1.
ANATOMY OF
CERVICAL
SPINE
Dr. MD. NURNOBI HOSSAIN
IMO[Orthopaedics and Traumatology]
KHWAJA YUNUS ALI MEDICAL COLLEGE AND HOSPITAL

2.
SPINAL COLUMN
Spinal column is also
known as Back bone which
is made up of 33 bones
stacked on top of another
called the vertebrae. The
length of vertebral column
: averages 72 cm in
men and 7 to 10 cm less in
women.

3.
Regions of the Spine
• Cervical
- Upper cervical: C1-C2
- Lower cervical: C3-C7
• Thoracic: T1-T12
• Lumbar: L1- L5
• Sacrococcygeal: 9 fused
vertebrae in the sacrum and
coccyx.

4.
ANATOMY OF VERTEBRAL COLUMN
Vertebral column -33 vertebrae divided into five sections
 Cervical- Seven
 Thoracic- Twelve
 Lumbar- Five
 Sacral- Five
 Coccygeal- Four
vertebral body increases in size from cranial to
caudal.

5.
Sagittal Plane Curves
• Primary Curves • Secondary Curves

6.
• The thoracic and sacral segments
maintain kyphotic postures found in
utero- attachment points for the rib cage
and pelvic girdle.
• The cervical and lumbar segments
develop lordosis as erect posture is
acquired.

7.
Sagittal Plane Curves
Cervical Lordosis 20°- 40°
Thoracic Kyphosis 20°- 40°
Lumbar Lordosis 30°- 50°
Sacral Kyphosis

8.
Cervical Spine Anatomy
• Primary function
–Mobility,
support, and
protection of
spinal cord and
nerve roots.

9.
Cervical Spine Anatomy
• Vertebrae (7)
• Intervertebral discs (6)
• Pairs of exiting nerve
roots (8)
• Cervical lordosis Occ-C7
averages 40°
– Most of the lordosis occurs
at the C1-C2 segment
1
2
3
4
5
6
7

10.
Cervical vertebrae
2 TYPES
Atypical
Axis
Atlas
C 7
Typical
C 3-6

11.
A TYPICAL CERVICALVERTEBRA

12.
CERVICAL VERTEBRAE
 small size
 Foramen Transversarium in trough transverse process for
the passageof the vertebral artery and veins
 verterbral artery passes through the transverse process of C1 to C6
not C7.
 The vertebral body is short in height ,square shaped when
viewed from above -- concave superior surface and a convex
inferior surface
 spinous process is short and bifid
 vertebral foramen is triangular
and large

13.
ATYPICAL CERVICAL VERTEBRAE
• The first , second and seventh cervical vertebrae
• The first and second cervical vertebrae- the atlas and
axis-
specialized to accommodate movement of the head.
• The seventh cervical vertebrae – (vertebrae
prominens ) named cos it had the longest spinous
process, and its not bifid .

14.
The Atlas (C1)
Anterior
Tubercle
Transverse
Process
Transverse
Foramen
Posterior
Tubercle
Superior View
Articular Facet
for Dens
Superior
Articular
Facet
Lateral
Mass
Lamina

15.
Atlas
…Doesn’t Have body
&spinous process
…Its ring-like, has anterior and
a posterior arch and two
lateral masses.
…Each lateral mass has
superior articular
facet&inferior articular facet.
… Superior articular facet
articulate with occipital
condoyle- atlanto-occipital
joint.
…Inferior articular facet
articulate with axis superior
facet -atlanto-axis joint.
…Transverse process project
laterally from lateral mass
which is pierced by foramen
transversorium

16.
Atlas
…The vertebral body of C1
fuses onto the body of C2
during development to
become the dens of CII.
As a result, there is no
intervertebral disc between
Atlas and Axis.
…
…
…

17.
The Axis (C2)
Lateral
Body
Inferior
Articular
Facet
Anterior View
Odontoid
Process
(Dens)
Superior
Articular
Facet
Transverse
Process
Mass
Spinous
Process
Posterior View

18.
AXIS
…The second cervical
vertebra
(C2) of the spine is
named the axis
…The most distinctive
characteristic
of this bone is the
strong odontoid
process ("dens") which
rises perpendicularly
from the upper surface
of the body

19.
…Dens provide attachment at its apex to apical
ligament& on each side to alar ligament.
…Anterior surface of body gives attachment to
ant. Longitudinal ligament.
…Posterior surface of body gives attachment to
vertical limb of cruciate ligament , membrana
tectoria, post.longitudinal ligament.

