Cervical_Spine_-_Important_Structures_

Important Structures of the Cervical Spine

Review bony anatomy and ligaments of the cervical spine.
Review major nerve and arterial pathways of the cervical spine.
Understand precautions necessary for palpation of cervical spine, specifically the anterior structures of the neck.
Discuss contraindications for neck palpation/massage.

Lacks body; no intervertebral disc between occiput and C2.
Body is replaced by the Dens of C2.
Transverse processes (TPs) are considerably longer than in other cervical vertebrae.

Serves as the axis of rotation for the atlas; approximately 50 degrees of rotation occurs at the atlantoaxial joint.
The Dens measures about 1.5 cm in length.
Features a bifid spinous process; it is significantly large for enhanced muscle attachment.

Vertebral bodies are smaller yet broader compared to other regions.
Unique anatomical features include:
- Bifid spinous processes.
- Cervical pillar formed by superior and inferior articular facets.
- Bodies are concave superiorly.
C7 is particularly notable for its very prominent spinous process.
Palpating other cervical spinous processes can be challenging when the neck is extended due to the lordotic curve of the spine.

Visual representation in a lateral view highlighting structural characteristics.

Nuchal Ligament: Continuation of supraspinous ligament attaching to spinous processes from C1-C7.
Provides proximal attachment for the rhomboids and trapezius muscles.

Transverse Ligament: Strongly connects tubercles on the medial aspect of lateral masses of C1; forms a cruciate ligament anchoring the Dens in place.
Alar Ligament: Connects the sides of the Dens to lateral margins of foramen magnum, preventing excessive rotation.
Tectorial Membrane: Continuation of PLL that supports cervical stability.

Overview includes:
- Supraspinous Ligamentum
- Intervertebral Disc
- Transverse Process
- Various types of ligaments that structure the spine.

A network of nerves formed by anterior rami of lower four cervical nerves (C5, C6, C7, C8) and first thoracic nerve (T1).
Extends from spinal cord, traversing the cervicoaxillary canal into the axilla.

Supplies head and neck with oxygenated blood; bifurcates into external and internal carotid arteries in the neck.
Palpated just anterior to the sternocleidomastoid muscle, often utilized for pulse assessment.
Important to ensure no pulse is felt during palpation to avoid complications.

Supplies blood to upper spinal cord, brainstem, cerebellum, and posterior part of the brain.
Transverse foramina of cervical vertebrae allow the passage of this artery and associated veins/nerves.

Serious Pathological Conditions: Known as "Red Flags" indicating urgent medical attention, such as:
- Ligament instability in the neck.
- Unsteady gait, impaired motor control, or movement dysfunction.
- Muscle wasting or sensory disturbance in the hands.
- Bowel or bladder disturbances.
- New, worsening headaches in individuals over 50.
- Unexplained weight loss or night pain.
- Drop attacks, dizziness, dysphagia, dysarthria, diplopia (the 5 D’s).
- Symptoms like nausea, fatigue, high blood pressure/pulse/respiratory rate.

Open the floor for discussion or inquiries regarding the cervical spine anatomy and related clinical implications.