ANATOMY OF CERVICAL SPINEDR ASHISH KUMAR GUPTA

Pg 2nd year RADIODIAGNOSIS

SLIMS

Cervical vertebrae 2 TYPES

Atypical Axis Atlas C 7

Typical C 3-6

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

Attachment Anterior tubercle & lower border of

the anterior arch give attachment to ant. Longitudinal ligament.

Upper border of anterior arch gives attachment to ant. Atlanto-occipital membrane.

Upper surface of posterior arch has a groove- occupied by vertebral artery & first cervical nerve.

Behind the groove the upper border of posterior arch give attachment to post. Atlanto-occipital membrane

Lower border of posterior arch –highest pair of ligamenta flava.

Posterior tubercle provide attachment to ligamentum nuchae

Tubercle on medial side of the lateral mass –give attachment to transverse lig.of atlas.

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

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.

Ligamentous Anatomy Anterior longitudinal ligament

Reinforces anterior discs, limits extension

Posterior longitudinal ligament Reinforces posterior discs, limits flexion

Ligamentum nuchae = supraspinous ligament Thicker than in thoracic/lumbar regions Limits flexion

Interspinous/intertransverse ligaments Limit flexion and rotation/limits lateral

flexion Ligamentum flavum

Attach lamina of one vertebrae to another, reinforces articular facets

Limits flexion and rotation

Ossification centres of atlas

C1-3 primary ossification centre.

One for anterior arch &two for neural arch.

Anterior ossification centre appear 20% at birth & visible by 1 year.

Neural arch appear at 7th fetal week & fuse with anterior arch at 7th year

Neural arch fuse posteriorly by 3th year of life.

Ossification centres of axis C2-4 ossification centre. One for each neural arch,

body & odontoid process each one.

Odontoid process forms in utero from 2 separate ossification centre & fuse in mid line by 7th fetal month.

Secondary ossification centre appear at apex of odontoid process between 3 to 6 yrs & fuse by 12-13 yrs.

Body fuse with odontoid process by 3-6yrs.

Neural arch fuse with body of odontoid between 3-6 yrs & fuse posteriorly 2-3yrs.

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 the foramen.

Cervical Vertebra (C7)  .Its has a long and prominent spinous

process. Its thick, nearly horizontal, not bifurcated.Foramen transversorium may be as large as that in the other cervical vertebrae

On the left side it occasionally gives passage to the vertebral artery; more frequently the vertebral vein transverses it on both sides; but the usual arrangement is for both artery and vein to pass in front of the transverse process, and not through the foramen.

Sometimes the anterior root of the transverse process attains a large size and exists as a separate bone, which is known as a cervical rib. 

Ossification of c3-c7 3 ossification centre-one

for body & 2 neural arch.

Body fuse with neural arch by 3-6yrs.

Neural arch fuse posteriorly by 2-3yrs.

Secondary ossification centre may be seen at the tip of transverse process/spinous process and persist until early 3th decade of life & stimulate fracture.

Spinal Nerves C1-c8 Cervical Plexus

C1-C4 C4 -Phrenic Nerve - Breathing

Brachial Plexus C5-T1

C3