20.
Cervical Vertebrae C3 – C6
Sulcus for
Spinal Nerve
Transverse
Body Process
Transverse
Pedicle
Lateral
Mass
Lamina
Axial View
Foramen
Superior
Articular Facet
Vertebral
Foramen
Bifid Spinous Process

21.
C3-c6 vertebra
… The body of these four vertebrae is small, and
broader from side to side than from front to back.
… The pedicles are directed laterally and backward,
and are attached to the body midway between its
upper and lower borders, so that the superior
vertebral notch is as deep as the inferior.
… The laminae are narrow, and thinner above than
below; the vertebral foramen is large, and of a
triangular form.
… The spinous process is short and bifid, the two
divisions being often of unequal size.
… The superior and inferior articular processes of
neighbouring vertebrae often fuse on either or
both sides to form an articular pillar, a column
of bone which projects laterally from the junction
of the pedicle and lamina.
… The transverse processes are each pierced by
the foramen transversorium, which, in the upper six
vertebrae, gives passage to the vertebral
artery and vein, as well as a plexus of sympathetic
nerves. Each process consists of an anterior and a
posterior tubercle. These two parts are joined, outside

22.
Vertebra Prominens (C7)
C7 is referred to as the VERTEBRA
PROMINENS because it has a longer
and larger spinous process than the
other cervical vertebrae.
This spinous process is not usually bifid.
C7 may possess a cervical rib
Spinous
Process
Axial View

23.
The Motion Segment
• The FUNCTIONAL UNIT of the spine
• Composed of:
- Two adjacent
- The intervertebral disc
– Connecting ligaments
- Two facet joints and
capsules

24.
JOINTS

25.
Occipitocervical Joint
Occipital
Condyles
Foramen
Magnum
articulate with
C1 superior
facets
The atlanto-occipital joint (synovial joint) allows the head to nod up
and down on the vertebral column.
Motion at the occiput-C1 segment is restricted primarily to flexion-
extension due to bony structures, ligamentous constraints, and the
absence of an intervertebral disc

26.
Atlantoaxial Joint
Dens
JOINT between the atlas (C1) and the
axis (C2); has a range of motion in the
transverse plane for rotation.
The DENS of C2 acts as a
pivot point for the rotation of
C1.
The articulating surfaces of the two
vertebrae form ZYGAPOPHYSEAL
(FACET) JOINTS that allow flexion-
extension, side bending, and
rotational movements.
C1
C2
Zygapophyseal
joints

27.
The Facet Joints
Also called ZYGAPOPHYSEAL JOINTS.
The facet joints are formed by the
articular processes of adjacent vertebrae.
The inferior articular process of a vertebra
articulates with the superior articular
process of the vertebra below.
These are synovial gliding joints
Facet joints are oriented in different
planes depending on their anatomic
location.

28.
Uncovertebral Joints
Uncovertebral
The bony elevations on the
superior lateral margins of the cervical
vertebrae are called UNCINATE
PROCESSES.
These joints articulate with the
inferior, lateral aspect of the vertebra
above to form the UNCOVERTEBRAL
JOINTS, also known as the JOINTS
OF LUSCHKA. These are fibrous joints
The uncovertebral joints are not true
joints
JointUncinate
Process

29.
Movements of Joints
• Approximately 50% of flexion-
extension motion occurs at
occiput-C1
• Approximately 50% of rotation
occurs at C1-C2
• Lesser amounts of flexion-
extension, rotation, and lateral
bending occur segmentally
between C2-C7

30.
Cervical Spine Anatomy
• Ligaments
– The cervical spine
also features a
complex
arrangement of
ligaments to
supplement its
structure and
mobility

31.
Ligaments
– Anterior longitudinal
ligament
– Posterior longitudinal
ligament
– Ligamentum flavum
– Intertransverse
ligaments
– Interspinous ligaments
– Ligamentum nuchae

32.
Anterior Longitudinal
Ligament (ALL)
•Extending from the axis (C2)
anteriorly to the sacrum.
•Is broader at the level of each
vertebral body than at the level of the
discs where the fibers adhere to the
annulus fibrosus.
•Attaches to each vertebral body
superiorly and inferiorly at the levels of
the end plates.

