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Cervical Spine Biomechanics Explained
1. Biomechanics of Cervical Spine
Biomechanics of
Cervical Spine
Presented By-Debanjan Mondal
MPT(Musculoskeletal), BPT, CMT,
Ergonomist.
2.
3. Made up of two anatomically and
functionally distinct segments.
1.Superior segment/suboccipital
segment-
-consist of c1 /atlas and c2/axis
-connected to eachother and
occiput with complex chain of joints.
-having 3 axes and 3 degrees of
freedom.
4. 2.Inferior segment-
-streching from inferior surface
of axis to the superior surface of
T1.
-In total there are 7 cervical
vertebras-
c1-c2 c3-c6
c7
5.
6. Structure of a typical cervical
vertebra
Vertebral body-superior plateau
is raised on either sides by 2
buttresses.
which is called as unciform process.
It is concave transversely and
convex anteroposteriorly-resembling
a saddle .
Unciform processes guoides the AP
movements during flexion and
7.
8. Pedicals-connects the vertebral
body to the transverse process.
Project posterolaterally.
Lamina-part of the posterior arch
Meets in the midline to form the
bifid spinous process
Projects posteromedially and are
thin and slightly curved.
9.
10. Spinous process-short slender and
extend horizontally
The tip is bifurcated
Face superiorly and medially
The length of spinous process
decreases from c2-c3
C3-c5 remains constant
And undergoes a significant increase
at c7.
Vertebral foramen –is large and
triangular
11. Transverse process
They are peculiar in
orientation
They are hollowed in to
a gutter AP and they
point AL.
The posteromedial end
of the gutter lines the
intervertebral foramen.
The AL end is bifid
12. Articular processes-they bear
superior and inferior articular facets.
Superior facets face superiorly and
medially
Inferior facets face anteriorly and
laterally
13. Structure of a atypical cervical vertebra
Atlas /c1-its ring shaped
Transverse diameter greater than AP
diameter
Has two lateral faces oval in shape
running obliquely anteriorly and
medially
Which bear biconcave superior
articulate facet superiorly and medially
meant to articulate with occipital
condyles
14. Inferior articular facet –facing
inferiorly and medially
Convex AP
Corresponds to superior facet of axis
15. Anterior arch consist of small
cartilagenous oval shaped articular
facets for the odontoid process of axis
Posterior arch is initially flattened but
becomes thicker posteriorly to form
posterior tubercle on the midline.
Transeverse process
No spinous process
No intervertebral disc
16.
17. The axis-is atypicsl
Superior surface of the body carries
centrally the odomtoid process which
acts as a pivot for atlantoodontoid
joint .
Laterally possess 2 articular facets
facing superior and laterally
Facets are convex AP and flat
transversely
Posterior arch consist of narrow
laminae
18. The cartilage lined inferior articular
process corresponds to the superior
articular process of c3
Transverse process
19. The atlanto-axial joint complex
it is a plane synovial joint
comprises of 3 mechanically linked
joints
The central joint is the atlanto
odontoid joint
Two lateral joints-atlanto axial joint
20. Atlantoodointoid joint
it is synovial trochoid /pivot joint
Jointsurfaces-anterior articular facet
of odontoid and posterior articular
facet of the anterior arch of the
atlas
21. Movements at atlantoaxial and
atlanto
odontoid joint
Flexion-point of contact b/w two
convex surface moves forward
interspace of atlanto odontoid joint
opens superiorly
22.
23. Extention
Interspace of atlanto odontoid
jointopens inferiorly
Radiological findingas does not shoe
opening of interspaces
This is due to transverse ligament and
keeps the anterior arch and odontoid
process in close contact
During flxn and extn tha inferior
surface of atlas rols and sides over
superior articular surface of axis
24.
25. rotation
Left to right rotation-
The left lateral mass of
the atlas moves forward
Right lateral mass
recedes in rotation from
left to right and vice
versa from right to left
26.
27. Movement of atlanto occipital joint
Formed b/w superior articular
facets of atlas and the occipital
condyles.
It is an enarthodrial kind of joint
Gives 3 degrees of freedom
Axial rotation-about vertical axis
Flexion/extension-about
transverse axis
Lateral flexion-about AP axis.
28. flexion
The occipital condyles
recede on the lateral
masses of the atlas.
