The cervical spine functions to house and protect the spinal cord, support the head and facilitate movement. It has a normal anterior curvature of 20-40 degrees. Non-palpable structures include the cranium, mandible, and vertebrae. Palpable structures are the superior nuchal line, external occipital protuberance, mastoid process, and vertebral levels C3-C6. Typical cervical vertebrae have transverse processes and spinous processes while C1-C2 are atypical. The intervertebral discs act as shock absorbers between vertebrae. Key joints are the atlanto-occipital and atlanto-axial, which allow nodding and rotation. Ligaments

1. by: Aubrey Vale Sagun, Lady Leanne Esteban, Kamille Chloie Ferrer

3. Function of Cervical Spine
• Housing and protecting the Spinal cord
• Supporting the head and its movement
• Facilitating the flow of blood to the brain

4. Normal Curves of Vertebral Column
• Cervical Spine – is a
secondary curve; convex
anteriorly and concave
posteriorly
• Normal Curvature of
Cervical Spine: 20 – 40
degrees
• COG of head – falls on the
concave side of the curves

5. Non-palpable Structures
• Cranium (Skull):
• Inferior Nuchal Line: almost parallel with
the superior nuchal line but is hidden
from palpation by the overlying
musculature
• Occipital condyles: serve as a
component of the atlanto-occipital jts
• Jugular processes: located lateral to the
occipital condyles & serves as
attachments to one of the short
posterior neck muscles (rectus capitis
lateralis)
• Foramen Magnum: transmits the
medulla oblongata

6. Non-palpable Structures
• Mandible (Lower Jaw):
• Body
• Ramus
• Convex Condyles
• Coronoid process for
attachment of the temporalis
muscle

7. Palpable Structures
• Cranium:
• Superior Nuchal Line: moved in
posterior direction from mastoid
process
• External Occipital Protuberance: small
eminence when the two superior
nuchal lines of R & L sides meet at the
median line
• Ligamentum Nuchae: extends from
the 7th cervical vertebrae of skull
• External Occiptal Protuberance &
Ligamentum Nuchae: best palpable
when head is tilted backward

8. Palpable Structures
• Mandible :
• Mastoid Process: can be
palpated behind the
earlobes
• Cervical Flexion – best felt
• Cervical Extension – only
part of the process is
palpated
• Condyles of Mandible: can
be palpated just anterior to
the external auditory canal

9. Palpable Structures
• Vertebral levels with
corresponding anatomic
landmarks:
• C-3: level with the hyoid bone, which
can be palpated anteriorly just below
the mandible
• C-4 & C-5: level with thyroid cartilage
• C-6: level with the arch of the cricoid
cartilage

10. Cervical Vertebrae

12. C1 Vertebra

13. C2 Vertebra

14. C7

15. Typical
Vertebra
Typical vertebra have:
C3-C6

16. C1 and C2 : Atypical Vertebrae

17. C7

18. Intervertebral Disc
• An intervertebral disk acts as shock
absorber between each
of the vertebrae in the spinal column
by keeping the vertebrae separated
when there is impact from activity.
• They also serve to protect the nerves
that run down the middle of the spine
and intervertebral disks

19. C1 vs. Typical Vertebra

20. C2 Superior and Lateral View

21. Vertebral Motion
• Motion segment – consist of two adjacent vertebrae, three
intervertebral joints, the soft tissues of intervertebral disc,
longitudinal and intersegmental ligaments, facet joint capsules
• Disc and L & R facet joints – form a triangle whereby motion at
one joint always produces motion at the other two joints
• Osteokinematic Motions – flexion & extension (sagittal plane), L
& R lateral flexion (frontal plane), and L & R rotation (transverse
plane)
• Arthrokinematic Motions – anterior/posterior shear/slide, lateral
shear/slide, and distraction & compression

22. Coupling Motions
• Combined motions of spine
• It occurs because of the orientation of the planes of the left and right facet
joints and limitation of motion provided by the disc, vertebral ligaments,
fascia, and muscles
• The greatest complexity of coupling in the spine is with side bending and
rotation. After one or two degrees of motion, side bending is always
accompanied by rotation, and rotation is always accompanied by side
bending
• It has been traditionally viewed that coupling is influenced by the position
the spine assumes in the sagittal plane.
• When the spine is in neutral position and moves in the sagittal plane,
rotation and side bending occur contralaterally. However, when the spine is
either flexed or extended, rotation and side bending occur in an ipsilateral
fashion

23. Cervical Region
• Craniovertebral area – form by the occiput (0), atlas (C1), and
axis (C2); the facet joints here are specialized (two to three
degrees of freedom exist), and the planes of motion are nearly
horizontal
• Atlanto-occipital joint (0-C1) – movement is mainly nodding in
the sagittal plane; small lateral bending are also possible but
are quite limited
• Atlanto-axial joint (C1-C2) – axis of motion is vertical through
the dens, the motion occuring is rotation; Approximately 50% of
rotation in cervical occurs in AA jt.