33.
• Is weaker than the ALL.
• It runs from the axis (C2) caudally to
the sacrum.
•The PLL is narrow at the levels of the
vertebrae, but the fibers extend laterally at
the disc levels. These fibers may help to
contain herniated disc material.
•Like the ALL, the PLL is attached to
the vertebra at the superior and inferior
margins, and to the annular fibers of the
intervertebral disc.
Posterior longitudinal ligament
Posterior longitudinal ligament

34.
LIGAMENTUM FLAVUM
Also called the YELLOW
LIGAMENT
Consists of elastic fibers
oriented vertically that extend from
the anterior inferior surface of the
lamina above to the superior
posterior surface of the lamina
below.
The ligamentum flavum tends to
thicken as it progresses down the
spine, beginning at the axis (C2)
and extending to the sacrum.
Ligamentum
flavum

35.
Intertransverse
Costal
ligaments
The INTERTRANSVERSE
LIGAMENTS extend from the
inferior surface of the entire
length of the transverse process
to the superior surface of the
adjacent transverse process.
Intertransverse

36.
THE LIGAMENTUM NUCHAE
• is a triangular,
• sheet-like structure in the median sagittal plane:
• base :attached to the skull, from the external occipital protuberance to the
foramen magnum
• apex :attached to the tip of the spinous process of vertebra CVII
• the deep side of the triangle is attached to the posterior tubercle ofvertebra
CI and the spinous processes of the other cervical vertebrae.
• supports the head and resists flexion and facilitates returning the head to
anatomical position.

37.
INTERSPINOUS LIGAMENTS
• pass between adjacent vertebral
spinous processes
• They attach from the base to the
apex of each spinous process and
blend with the supraspinous
ligament posteriorly and the
ligamenta flava anteriorly on each
side.

38.
INTERVERTEBRALDISC

39.
Intervertebral Disc
• Fibrocartilaginous joint of the
motion segment
• Make up ¼ the length of the
spinal column
• Present at levels C2-C3 to L5-
S1
• Allows compressive, tensile,
and rotational motion
• Largest avascular structures
in the body

40.
Intervertebral Disc
Annulus
• Annulus Fibrosus
- Outer portion of the disc
- Made up of lamellae
• Layers of collagen fibers
• Arranged obliquely 30°
• Reversed contiguous
layers
- Great tensile strength
Fibrosus

41.
Intervertebral Disc
• Nucleus Pulposus
- Inner structure
- Gelatinous
- High water content
- Resists axial forces
Nucleus
Pulposus

42.
Intervertebral Disc
Blood Supply
•Intervertebral discs have no
significant vascular structures.
•They receive their blood supply by
diffusion through the vertebral body
endplates.
• A network of vessels located
centrally in the endplate allows
nutrients to diffuse into the nucleus
pulposus and annulus fibrosus.

43.
MUSCLES OF NECK REGION

44.
Neckmuscles are
amazing.Theyare
responsible forhead
movement, stabilizing the
upper region of the body,
assisting in swallowing,
helping to elevate the rib
cage during inhalation, and
more.
Let’s take a look!

45.
Thereare26muscles intheneck--
10pairs of2 and 2 setsof3, tobe
precise.
- Sterncleidomastoid
- Trapezius
- Scalenes
- Platysma
- Splenius capitis
- Digastric
- Omohyoid
- Sternohyoid
- Sternothyroid
- Mylohyoid
- Stylohyoid
- Geniohyoid
- Thyrohyoid

46.
STERNOCLEIDOMASTOID MUSCLE

47.
STERNOCLEIDOMASTOID MUSCLE
Muscle Origin Insertion Action Nerve
Two heads:
Sternal
head –
manubrium
sterni
Clavicular head
- Medial 2/3 of
the clavicle
Mastoid
process of
the of the
temporal
bone and
lateral half
of the
superior
nuchal line.
Bilateral:
Flex the
neck
Single:
Flex the
head and
laterally
rotate to
the
opposite
side
1.Spinal
accesory
nerve
2.Anterior
primary rami
of spinal
nerves C2
and C3.
Two heads:
Sternal
head –
manubrium
sterni
Clavicular head
- Medial 2/3 of
the clavicle

