Cervical Anatomy

Movement of the spine

Ensuring the Cx spine is safe to
mobilise.
Overview
Seperated into 2
different sections
UPPER CERVICAL
Occiput
Atlas
Axis

LOWER CERVICAL
C2 C7 as similar boney units
Joint alignment and subsequent
movement
Critical Anatomy VBI
Verebral
Arteries
supply blood
to brain from
both right and
left
If both
arteries are
blocked a
stroke will
occur
VBI Symptoms
Ask EVERY cervical patient about
these symptoms.
Dizziness - Headaches
Drop attacks - Nausea
Vision disturbances - Trauma
VBI Testing
Bilateral hold at EOR rotation in both
directions for 10 seconds
Observe for 10 seconds post test
Check for any of following symptoms
Fainting
Vertigo
Nausea
Diplopia (double vision)
Blurred/disturbed vision
VBI Test Practical
Pair off
Do full VBI test protocol on each
other

REPORT ANY ABNORMAILITIES

Critical Anatomy Upper
Cx
The craniovertebral
(CV) junction is a
term that refers to
the occiput, atlas
(C1) and axis (C2)
The joints between
these vertebra are
very unique and
different
Boney Anatomy
Occiput
the base of the skull
Articulates inferiorly with the Atlas
(C1) through large rounded
prominences
Boney Anatomy
Atlas (C1)
essentially a ring of
bone
Has no spinous
process
Articulates
superiorly through
concave sections
Articulates inferiorly
through facet joints
with the Axis (C2)
Boney Anatomy
Axis (C2)
Most striking feature is
the Dens prominence
which lies in the
foramen formed in the
arch of C1
Articulates superiorly
with horizontal facet
joints
Artciulates inferiorly
with angled facet joints
Movements Upper Cx
Occiputo- Antlanto
Cup and saucer type joints
Performs nodding action
Gliding joint (no roll)

Flexion = 15

Extension = 15

Abduction = 8
(each side)

Rotation = 6
(each side)
Movements Upper Cx
Atlanto Axial
Two near flat facets
Performs a pure cervical rotation movement
Movement restricted by ligament (transverse lig)

Flexion = 5

Extension = 5

Abduction = 3
(each side)

Rotation = 45
(each side)
Boney Anatomy
C2 (inferior) C7
Mid to lower cervical
joints all very similar
Facet joints with
alligment of approx
45
When on side slides
up other slides down
Movements are
combined.
Boney Anatomy
C2 (inferior) C7
Movements are
combined.
i.e. if left slides down
right slides up
Rotation of the head
and side bend are the
same for C2 C7
Total movement =45
Approx 9 per level
Cervical Movement
Summary
O/C1 nodding movement (YES)
C1/C2 rotating head (NO)
C2/C7 combined movements
Flexion = double up slope
Extension = double down slope
Rotation and side flex same
Rot/Side Flex = 1 up slope with 1 down slope
Upper Cx Ligaments
Nuchal Ligament.
Extends from
occiput to spinous
process of C7
Attaches to each
spinous process of
Cx spine
Superior portion
(Occ. C2) stops
nodding motion of
Atalnto Occipital nod
Upper Cx Ligaments
Transverse
Ligament
Extends across C1
foramen
Attaches bilaterally
to inner portion of
anterior and lateral
arch of C1
Holds the Dens
against the anterior
portion of C1
foramen
Upper Cx Ligaments
Alar Ligaments
Attach the Dens to
Occipital condyles
Are responsible for
stopping rotation at
the C1/C2 level
Also limit side bend
Very strong, thick
ligaments
Cx Ligament Practical
Alar Ligament
Patient in supine
Fix C2 between fingers
Side flex head until feel C2 move
Should be only 5-10 of side flex
movement
Cx Ligament Practical
Transverse Ligament
Places fingers above C2 so as to lie
over the arches of C1
Translate C1 forward with fingers
If there is ligamentous insufficiency
the Dens will press against spinal cord
Hold position for 20 seconds, checking
for symptoms (severe and obvious)
Cx Ligament Practical
Nuchal ligament test
Grasp C2 in pincer grip (as with Alar
test)
Perform nodding action
Should feel C2 begin to move after
15-20 degrees of nodding
After this point the neck will flex as
opposed to nod
Ligamentous Summary
3 ligaments to test
Vertebro Basalar Arteries (always)
Alar Ligaments
Transverse Ligament
Nuchal Ligament

Ligamentous damage usually occurs

post trauma
Often patients with instability will tell
you there head feels like it will fall off
Cx Anatomy Summary
Test structures for safety
VBI
Ligamentous Tests
Occ/C1 responsible for 15-20 flex/ext
(pure translation)
C1/C2 responsible for 45 rotation in
each direction (pure rotation)
C2 7 work in combined movements
(movement occurs in 2 planes)