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Anatomy of cervical spine

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Anatomy of cervical spine

  2. 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. 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. 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. 5. Sagittal Plane Curves • Primary Curves • Secondary Curves
  6. 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. 7. Sagittal Plane Curves Cervical Lordosis 20°- 40° Thoracic Kyphosis 20°- 40° Lumbar Lordosis 30°- 50° Sacral Kyphosis
  8. 8. Cervical Spine Anatomy • Primary function –Mobility, support, and protection of spinal cord and nerve roots.
  9. 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. 10. Cervical vertebrae 2 TYPES Atypical Axis Atlas C 7 Typical C 3-6
  12. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 24. JOINTS
  25. 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. 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. 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. 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. 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. 30. Cervical Spine Anatomy • Ligaments – The cervical spine also features a complex arrangement of ligaments to supplement its structure and mobility
  31. 31. Ligaments – Anterior longitudinal ligament – Posterior longitudinal ligament – Ligamentum flavum – Intertransverse ligaments – Interspinous ligaments – Ligamentum nuchae
  32. 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. 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. 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. 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. 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. 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.
  39. 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. 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. 41. Intervertebral Disc • Nucleus Pulposus - Inner structure - Gelatinous - High water content - Resists axial forces Nucleus Pulposus
  42. 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.
  44. 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. 45. Thereare26muscles intheneck-- 10pairs of2 and 2 setsof3, tobe precise. - Sterncleidomastoid - Trapezius - Scalenes - Platysma - Splenius capitis - Digastric - Omohyoid - Sternohyoid - Sternothyroid - Mylohyoid - Stylohyoid - Geniohyoid - Thyrohyoid
  47. 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. 48. TRAPEZIUS
  49. 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. 50. SCALENIUS
  51. 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. 52. PLATYSMA
  53. 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
  55. 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. 56. DIGASTRIC
  57. 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. 58. OMOHYOID
  59. 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. 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. 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. 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. 63. Others Muscles of Neck
  64. 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. 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. 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. 67. Spinal Nerve Topography 31 pairs of spinal nerves • 8 cervical • 12 thoracic • 5 lumbar • 6 sacrococcygeal
  68. 68. Spinal Nerves Spinal Epidural cord space Dura mater and Arachnoid layers Dorsal root Subarachnoid space Dorsal root ganglion Ventral Peripheral root nerve
  69. 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. 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. 71. TheCervical Plexus
  72. 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. 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. 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. 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. 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. 77. Thank You!