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Updated: Aug 2 2024

Cervical Spine Anatomy

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  • Embryology
    • Genetics
      • homeobox (Hox) genes direct and regulate processes of embryonic differentiation and segmentation along the craniocaudal axis
  • Osteology
    • The cervical spine contains 7 vertebral bodies
      • C1 (atlas)
      • C2 (axis)
      • C1 to C7
        • have a transverse foramen
        • vertebral artery travels through the transverse foramen of C1 to C6
      • C2 to C6
        • have bifid spinous processes
      • C7
        • despite having a transverse foramen, the vertebral artery does NOT travel through it in the majority of individuals
        • there is no C8 vertebral body, but there is a C8 nerve root
  • Alignment
    • Normal sagittal lordosis (measured from C2 to C7)
  • Spinal Canal
    • Spinal canal
      • normal diameter is 17 mm
        • <13 mm indicates possible cord compression
  • Atlas (C1)
    • Has no vertebral body and no spinous process
    • Embryology
      • three ossification centers
        • one for each lateral mass (come together posteriorly to form posterior neural arch)
          • lateral masses fuse to the body at age 7
        • one for the anterior arch
          • anterior arch does not appear until 1 year of age
    • Articulations
      • occiput-C1
        • two superior concave facets that articulate with the occipital condyles
        • makes up 50% of neck flexion and extension
  • Axis (C2)
    • Osteology
      • has an odontoid process (dens) and body
      • embryology
        • develops from five ossification centers
        • subdental (basilar) synchondrosis is an initial cartilaginous junction between the dens and vertebral body that does not fuse until ~6 years of age
        • the secondary ossification center appears at ~3 years of age and fuses to the dens at ~12 years of age
    • Kinematics
      • C1-C2 (atlantoaxial) articulation
        • is a diarthrodial joint that provides
          • 50° (of 100°) of cervical rotation
          • 10° (of 110°) of flexion/extension
          • 0° (of 68°) of lateral bend
      • C2-C3 joint
        • participates is subaxial (C2-C7) cervical motion that provides
          • 50° of cervical spine flexion/extension 
          • 50° of cervical spine rotation 
          • 60° of lateral bending
    • C2 blood supply
      • a vascular watershed exists between the apex and the base of the odontoid
        • apex is supplied by branches of the internal carotid artery
        • base is supplied by branches of the vertebral artery
        • the limited blood supply in this watershed area is thought to affect healing of type II odontoid fractures
  • Occipital-C1-C2 Ligamentous Complex
    • Provided by the odontoid process and its supporting ligaments
      • transverse ligament
        • limits anterior translation of the atlas
      • apical ligaments
        • limit rotation of the upper cervical spine
      • alar ligaments
        • limit rotation of the upper cervical spine
  • Subaxial Cervical Spine (C3 to C7)
    • C1 to C7
      • have a transverse foramen
      • vertebral artery travels through transverse foramen of C1 to C6
    • C2 to C6
      • have bifid spinous processes
    • C6
      • contains palpable carotid tubercle, which is a valuable landmark for the anterior approach to the cervical spine
    • C7
      • non-bifid spinous process
      • despite having a transverse foramen, the vertebral artery does NOT travel through it in the majority of individuals
      • there is no C8 vertebral body, but there is a C8 nerve root
    • The superior articular facets of the subaxial cervical spine (C3-C7) are oriented in a posteromedial direction at C3 and posterolateral direction at C7, with variable transition between these levels
Card
1 of 4
Which cervical vertebra have transverse foramen?
    • The cervical spine contains 7 vertebral bodies
      • C1 to C7
        • have a transverse foramen

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Question
1 of 3
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QID 7977 (Type "7977" in App Search)
Which of the flowing trajectories is preferred for placement of C1 lateral mass screws?

7.5 degrees lateral and 5 degrees cephalad

11%

108/1002

7.5 degrees medial and 10 degrees cephalad

15%

152/1002

10 degrees medial and 22 degrees cephalad

54%

544/1002

10 degrees lateral and 22 degrees cephalad

17%

168/1002

20 degrees medial and 22 degrees caudal

1%

14/1002

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