vertebral column of the neck

Question 1

what are the functions of the vertebral column?

Answer 1

• muscle attachment
• mobility
• protection
• weight transfer
• haematopoiesis

Question 2

what classification of joint exists between the vertebral bodies?

Answer 2

secondary cartilagenous

Question 3

what region of the vertebral column would you find the atlas and axis?

Answer 3

cervical region

Question 4

is the curvature in the cervical region primary or secondary?

Answer 4

secondary

Question 5

what shape is the atlas C1?

Answer 5

ring shaped

Question 6

where does the atlas lie?

Answer 6

above axis

Question 7

what is the anatomy of the atlas C1?

Answer 7

transverse process
intervertebral process
anterior and posterior arches
2 thick lateral masses
groove for vertebral artery at base of posterior arch

Question 8

where are the 2 lateral masses on the atlas?

Answer 8

lie anteriorly and medially forming a bony bridge

Question 9

are the superior articular facets concave or convex?

Answer 9

concave for occipital condyles

Question 10

what is the shape of the inferior articular facets?

Answer 10

round and flat for axis

Question 11

what runs within the groove of the atlas?

Answer 11

first spinal nerve runs parallel to the vertebral artery within the groove

Question 12

what is the anatomy of the axis C2?

Answer 12

Large spinous process
pedicle
dens
body 
large laminae

Question 13

what is the dens of the axis C2?

Answer 13

transverse groove which the transverse ligament of the atlas passes

Question 14

what does the axis C2 articulate with?

Answer 14

C3 vertebrae via an oblique apophyseal joint

Question 15

the angle upwards of the axis C2 is forming what?

Answer 15

pars interarticularis

Question 16

what is the anatomy of the occipital bone?

Answer 16

superior nuchal line
inferior nuchal line
external occiput protuberance
occipital condyles

Question 17

what is the midline protuberance along the superior nuchal line known as?

Answer 17

external occipital protuberance

Question 18

what is more noticeable the inferior nuchal line or the superior nuchal line?

Answer 18

superior nuchal line

Question 19

where is the inferior nuchal line?

Answer 19

between foramen magnum and superior line

Question 20

what are the occipital condyles?

Answer 20

a pair of convex oval swellings flanking the foramen magnum

Question 21

what do the occipital condyles articulate with?

Answer 21

the superior facets of the atlas

Question 22

what are the ligaments of the cranio- cervical junction?

Answer 22

anterior longitudinal ligament
interspinous ligament
tectorial membrane
small apical ligament
alar ligaments
nuchal ligament
transverse ligament

Question 23

where does the anterior longitudinal ligament extend?

Answer 23

along the ventral surface of the vertebral bodies

Question 24

what does the interspinous ligament connect to?

Answer 24

the posterior margin of the foramen magnum to the posterior arch of the atlas

Question 25

what is the tectorial membrane?

Answer 25

an extension of the posterior longitudinal ligament

Question 26

where does the small apical ligament extend to?

Answer 26

from the tip of the odontoid to the foramen magnum

Question 27

where do the alar ligaments extend?

Answer 27

from the opposite sides of the odontoid process to occipital condyles

Question 28

where does the nuchal ligament come from?

Answer 28

spinous process of C7 to the external occipital protuberance and crest

Question 29

what do the transverse ligament connect?

Answer 29

connects both lateral masses of the atlas and passes dorsal to the odontoid

Question 30

what arteries provide blood supply to the cranio-cervical region?

Answer 30

the vertebral and occipital arteries

Question 31

what arises from the vertebral arteries?

Answer 31

anterior and posterior ascending vessels

Question 32

where do the anterior and posterior ascending arteries pass?

Answer 32

pass ventral and dorsal to the body of the axis and the odontoid process, and in apical arcade in the alar ligament

Question 33

what is the most mobile area of the spine and of the axial skeleton?

Answer 33

the cranio-cervical junction

Question 34

the complex bony features, ligaments and joint orientations of the cranio-cervical junction allows what?

Answer 34

rotation, flexion, extension and lateral bending of the neck

Question 35

extensive range of motion means the cranio-cervical joint is what?

Answer 35

the joint must compromise on stability

Question 36

the cervical spine is capable of axial rotation up to what degrees?

Answer 36

90' in either direction

Question 37

the largest degree of rotation of the neck occurs at which joint?

Answer 37

the atlanto- axial joint, approx 15'

Question 38

is the atlanto- occipital joint involved in axial rotation?

Answer 38

no

Question 39

rotation of the neck is brought about by which muscles?

Answer 39

suboccipital muscles, trapezius and sternomastoid

Question 40

The transverse ligament allows what?

Answer 40

the atlas to pivot around the stationary dens

Question 41

The lateral masses of the atlas do what?

Answer 41

glide over the articular facets of the axis, 1 anteriorly, 1 posteriorly

Question 42

the alar ligaments limit what?

Answer 42

limit axial rotation

Question 43

other movements of the atlanto-axial joint are limited by what?

Answer 43

the odontoid process abutting against the margins of the atlas and transverse ligament

Question 44

25' of flexion/ extension movements of the neck occur where?

