STRUCTURE OF CERVICAL SPINE

By Sparsh and Arpita

 Consists of seven vertebrae (C1, C2, C3, C4, C5, C6, C7)
 C3 to C6 display similar characteristics and are considered
typical cervical vertebrae
 C1, C2 and C7 exhibit unique characteristics and are considered
atypical cervical vertebrae
 Have unique features of transverse foramen located on the
transverse processes
 Divided into two distinct regions:
• Craniovertebtal region
• Lower cervical region
1. Craniovertebral Region
 Includes occipital condyles and the first two cervical
vertebrae (C1 and C2)
ATLAS (C1)
 Shaped like a ring
 It has no vertebral body or spinous process
 Huge vertebral foramen
 2 large lateral masses on the atlas formed by the two
superior and two inferior zygapophyseal facets
 Superior zygapophyseal facets are large, kidney-shaped,
and deeply concave, while inferior zygapophyseal facets
are slightly convex
 Also possess a facet on the internal surface of anterior
arch for articulation with the Dens of the axis
 Function – Cradle the occiput and to transmit forces from
occiput to lower cervical vertebrae
AXIS (C2)
 Anterior portion of body extends inferiorly
 A vertical projection called Dens arises from the superior
surface of the body
- Dens has an anterior facet for articulation with
anterior arch of atlas
- And a posterior groove for articulation with
transverse ligament
 Spinous process is large, elongated, with a bifid tip
 Function – Provide axial rotation of head and atlas and
transmit load to lower cervical spine
— Articulations
 There are 2 atlantooccipital joints
Between occipital condyles and superior zygapophyseal
facets of the atlas
 And 3 atlantoaxial joints
Median atlantoaxial between dens and anterior arch of
atlas
And two lateral joints between superior zygapophyseal
facets of axis and inferior zygapophyseal facets of atlas
— Craniovertebral ligaments
 Four of the ligaments are continuations of longitudinal
ligamentous system
 And remaining four ligaments are specific to the cervical area
a). Transverse ligament – Stretches across the ring of atlas
Has a this layer of articular cartilage for articulation with atlas
superior fibres -> attach to occipital bone
inferior fibres -> attach to posterior portion of axis
Transverse ligament and it’s longitudinal fibres are sometimes
referred to as Atlantal cruciform ligament
b). Alar ligaments – arise from either side of dens and attach to
the occipital condyles
Tightens at axial rotation
c). Apical ligament – fan-shaped, connects axis to occiput
2. Lower cervical region
 Includes C3 to C7 vertebrae

— Typical cervical vertebrae

BODY -> Small
Transverse diameter > AP diameter and height
Posterolateral margins of upper surface support
Uncinate process
PEDICLES -> Project posterolaterally
LAMINAE -> Thin, slightly curved and project posteromedially
ZYGAPOPHYSEAL ARTICULAR PROCESSES ->
Superior facets: face superiorly and posteriorly
Inferior facets: face inferiorly and anteriorly

TRANSVERSE PROCESSES -> Transverse foramen is located for

bilateral vertebral artery, vein and venous plexus

SPINOUS PROCESSES -> Short, extend horizontally, and have a

bifid tip

VERTEBRAL FORAMEN -> Relatively large and triangular

— Intervertebral Disc(IVD)
 Fibres of annulus fibrosus have a crescent shape
when viewed from above
 Thick anteriorly and taper laterally
 Fissures in the disc develop along with development
of uncinate processes and become clefts by approx. 9
years of age
 These clefts become the joint cavity of
uncovertebral joints or “joints of Luschka”
— Interbody joints
 Interbody joints of lower cervical region are saddle joints
 Motions that occur are predominantly tilting, although
translatory motions remain available

— Zygapophyseal joints
 True synovial joints and contain fibroadipose meniscoids
 Oriented approx. 45° from frontal and horizontal planes
 Joint capsule are lax to allow a large ROM
Muscles of cervical region
 Serve two primary roles: To hold the head upright against
gravity and to position the head in space to optimally
position the sensory organs

POSTERIOR MUSCLES (superficial to deep)

1. Trapezius -> Diamond shape, Run from occiput to lower

thoracic spine
ACTION – Upper fibres: elevate scapula (unilaterally)
extend neck (bilaterally)
Middle fibres: retract scapula
 When upper limbs are fixed,
Unilaterally - Ipsilateral lateral flexion and
contralateral rotation of head and neck
Bilaterally – head and neck extension
2. Levator Scapulae -> Run from transverse processes of
C1-C4 to medial border of scapula
ACTION – elevation and downward rotation of scapula
(When neck is stabilized)
Unilaterally - Ipsilateral lateral flexion and
rotation of cervical spine (When scapula is stabilized)
3. Splenius Capitis -> Run from spinous processes of C7-T3
to mastoid process of temporal bone
ACTION – Bilaterally: head and neck extension
Unilaterally: Ipsilateral head and neck rotation
4. Splenius Cervicis-> Run from spinous processes of T3-T6
to transverse processes of C1-C4
ACTION – Bilaterally: head and neck extension
Unilaterally: Ipsilateral head and neck rotation
5. Semispinalis Capitis -> Run from occiput to cervical
spinous processes
ACTION – Bilaterally: head extension
Unilaterally: head lateral flexion
6. Semispinalis Cervicis -> Run from thoracic transverse
processes to articular processes of lower cervical spine
ACTION – Bilaterally: head extension
Unilaterally: head lateral flexion
7. Longissimus Capitis -> Run from transverse processes of
C4-T5 to mastoid process of temporal bone
ACTION – Bilaterally: frontal plane stabilization
Unilaterally: Ipsilateral lateral flexion of neck
8. Longissimus Cervicis -> Run from transverse processes
of T1-T5 to transverse processes of C2-C6
ACTION – Bilaterally: frontal plane stabilization
Unilaterally: Ipsilateral lateral flexion
9. Suboccipital muscles -> Run only between the occiput
and C2
consist of rectus capitis posterior major and minor, and
the obliquus capitis superior and inferior
ACTION – Bilaterally: cranial
extension
Unilaterally: Ipsilateral rotation
and lateral flexion
of atlas
LATERAL MUSCLES
1. Scalene muscles -> Frontal plane stabilizers
Accessory muscles of respiration
Anterior – Run from 1st rib to transverse processes of C3-C6
ACTION – Bilaterally: neck flexion
Unilaterally: ipsilateral lateral flexion and
contralateral rotation
Middle – Run from 1st rib to transverse processes of C3-C7
ACTION – frontal plane stabilization
Posterior – Run from 2nd rib to transverse processes of C3-C7
ACTION - Lateral flexion of neck, elevation of rib
2. Sternocleidomastoid -> Run from manubrium and medial
clavicle to the mastoid process
ACTION – Bilaterally: cervical flexion, head and neck extension
Unilaterally: Ipsilateral lateral flexion
contralateral rotation of head and neck
ANTERIOR MUSCLES
1. Longus Capitis -> Run from cervical transverse processes
to the occiput
ACTION - Bilaterally: Head flexion
Unilaterally: Ipsilateral head rotation
2. Longus Coli -> Run from thoracic vertebral bodies to
cervical transverse processes and from transverse processes of
C3-C5 to the atlas
ACTION – Bilaterally: neck flexion
Unilaterally: Ipsilateral lateral flexion
Contralateral rotation
3. Rectus capitis anterior -> Transverse process of atlas to
the occiput
ACTION – Head flexion
4. Rectus capitis lateralis -> Transverse process of atlas to
the occiput
ACTION – Ipsilateral head lateral flexion
Stabilizes the atlanto-occipital joint