48.
TRAPEZIUS

49.
TRAPEZIUS
Origin Insertion Action Nerve
External occipital
protruberance,
the medial half of
the superior
nuchal line, the
ligamentum
nuchae, and the
lower cervical
and all the
thoracic spines
Fibers originating
from the head
insert into the
lateral third of
the clavicle, and
the remaining
fibers insert into
the acromion
process and
spine of the
scapula
Contract to rotate
and elevate the
scapula. Its
cervical portion,
acting bilaterally,
can extend the
head and singly,
it can rotate the
head and face to
the opposite side
1.Spinal
accessory nerve
2.Anterior
primary rami of
the spinal nerves
C3 and C4.
15

50.
SCALENIUS

51.
Scalenius
Muscle Origin Insertion Action Nerve
Scalenius
posterior
Transverse
processes of
C5 and C6
Superior
aspect of the
second rib
Flexes the
neck
APR of C5 to
C8
Scalenius
Medius
Transverse
processes of
C2 to C7
Superior
aspect of the
first rib
Flexes the
neck
APR of C3
and C4
Scalenius
anterior
Transverse
processes of
C3 to C6
Scalene
tubercle of
the first rib
Participates
in forced
inspiration
by elevating
the ribs and
sternum
APR of C5 to
C8

52.
PLATYSMA

53.
PLATYSMA
Muscle Origin Insertion Action Nerve
Platysma Superficial
fascia of the
deltoid and
pectoral
Regions
Inferior
border of
the
mandible,
some fibers
sweep
upward and
blend with
Risorius
Stretches
tight the
skin of the
neck,
depresses
the mandible
Facial nerve

54.
SPLENIUS CAPITIS

55.
SPLENIUS CAPITIS
Origin Insertion Action Nerve
Lower part of
the ligamentum
nuchae, lower
cervical spines
Mastoid process
and the superior
nuchal line
Bilateral:
Extends the
head
Individual:
Flexes the head
laterally
Cervical spinal
nerves

56.
DIGASTRIC

57.
Digastric
Muscle Origin Insertion Action Nerve
Supply
Digastric
(Posterior
belly)
Digastric notch
of the temporal
bone at the
base of the
skull
Intermediate
tendon
Raises the
hyoid bone
Facial nerve
Digastric
(anterior
belly)
Intermediate
tendon
Digastric
fossa of the
mandible
Elevates the
hyoid bone
Nerve to the
mylohyoid
muscle
20

58.
OMOHYOID

59.
OMOHYOID
Muscle Origin Insertion Action Nerve Supply
Omohyoid Inferior belly:
Superior border
of the scapula
Superior belly:
Intermediate
tendon
Inferior belly:
Intermediate
tendon
Superior
belly:
Lower border
of the body of
the hyoid
bone
Depresses the
hyoid bone and
larynx
Ansa cervicalis
(APR of C1, C2,
C3)

60.
STERNOHYOID
Muscle Origin Insertion Action Nerve Supply
Sternohyoid Manubrium of
the sternum,
posterior
aspect
Lower border
of the body of
the hyoid bone
Depresses the
hyoid bone
and larynx
Ansa cervicalis
(APR of C1, C2,
C3)

61.
STERNOTHYROID
Muscle Origin Insertion Action Nerve Supply
Sternothyroid Manubrium of
the sternum,
posterior
aspect
Oblique line
of thyroid
cartilage
Depresses the
larynx
Ansa
cervicalis
(APR of C1,
C2, C3)

62.
Others Muscles of Neck
Muscle Origin Insertion Action Nerve Supply
Mylohyoid Mylohyoid line
on the medial
aspect of
mandibular
body
Median raphe
and body of
hyoid
Elevates the
hyoid bone,
base of the
tongue, and
floor of the
Mouth
Nerve to
mylohyoid
muscle
Stylohyoid Styloid
process
Greater horn
of hyoid bone
Elevates
hyoid bone
Facial nerve
Geniohyoid
muscle
Inferior
border genial
tubercle of
the mandible
Body of hyoid
bone
Elevates hyoid
bone, protracts
hyoid bone
APR of C1
Thyrohyoid Oblique line of
thyroid
cartilage
Body and
greater horn of
hyoid bone,
lower border
Depresses the
hyoid bone
Thyrohyoid
branch of the
hypoglossal
nerve

