joint surfaces present on the odontoid process of C2
five
Joint surfaces present on the odontoid process of C2
- Facet for fovea dentis
- Groove for transverse atlantal ligament
- Attachment sites for the alar ligaments
- Attachment site for the apical-dental ligament
Joint classifications represented at the odontoid process of C2
fibrous (amphiarthrosis) syndesmosis and synovial pivot (diarthrosis trochoid) joints
Name/classification given to the odontoid process when the tip of the dens is directed posterior
lordotic dens
Name/classification given to the odontoid process when the tip of the dens is directed anterior
kyphotic dens
Number of joints formed by the inferior part of the vertebral body of C2
five
Joint classifications present at the inferior part of the vertebral body of C2
fibrous (amphiarthrosis) syndesmosis, modified synovial saddle (diarthrosis cellar) and cartilaginous (amphiarthrosis) symphysis
What ligament will represent the cranial continuation of the posterior longitudinal ligament?
membrana tectoria
Ligament that forms the anterior boundary for the spinal canal above C2
membrana tectoria
Ligament that forms the anterior boundary for the spinal canal below C2
posterior longitudinal ligament
Location of the superior vertebral notch of C2
on the lamina-pedicle junction
What attaches to the lamina of C2?
- Obliquus captifs inferior muscle
- Posterior atlanto-axial ligament
- Ligamentum flavum
What muscle attaches to the lamina of C2?
Obliquus capitis inferior
What is the appearance of the superior articular facets of C2?
they are asymmetrical and slightly convex
What is the facet orientation of the superior articular facet of C2?
Backward, upward, and lateral (BUL)
What is the orientation of the inferior articular facets of C2
forward, lateral and down (FoLD)
Muscle that attaches to the articular processes of C2
longissimus crevicis
Osseous parts of the typical cervical transverse process that are absent at C2
Anterior tubercle and costotransverse bar
What is observed in the transverse foramen at C2
- Vertebral artery
- Vertebral venous plexus
- Postganglionic sympathetic motor nerve fibers
Characteristic appearance of the C2 spinous process in humans
bifid
Location for palpation of the spinous process of C2
In the midline, about two inches below the external occipital protuberance
Ligaments attached to the spinous process of C2
ligamentum nuchae, interspinous ligaments
Names given to C7
vertebra prominens and vertebral prominence
Name given to the topographical elevation observed at the base of the neck
vertebral prominence
Name given only to C7
vertebra prominens
Percentages of men and women that have C7 as the vertebral prominence
Men: 86%
Women: 79%
Segment and gender bias for vertebrae other than C7 becoming the vertebral prominence
C6 more common in women
T1 more common in males
Number of joint surfaces present on vertebral body of C7
eight
Joint classification are observed at the vertebral body of C7
fibrous (amphiarthrosis) syndesmosis, cartilaginous (amphiarthrosis) symphysis and modified synovial saddle (diarthrosis sellar) joint
Synovial joint surfaces observed at the vertebral body of C7
right and left uncinate processes
Muscles attached to the vertebral body of C7
longus colli muscle
Features are typically present in the transverse foramen of C7
vertebral venous plexus, postganglionic sympathetic motor fibers
Angulation of the articular facet at C7
more vertical at about 63 degrees
Orientation of the superior articular face of C7
backward, upward, medial (BUM)
Orientation of the inferior articular facet of C7
forward, medial, downward (ForMeD)
Features of the spinous process of C7
long, horizontal, nonbifid
Ligaments attaching to the spinous process of C7
Ligamentum nuchae and interspinous ligaments
Which vertebral artery is typically larger
Left
Gender bias regarding size of vertebral artery
Men have larger vertebral arteries
Name of physical exam used to determine vertebral artery patency
Vertebrobasilar artery insufficiency test
Which side artery was tested during the course of vertebrobasilar artery insufficiency exam
Ipsilateral artery on side of rotation
Symptoms of failure of vertebral artery to compensate during vertebrobasilar artery insufficiency exam
Dizziness, vertigo, nausea
What vertebral level will the vertebral artery first become located in transverse foramen
C6
What location will vertebra artery form its first compensatory loop
Atlanta-axial interspace
What location will vertebral artery form its second compensatory loop
Atlanto-occipital interspace
What segments will vertebral artery be firmly attached to transverse Foramen
Both C1 and C2
Purpose of vertebral artery looping between C2, C1, and occipital
Increased length will accommodate greater rotation at these locations
What happens to vertebral artery after it enters the subarachnoid space at C1
Ascends along MO to pontine-medullary junction where the R and L arteries unite to form the basilar artery
Which suboccipital muscles attach to C1
RCP minor
Obliquus capitis superior and inferior
Which suboccipital muscles attach to C2
RCP major, Obliquus capitis inferior
What joint classifications are present at C1
Synovial ellipsoidal
Synovial pivot
Synovial plane
Fibrous syndesmosis
What joint classification present at C2
Synovial pivot Synovial plane Modified synovial saddle Fibrous syndesmosis Cartilaginous symphysis
Joint classifications present at each typical cervical
Synovial plane
Modified synovial saddle
Fibrous syndesmosis
Cartilaginous symphysis
Joint classifications present at C7
Synovial plane
Modified synovial saddle
Fibrous syndesmosis
Cartilaginous symphysis
What forms boundaries for exit of C1 nerve from spinal canal
Occipital condyle Superior articular process of C1 Capuslarligament Arcuate rim Groove for vertebral artery Posterior Atlanto-Occipital ligament
What forms the anterior boundary for C2 nerve exit from spinal canal
Inferior articular process of C1 Superior articular process of C2 Capsular ligament Inferior vertebral notch of C1 Superior vertebral notch of C2 Posterior arch of C1 Lamina of C2 Posterior atlanto-axial ligament
What forms the anterior boundary for the C2 nerve exit from spinal canal
Inferior articular process of C1
Superior articular process of C2
Capsular ligament
What forms the posterior boundary for the C2 nerve exit from the spinal canal
Posterior arch of C1
Lamina of C2
Posterior atlanto-ligament
What forms the anterior boundary for the C3-C7 nerve exit from the spinal canal
Vertebral bodies IVD PLL Uncinates Lateral groove
What forms the anterior boundary for C8 nerve exit from spinal canal
Vertebral bodies of C7 and T1 IVD PLL Capsular ligament of costocentral joint Superior costal facet of T1 Articular surface of the first rib
Superior articular facet orientations for cervical vertebrae
C1 is BUM
C2 is BUL
C3-C7 is BUM
Inferior articular facet orientations for cervicals
C1 is BMD
C2-C6 is FoLD
C7 is ForMeD
How many synovial joints are ID’d for each cervical
C1 = 5 C2 = 8 C3-C6 = 8 C7 = 6
How many joints are ID’d at vertebral body of each cervical
C1 = 0 C2 = 10 C3-6 = 10 C7 = 8