The occipital bone
moves away from the
posterior archof the
atlas
Limited by tension
developed in the
articular capsules and
29. extension
Occipital condyles
slides anteriorly on the
lateral masses of the
atlas.
Occipital bone moves
neatrer to the posterior
arch of the atlas
Posterior arch of the
atlas and axis are
approximated
30. Lateral flexion
Movement only occurs b/w c0-c1
and c2-c3
Left lateral flexion-slipping of
occipital condyles on right of atlas
Right lateral flexion-vice versa
Ther is asmall range of motion
Total ROM-C0-C3=8 degrees
C0-C1=3 degrees,C2-C3=5
degrees
31. rotation
When occiput rotates on atlas its
rotation is secondary to rotation of
atlas on axis
Around vertical axis passing
through the centre of odontoid
Causes right anterior displacement
of oright occipital condyle on right
lateral mass of the atlas
Lateral atlanto occipoital ligamenr is
32. Thus rotation of occiput to left is
associated with –
Linear displacement of 2-3 mm to the
left
Lateral flexion to the right
33. Movements at the lower cervical
vertebral column
Extension-ovrlying
vertebral body tilts and
slides posteriorly
IV space is compressed
posteriorly and opened
wide anteriorly
Nucleus palposus is driven
slightly anteriorly
Anterior fibers of annulus
fibrosus is streched
34. Superiorly articulating facet slides
inferiorly posteriorly and tilts posteriorly
Limited by anterior longitudinal ligament
and by the impact of the posterior
arches through ligaments
Flexion-upper vertebral body tilts and
slides anteriorly
Intervertebral space is compressed
anteriorly and opened wide posteriorly
Nucleus pulposus is driven posteriorly
35. Posterior fibres of
annulus fiberosus is
streched
Limited by the tension
developed in the
posterior longitudinal
ligament
By the capsular
ligament,ligamentum
36. Combined lateral flexion and
rotation-
Does not occur as pure motions
Governed by orientation of articular
facets which are oblique inferiorly and
posteriorly
Rotation is always coupeled with lateral
flexion
Considering the whole cervical column
from C2-T1 extension component is
37. Where as any movement b/w C6-C7
also adds up extension component
Thus three composite movement occurs
in 3 planes-
Lateral flexion –frontal plane
Extension-sagittal plane
Rotation-transverse plane
38. RANGE OF MOTION
JOINT COMBINED FLEXION ONE SIDE ONE SIDE
EXTENSION LAT BENDING AXIAL ROTATION
C2-C3 10 10 3
C3-C4 15 11 7
C4-C5 20 11 7
C5-C6 20 8 7
C6-C7 17 7 6
C7-T1 9 4 2
FROM- WHITE
39. stability
Cervical region bears less weoight
and are more mobile
Stability is provided by bony
configuration,muscles,ligamants
Muscles-flexion of head and
neck-
Depends on anterior muscles of the
neck
40. They are rectus capitis major, rectus
capitis minor
Longus cervicis which plays an
important role in straightening the cervical
column and holding it rigid
Scalene anterior posterior and medius
Suprahyoid and infrahyoid muscles
helps in supporting the cervical column at
rest
Thry are located at a distance from
cervical column
Thus acts via long arm of lever and are
41. Extension of head and neck-
Brought about by posterior neck
muscles
They are0-splenius
cervicis,semispinalis
cervicis,leavator
scapulae,transverso
spinalis,longismus
capiis,spenius capitis,trapezius
These muscles helps in
42. When contract unilaterally they
produce extension rotation and lateral
flexion on the same side
Both flexors and extensor group of
muscles are responsible to maintain
cervical column rigid in neutral
position
Essential in balancing the head and in
supporting weights carried on head
43.
44.
45. ligaments
Anterior atlnatoaxial
ligament,posterior atlantoaxial
ligament,tectorial
membrane,ligamentum nuchae
Transverse atlantal ligament-21.9
mm in length
Also refered as atlantal cruciform
ligament
Holds dense in closed
46.