Answer 44

cranio- cervical joint

Question 45

what facilitates most of the movement of flexion and extension of the neck?

Answer 45

the atlanto-occipital articulations

Question 46

what other articulations contribute to flexion and extension of the neck?

Answer 46

atlanto- axial articulations

Question 47

what degree of movement is the atlanto- occipital joint capable of doing in flexion and extension of the neck?

Answer 47

20', by sliding of occipital condyles on lateral masses of the atlas

Question 48

flexion of the head is due to what?

Answer 48

at the atlanto- occipital articulation

Question 49

what slides posteriorly in flexion of the head?

Answer 49

occipital condyles

Question 50

where does the occiput move in flexion of the head?

Answer 50

moves superiorly away from posterior arch of atlas

Question 51

what is flexion of the head limited by?

Answer 51

the nuchal ligament and posterior suboccipital muscles

Question 52

what is the active force driving flexion in an upright position?

Answer 52

the weight of the head

Question 53

what controls the movement by acting against gravity in flexion of the head?

Answer 53

the postvertebral muscles

Question 54

what prevents head from flexing in a relaxed state?

Answer 54

neck muscle tone

Question 55

from a supine position flexion of the head is brought about by what?

Answer 55

the anterior neck muscles

Question 56

extension of the head is caused by what?

Answer 56

extension of atlanto-occipital articulation

Question 57

what occurs to the occipital condyles in extension of the head?

Answer 57

they slide anteriorly

Question 58

what happens to the occiput in extension of the head?

Answer 58

moves closer to posterior arch of the atlas

Question 59

what is extension of the head limited by?

Answer 59

collision of occiput and posterior arch of atlas

Question 60

extension of the head from upright position is controlled by what?

Answer 60

anterior neck muscles acting against weight of head like flexion

Question 61

from a prone position extension of the head is initiated by what?

Answer 61

the postvertebral muscles

Question 62

which junction is capable of a very small degree of lateral flexion of the neck, around 5'?

Answer 62

cranio- cervical junction

Question 63

what happens to the occipital condyles as the neck laterally flexes?

Answer 63

the slide laterally over the articular facets of the atlas, ipsilateral moves towards the midline, contralateral moves away from the midline

Question 64

lateral flexion of the neck is limited by what?

Answer 64

the contralateral alar ligament

Question 65

how does a dislocation of the atlanto- occipital joint occur?

Answer 65

when the ligaments and bony structures become damaged

Question 66

what is atlanto- occipital joint dislocation associated with?

Answer 66

high levels of morbidity and mortality but can be survivable due to improvements in the management

Question 67

what can occur with a atlanto- occipital joint dislocation?

Answer 67

often have some sort of neurological impairment | may cause trauma

Question 68

where is a atlanto-occipital dislocation most likely to occur? and why?

Answer 68

- in children and adolescents - more horizontal plane of the articular surfaces - ligaments being more lax - relatively large head - higher effective fulcrum in the cervical spine

Question 69

what is the diagnosis of a atlanto-occipital dislocation?

Answer 69

MRI, CT

Question 70

what is the treatment for a atlanto- occipital dislocation?

Answer 70

conservative using collars, fusion

Question 71

the atlanto- axial joint relies on what in order to limit dislocation?

Answer 71

the transverse ligament rather than the bony features

Question 72

what are the causes of a atlanto- axial dislocation?

Answer 72

trauma congenital abnormalities e.g. downsydrome inflammation e.g. rheumatoid arthritis

Question 73

what does a atlanto- axial dislocation cause?

Answer 73

type II odontoid fractures which are the most common and only type linked with this dislocation

Question 74

where does a type II odontoid fracture occur?

Answer 74

between transverse ligament and body of C2 body

Question 75

where is a atlanto- axial dislocation seen most?

Answer 75

adolescents

Question 76

what symptoms are associated with atlanto- axial dislocations?

Answer 76

numbness and weakness

Question 77

movement restrictions of numbness in the neck?

Answer 77

respiratory distress

Question 78

movement restrictions of weakness in the neck?

Answer 78

lower cranial nerve dysfunction

Question 79

diagnosis of atlanto- axial dislocations?

Answer 79

CT, MRI, radiographic measurements

Question 80

treatment for atlanto- axial dislocations?

Answer 80

surgical; fusion of atlantoaxial joint | conservative; cervical halter traction

Question 81

outcomes of atlanto- axial dislocations?

Answer 81

sudden death, neurological impairements

Question 82

what is Rheumatoid arthritis?

Answer 82

an inflammatory process affecting the joints and ligaments in the cervical spine

Question 83

in relation to Rheumatoid arthritis destructive changes are more pronounced where?

Answer 83

at the occipitoatlantoaxial junction

Question 84

when does Rheumatoid arthritis occur?

Answer 84

usually occur in those who have had arthritis for 10 or more years, can be asymptomatic for many years

Question 85

diagnosis of Rheumatoid arthritis?

Answer 85

CT, MRI, plain radiographs

Question 86

treatment of Rheumatoid arthritis?

Answer 86

regular radiographic follow up, surgical intervention- fusion