anatomy of atlanto-occipital joint atlanto-axial joint and lower cervical spine. kinematics (includes osteokinematics and arthrokinnematics) and kinetics
2. STRUCTURE
Consists of 7 vertebrae in total
Divided into 2 distinct parts:
a. The upper cervical spine or cranio-vertebral region
b. The lower cervical spine
Cranio-vertebral region includes the occipital condyles and C1-C2
Lower cervical spine includes the vertebrae of C3-C7
3. CRANIO- VERTEBRAL REGION
A. ATLAS:
Function of the atlas is to cradle the occiput and to transmit forces from the occiput to
the lower cervical spine.
It has no V.B or spinous process
Shaped like a ring
There are 2 large lateral masses that have a vertical alignment under each occipital
condyle that transmit forces
The lateral masses are connected by an anterior and posterior arch that form the ring
structure and also creates large transverse process for muscle attachments
4. The lateral masses include 4 articulating facets:
a. 2 superior facets
b. 2 inferior facets
Atlas also possesses a facet on the internal surface of the anterior arch for articulation
with the dens of axis
Superior zygapophseal facets:
a. Large
b. Kidney shaped
c. Deeply concave to accommodate the large convex articular surfaces of the occipital
condyles
5.
6.
7. Inferior zygapophyseal facets:
a. Slightly convex
b. Directed inferiorly
c. Articulates with the superior zygapophyseal facets of the axis
8.
9. B. AXIS:
Primary function of the axis are:
a. Transmit the combined load of the head and the atlas
b. Provide motion into axial rotation of the head and atlas
Anterior portion of the body extends inferiorly and a vertical projection called the dens
arises from the superior surface of the body
Dens has an anterior facet for articulation with the anterior arch of the atlas and a
posterior groove for articulation with the transverse ligament
10. The arch of the axis has inferior and superior zygapophyseal facets for articulation
The spinous process is large and elongated with a bifid tip
Superior facets face upward and laterally
Inferior facets face anteriorly
11.
12.
13. ARTICULATIONS
A. ATLANTO-OCCIPITAL JOINT:
Composed of the right and left deep concave superior facets of the atlas that
articulates with the right and left convex occipital condyles
True synovial joint
Lie nearly in the horizontal plane
14.
15. B. ATLANTO-AXIAL JOINT:
3 synovial joint
1 median (pivot joint) and 2 lateral joint
Median joint consists of odontoid process of C2 that articulated with a facet on the
internal surface of the atlas (C1)
2 lateral joints are composed of right and left superior facets of the axis that
articulates with the right and left slightly convex inferior facet on the atlas
16.
17. CRANIO VERTEBRAL LIGAMENTS
A. 4 of the ligaments are continuation of the longitudinal tract system:
a. Posterior atlanto-occipital and atlanto-axial membranes:
Continuation of the ligamentum flavum
Less elastic
Therefore permit greater ROM, especially into rotation
b. Anterior atlanto-occipital and atlanto-axial membranes:
Continuation of ALL
18.
19. c. Tectorial membrane:
Continuation of the PLL in the upper 2 segments
Broad and strong
Originates from the posterior V.B of axis
Covers the dens and its cruciate ligament
Inserts at the anterior rim of the foramen magnum
20.
21. d. Ligamentum nuchae:
Thick
Extends from the spinous process of C7 to the external occipital protuberance
Evolution of the supraspinous ligament
Resist the flexion moment of head
22.
23. B. Transverse ligament:
Stretches across the ring of the atlas
Divides the ring into a large posterior section for the spinal cord
Has a thin layer of articular cartilage on its anterior surface for articulation with the
dens
Longitudinal fibres extend superiorly to attach to the occipital bone
Inferior fibres descend to the posterior portion of the axis
Transverse portion holds the dens in close approximation against the anterior ring of
the atlas
24.
25. Prevent anterior displacement of C1 and C2
Transverse atlantal ligament is very strong and the dens will fracture before the
ligament will tear
C. Alar ligament:
2 alar ligament
Arise from the axis or either side of the dens
Extend laterally and superiorly to attach to roughened areas on the medial sides of the
occipital condyles and to the lateral masses of the atlas
26. Relaxed with the head in mid-position or neutral
Taut in flexion and rotation of the head and neck
Right upper and left lower portion limit left lateral flexion
Prevent distraction of C1 and C2
Weaker than the transverse atlantal ligament
Runs in a fan shaped arrangement from the apex of the dens to the anterior margin of
the foramen magnum of the skull
27.
28. LOWER CERVICAL REGION
A. BODY:
Small
Transverse diameter is more than AP diameter and height
Transverse and AP diameter increases from C2 to C7 with a significant increase in both
diameters in the upper end plate of C7.
Posterolateral margins of the upper surfaces of the V.B from C3 to C7 support
uncinated processes that give the upper surfaces of these vertebrae a concave shape
in the frontal plane.
Anteroinferior border of the V.B forms a lip that hangs down toward the V.B below,
which produces a concave shape of the inferior surface of the superior vertebra.
29.
30. B. ARCHES:
a. PEDICLES:
Project posterolaterally
Located halfway between the superior and inferior surfaces of the V.B
b. Laminae:
Thin and slightly curved
Project posteromedially
31. c. Zygapophyseal articular processes:
Support paired superior facets that are flat and oval, face superoposteriorly
Width and height of these facets gradually increase from C3-C7
Inferior facets face anterolaterally and lie closer to the frontal plane
d. Transverse processes:
Foramen is located in the transverse process bilaterally
Groove for the spinal nerves
32. e. Spinous processes:
Short, slender and extend horizontally
Tip is bifid
Length of the spinous process decreases slightly from C2-C3, remains constant from
C3-C5 and increase at C7
f. Vertebral foramen:
Large
triangular
33.
34. KINEMATICS
A. OSTEOKINEMATICS/ ARTHROKINEMATICS:
a. ATLANTO- OCCIPITAL JOINT:
Condylar synovial joint
Permits active F-E as a nodding motion
Deep walls of the atlantal sockets prevent translation, but the concave shapes does
allow rotation to occur
F/E: sagittal plane around mediolateral axis
F: occipital condyles roll forward and slide backward
E: occipital condyles roll backward and slide forward
35. Flexion is limited by:
i. Osseous contact of the anterior ring of the foramen magnum with the dens
ii. Tension in the posterior neck muscles and tectorial membrane
iii. Impaction of submandibular tissues against the throat
E is limited by occiput compressing the sub occipital muscles
36.
37. b. Atlanto- axial joint:
Plane synovial joiont
Allow F/E, lateral flexion and rotation
Median atlantoaxial joint permits rotation
Rotation is limited by 2 alar ligaments, capsule of lateral atlanto- axial joint
Rotation coupled with ipsilateral lateral flexion
Lateral flexion coupled with ipsilateral rotation
F: anterior tilt with anterior translation
E: posterior tilt with posterior translation
38.
39. KINETICS
No disks are present at either the atlanto- occipital or atlanto- axial joint
Compressive loads→ transferred directly through the atlanto- occipital joint→
articular facets at the axis→ transferred through pedicles and laminae of the
axis to the inferior surface of the body→ 2 inferior zygapophyseal articular
processes→ adjacent inferior disk
From C3-C7 compressive forces are transmitted by 3 parallel columns:
i. Single anterocentral column: V.B and disks
ii. 2 rodlike posterolateral column: left and right zygapophyseal joints
Compressive loads in end range F/E > erect stance and standing postures
40. CAPSULAR PATTERNS
Equal restriction of E and lateral flexion
Flexion and rotation are not affected