63.
Others Muscles of Neck

64.
Spinal Nerve Structures
Spinal Cord
• Contained in epidural space
• Network of sensory and motor
nerves
• Firm, cord-like structure
• Extends from foramen magnum to
L1
• Terminates at the
conus medularis
• The cauda equina begins
below L1
• Filum terminale extends from
conus medularis to the coccyx
Foramen
magnum
Conus
medularis
Cauda
equina

65.
• The spinal cord is enclosed
in three protective
membranes—the pia,
arachnoid, and dura mater.
• The pia and arachnoid
membranes are separated
by the subarachnoid space,
which contains
cerebrospinal fluid.

66.
SPINAL NERVES
 31 pairs of spinal
nervesattached by the
anterior ( motor ) and
posterior (sensory )
roots
 Each root is
attached bya series of
rootlets, which extend
the whole length of the
corresponding segment
of the cord.
 Each posterior
nerve root possesses
a posterior/dorsal
root ganglion, the
cells of which give
rise to peripheral and
central nerve fibers.

67.
Spinal Nerve Topography
31 pairs of spinal nerves
• 8 cervical
• 12 thoracic
• 5 lumbar
• 6 sacrococcygeal

68.
Spinal Nerves
Spinal Epidural
cord space
Dura mater and
Arachnoid layers
Dorsal root
Subarachnoid
space
Dorsal root
ganglion
Ventral Peripheral
root nerve

69.
Cervical Spine Anatomy
• Neural elements
– 8 pair of cervical
nerves
– Exit the spinal canal
superior to the
vertebrae for which
they are numbered
• C1 nerves exit the
canal between Occ
& C1
• C2 nerves exit the
canal between C1 &
C2
• C8 nerves exit the
canal between C7 &
T1

70.
Cervical Plexus
Formed by the anterior (ventral) rami of the cervical
nerves C1-C4 with contribution C5.
Supplies the skin and muscles of the head, neck and
superior part of the shoulders and chest.
Phrenic nerves arise from the cervical, innervate for
the diaphragm muscles.
Runs in series with brachial plexus on scalenus
medius under the prevertebral Fascia and upper
part of the sternocleidomastoid.

71.
TheCervical Plexus

72.
Terminal Branches
Superficial branches (Sensory)
2. Lesser occipital (C2) –skin of scalp posterior and
superior to ear.
3. Great auricular (C2-C3) –skin anterior, inferior, and
over ear and over parotid gland.
4. Transverse cervical (C2-C3) –skin over anterior
aspect of neck.
5. Supraclavicular (C3-C4) –skin over superior portion
of chest and shoulder.

73.
Transverse
Cervical nerve
C2,C3
Supraclavicular
nerve C2, C3
Greater
Auricular
nerve C2,C3
Lesser occipital
nerve C2 (ventral
rami)
Greater
occipital nerve
C2 (dorsal rami)

74.
Deep Branches (Motor)
2. Ansa cervicalis (superior root) –infrahyoid and
geniohyoid muscles of the neck.
3. Ansa cervicalis (inferior root) –infrahyoid muscles
of neck.
4. Phrenic nerve –diaphragm
5. Segmental branches –prevertebral muscles of the
neck, levator scapulae and middle fiber of scalene.
Terminal Branches

75.
Arteries of the Cranial and Cervical Region
Two VERTEBRAL
ARTERIES, one located on each
side the cervical vertebrae. These
arteries are branches of the right
Foramen
lacerum
and left subclavian vs. that exit from
aorta.
They ascend through the
transverse foramen of C6 through
C1,entering the skull through the
foramen magnum where they join
together to form the BASILAR
ARTERY.
Anterior to the cervical
vertebrae are the CAROTID
ARTERIES, which ascend through
the FORAMEN LACERUM and
join with the vertebral arteries to
form the CIRCLE OF WILLIS.
Vertebral
artery
Carotid
artery

76.
Veins of the Cervical and Thoracic Region
The most important venous structures in the
cervical spine are the internal and external
JUGULAR VEINS. The internal jugular veins follow
a path similar to the carotid arteries. They should
always be considered during any anterior cervical
spine procedure.
External
jugular
Anterior
jugular
Internal
jugular

77.
Thank You!