24. Cervical Region
• Typical cervical vertebral articulations (C2–C3 through C6–
C7):
• facet joints change from horizontal to a 45° angle between the
horizontal and frontal planes;
• The superior articular facets slide superior and anterior in forward
bending (flexion) and inferior and posterior in backward bending
(extension);
• In side bending right, the left superior facet moves superiorly and
anterior while the right superior facet moves inferior and posterior,
producing a rotation of the vertebral body to the right and the spinous
process to the left.

25. Movements in the Cervical Region

26. Cervical ROM Normal Value

27. Lordotic Curve

28. JOINTS AND
LIGAMENTS

29. Atlanto-occipital joints
- synovial joints
- articulation between atlas and occipital bone
- 2 degrees of freedom of motion
- movement: nodding motion in the
sagittal plane
small lateral bending is possible but
very limited
Atlanto-axial joints
- pivot joints
- consists of 3 distinct joints:
- median joint between dens of axis and
anterior arch of atlas.
- two are located between the lateral masses
of C1 and the superior articular facet of C2.
- movement: head rotation

30. • The weight-bearing bodies, the intervertebral
discs, and the longitudinal ligaments form the
anterior vertebral structures.
• Intervening discs
- protect the facet joints from compression
injury and permit motions of vertebrae.
- Each disc is composed of three parts:
- Annulus fibrosis
- a series of fibroelastic
cartilaginous rings that enclose the nucleus
pulposus.
- 2 vertebral end plates
- hyaline cartilaginous plates which
separate the nucleus and the annulus from
the vertebral bodies and merge with the
annulus fibrosus collagen fibers.

31. • Longitudinal Ligaments
- Anterior longitudinal ligaments
- attaches to the annulus and the edge of
each vertebral body.
- limits backward bending.
- Posterior longitudinal ligaments
- attaches to the annulus and the
superior margin of the vertebral body but
covers a plexus of arteries, veins, and
lymphatics as well as the nutrient foramina.
- forward flexion is somewhat restrained
but the leverage of the PLL is poor and it’s
tensile strength is relatively low.
- the width of the PLL decreases as the
ligament descends from the cervical to
lumbar spines.

32. Posterior Vertebral Joint Elements
• Posterior vertebral structures comprise the arches, the
transverse and spinous processes, the bilateral facet
joints, joint capsules, and ligaments.
• The facet joints (apophyseal or zygapophyseal joints)
are formed by inferior articulating process of one vertebra
with the superior articulating process of the vertebra
below.
• Major functions of the facet joints are to control vertebra
motions and to protect the disc from excessive shear,
flexion, side bending, and rotation.
• The direction and amount of motion permitted are
determined by the planes of the joint surfaces, which
change in their orientation from the cervical through the
lumbar areas.

33. Temporomandibular Joint (TMJ)
Motion
• Like a hinge joint in movable base
• Opening the mouth – rotation of the mandibular condyles around the
lower joint space, followed by translation of the articular disc on the
upper joint space down to the articular eminence.
• Closing of mouth – requires reversal of the translatory and rotational
motions.
• Other motions possible in mandible – protrusion (movement of the jaw
forward), retrusion (movement of the jaw posteriorly), and lateral shift to
the left and to the right, which includes mediolateral translatory motion.
• Functional movements of the jaw are combinations of these motions. In
chewing, these motions are called incision for cutting food and
mastication for crushing and grinding.

34. •Ligaments
- Ligamenta Flava (L., flavus, yellow)
- series of 23 intersegmental ligaments that connect the
lamina of the adjacent vertebrae from C2 to the sacrum.
- its yellow color reflects the high elastic content, which
contributes to the prestress of the disc and resistance to
forward flexion.
- the ligamentum flava fibers cover the anterior surface of
the capsule of the facet joint and provide tension on the capsule
to prevent nipping and injury by the facet joints during
movement.