47. Also serves as an articular surface for
dense
Prevents anterior displacement of C1
on C2
Alar ligaments-arise from axis on
either side of dens
Approx.1cm in legth
Are taut in flexion
Axial rotation of head and neck
tightens both alar ligaments
50. Biomechanics of cervical injury
WHIPLASH INJURY IS DUE TO HIT FROM
BEHIND CAUSING 1ST FORCED
EXTENSION OF THE NECK FOLLOWED BY
FOCED FLEXION OF THE NECK.
-2 PHAGES:
1)HYPEREXTENSION OF C5-C6 AND
MILD FLEXION AT C0-C4
2)HYPEREXTENSION OF THE
ENTIRE SPINE
-IF THE HEAD IS IN SLIGHT ROTATION THEN
BEFORE EXTENSION IS FORCED TO
FURTHER ROTATION CAUSING INJURY TO
51. LOWER CERVICAL FACET RESPOND WITH
SHEAR AND DISTRACTION MECHANISM IN
FRONT AND SHEAR AND COMPRESSION IN
THE BACK.
DUE TO THE INJURY CAUSE CHANGE IN
PIVOT POINT AT C5-C6 CAUSING JAMMING
OF THE INFERIOR FACET OF C5 AND
SUPERIOR FACET OF C6
C2-C3 FACET IS THE COMMON SITE FOR
THE PATIENTS WITH HEADACHE(60%) AND
C5-C6 IS THE SITE FOR REFFERED ARM
PAIN
52. Facet joint syndrome
FACET JOINT IS A SYNOVIAL JOINT AND
BETWEEN TWO FACET JOINT
CARTILAGENOUS DISC IS PRESENT,
DURING FACET LOCKING SYNOVIAL
MEMBRAME AND THE DISC GETS
ENTRAPPED BETWEEN TWO FACET
BONES.
PAIN IN SIDE FLEXION AND ROTATION TO
THE SAME SIDE AND EXTENSION AS
WELL.
COUPLING OF LATERAL FLEXION TO
ROTATION IS ALTERED DUE TO FACET
SYNDROME.
53.
54. - CERVICAL SPONDYLOSIS BEGINS WITH
CAPSULAR --RESTRICTION OF THE FACET
JOINTS WITHOUT BONY -CHANGES AND
GRADUALLY PROGRESS TO
CHARACTERISTIC FLATTENING,LIPPING
AND SPURRING OF THE VERTEBRAL BODY.
- ACCELERATED BY INJURY
- BONY STENOSIS OF INTERVERTEBRAL
FORAMEN IS POSSIBLE.
- LOWER CERVICAL SPINE WILL BE
KYPHOTIC
- ACTIVE ROTATION, LATERAL FLEXION TO
PAINFUL SIDE WILL BE RESTRICTED WITH
EXTENSION AS WELL.
- CAPSULAR RESTRICTION IN LOWER
CERVICAL AREA
55. - MOBILITY IN UPPER CERVICAL AREA IS
GENERALLY QUITE GOOD.
- OSTEOPHYTES STABILIZES THE
VERTEBRAL BODY ADJACENT TO THE
DEGENERATIVE DISC AND INCREASE
THE WT. BEARING SURFACE OF
VERTEBRAL END PLATES.
- CERVICAL MYELOGRAM SHOWS
SPONDYLOTIC CHANGE WITH
OSTEOPHYTIC CHANGE
56. Acute cervical injuries
The most common fracture mechanism in
cervical injuries is hyperflexion.
Anterior subluxation occurs when the
posterior ligaments rupture.
Since the anterior and middle columns remain
intact, this fracture is stable.
Simple wedge fracture is the result of a pure
flexion injury. The posterior ligaments remain
intact. Anterior wedging of 3mm or more
suggests fracture. Increased concavity along
with increased density due to bony impaction.
Usualy involves the upper endplate.
57. Unstable wedge fracture is an unstable
flexion injury due to damage to both the
anterior column (anterior wedge fracture) as
the posterior column (interspinous ligament).
Unilateral interfacet dislocation is due to
both flexion and rotation.
Bilateral interfacet dislocation is the result
of extreme flexion. BID is unstable and is
associated with a high incidence of cord
damage.
Flexion teardrop farcture is the result of
extreme flexion with axial loading. It is unstable
and is associated with a high incidence of cord
61. Axial compression injuries
Jefferson fracture is a burst fracture of the ring of
C1 with lateral displacement of both articular masses
.
Burst fracture at lower cervical level