35. • Ligamenta Flava
- the fibers of the ligamentum flava are continuous
with the interspinous ligaments, which attach
between adjacent spinous processes.
- the interspinous ligaments are continuous with the
supraspinous ligament.
- in the cervical area, the supraspinous ligament
becomes the ligamentum nuchae.
- Intertransverse ligaments are segmental with
attachments between adjacent transverse processes.
- the interspinous and supraspinous ligaments resist
motions of forward bending very effectively.
- the supraspinous ligament has great tensile
strength, especially in the lumbar area.

36. MUSCLES OF
THE CERVICAL
SPINE

37. ANTERIOR CERVICAL MUSCLES
M: Rectus capitis anterior
O: Base of the skull, immediately
ant. To the occipital condyle
I: Anterior surface of C1
N: C1-C2
A: Flexes Head, Head stabilizer
and provider of proprioception

38. ANTERIOR CERVICAL MUSCLES
M: Rectus capitis lateralis
O: Occipital’s bone jugular process
I: C1 transverse process
N: C1-C2
A: Stabilizes head and may provide
propoprioceptive feedback, medial-
lateral control of the head

39. ANTERIOR CERVICAL MUSCLES
M: Longus Capitis
O: Basilar portion of the occipital
bone
I: Transverse processes of C3-C6
N: C1-C3
A: Head and neck flexion, lateral
bending and rotation and significant
joint compression

40. ANTERIOR CERVICAL MUSCLES
M: Longus Colli
O: Ant. Tubercle of C1, bodies of C1-C3 and
transverse processes of C3-C6
I: Bodies of C5 through T3, transverse
processes of C3-C5
N: C2-C6
A: Cervical flexion, stabilizes head

41. ANTERIOR CERVICAL MUSCLES
M: Anterior Scalene
O: C4-C6 transverse processes
I: First rib
N: C4-C6
A: Forward flex the cervical spine,
laterally flexes the neck and rotates
to same side

42. ANTERIOR CERVICAL MUSCLES
M: Middle Scalene
O: Transverse processes of upper 6
cervical vertebrae
I: 1st rib
N: C3-C6
A: Forward flex cervical spine, laterally
flexes the neck and rotates to same side,
elevates rib during forces inspiration

43. ANTERIOR CERVICAL MUSCLES
M: Posterior Scalene
O: Transverse processes of lower
cervical vertebrae
I: 1st rib
N: C7-C8
A: Flexes neck forward, laterally flexes
neck and rotates to same side, elevates
second rib during forces inspiration

44. ANTERIOR CERVICAL MUSCLES
M: Sternocleidomastoid
O: Manubrium sterni and medial third of
clavicle
I: Mastoid process of temporal bone and
occipital bone
N: Spinal accessory nerve (XI) , C1-C3
A: Forward flexes the neck, rotates neck to
the opposite side, lateral flexion to same side
and extension of head and neck

45. POSTERIOR CERVICAL SUBOCCIPITAL
MUSCLES
M: Rectus capitis posterior major
O: Base of the skull, immediately
ant. To the occipital condyle
I: Anterior surface of C1
N: C1 suboccipital nerve
A: Head extension and lateral flexion

46. POSTERIOR CERVICAL SUBOCCIPITAL
MUSCLES
M: Rectus capitis posterior minor
O: Just above the atlas
I: Inferior nuchal line of occiput,
Inferior and superior oblique: occiput
N: C1 suboccipital nerve
A: Head extension and lateral flexion

47. POSTERIOR TRANSVERSOSPINAL
MUSCLES
M: Rotators
O: Transverse process of 1 vertebrae
I: Base of the spinous process above
N: Dorsal rami of spinal nerves
A: Extend head and neck, laterally flex and
rotate head to same side

48. POSTERIOR TRANSVERSOSPINAL
MUSCLES
M: Multifidus
O: Transverse processes of 2-5 vertebrae
I: Spinous processes above
N: Dorsal rami of spinal nerves
A: Extend head and neck, laterally flex and rotate head to
same side

49. POSTERIOR TRANSVERSOSPINAL
MUSCLES
M: Semispinalis capitis
O: Transverse processes of T1-T6
I: Above the inferior nuchal line
N: Dorsal rami of spinal nerves
A: Extend head and neck, laterally flex and rotate head to
same side

50. POSTERIOR TRANSVERSOSPINAL
MUSCLES
M: Semispinalis cervicis
O: Transverse processes of T1-T6
I: C2-C5 Spinous processes
N: Dorsal rami of spinal nerves
A: Extend head and neck, laterally flex and rotate head to
same side