So let's review the cervical spine
Here we have the 7 cervical vertebrae
and from C3 to C7, we consider
these the typical vertebrae
They're typical because they have similar
structures to the thoracic and lumbar spine.
The two atypical
vertebrae is C1 and C2.
The C0 and C1 articulation is the
articulation of the skull or the occiput
and there's 2 condyles in the occiput
articulating with C1 and this is important
because that's where your skull
will rest upon your neck.
So here is a superior view and here you could see
how the Atlas has two superior articular facets
where the occiput, the condyles of the occiput
kinda sit on top of that superior articular facet.
Here you could also note the dens which
comes up superiorly from the access.
The dens held tightly by ligaments.
The transverse ligament posteriorly
and the alar ligament anteriorly.
There's also a posterior and anterior arch
as opposed to a typical vertebral body.
Here is an image of C2 or the axis.
and with the axis here, you could see the dens as
the dens comes up and protrudes through the atlas
and you also have here more of a spinous process
and the lamina compared to the axis at the atlas.
Here's a lateral view of the axis.
You could see how the dens comes up
and protrudes through the atlas.
There's also a little bit more
of a vertebral body to the segment.
C3 to C7 is considered your
typical cervical vertebrae.
Generally it has a body, 2 pedicles,
2 laminae and 1 spinous process.
There's also 2 articular pillars, so the articular pillars
are more posterior than the transverse processes.
These are the points that are utilized when
you're palpating ang trying to diagnose
any sort of asymmetry
in the cervical spine.
So there are ligaments that run along
the cervical vertebrae.
They're anterior longitudinal ligament and posterior
longitudinal ligament come up and attach to the occiput.
You have your ligamentum flavum which
runs between the cervical segments
and there's other ligaments that help to
maintain the structure of the cervical spine.
Your OA articulation is mostly responsible for
flexion and extension of the cervical spine.
The head when it goes into flexion,
the condyles will glide posteriorly
and when the head goes into extension, the
occipital condyles will glide anteriorly.
This is different from
the rest of the spine.
So the motion at the OA junction
is primarily flexion and extension
and there's a small
component of side bending.
Usually when there is a somatic dysfunction present,
the flexion and extension component is significant
and you have rotation and side bending
coupled in opposite directions
because of the anatomical
structure of the region.
It's almost as you have to think of the skull
or sphere gliding on the neck or stick.
And so the motion there, because of the condyles
being pointed anteriorly and superiorly,
it's gonna create certain motions creating
that rotation and side bending similar to
Type 1 dysfunctions of the thoracic and
At the AA joint of C1-C2 articulation,
the motion is primarily rotation.
Ligaments that hold the dens in place prevent really
other motions such as flexion and extension.
Dysfunctions in this region really is
only in rotation.
For C3 to C7, these are
The facet orientation is more of a transverse
plane so a lot more rotation in the region
The facets help to guide motion but the limitations
of motion is really through ligaments and muscles.
Uncate processes sometimes could form along the
body which usually occurs through degeneration.
So C3 to C7 are your typical vertebrae
and they do have intervertebral disc
These disc do have pressure upon them
and the pressure does increase when you
lean forward and when you're sitting.
And so, these forces compress on the disc and
if you think about the head
really is almost like a bowling ball in weight,
10 lbs., and your neck being a thin stick.
So any sort of forward bending or flexion, any
slouching will put a lot of pressure on the neck
and cause, could potentially cause
problems and issues.
C3 to C7 are your typical cervical vertebrae.
These segments follows Fryettes principles
for type II somatic dysfuction
Fryettes principles applies to thoracic
and lumbar spine biomechanics.
So we are gonna further discuss that in
our thoracic's lecture.
But what it really says is that in a single segment
dysfunction, there is a flexion and extension component.
So it is a non-neutral segment.
And so our cervical spine act in a similar fashion
They act as an individual segment and there
are certain motions that are coupled with it.
So whenever you rotate and side bend a
it is always gonna be in the
same direction for C3 to C7.
The vertebrobasilar artery system
This system is really important when talking
about evaluation of the cervical spine.
It is important to keep in mind the anatomy of this
vessel because it could traverse the cervical spine
through the transverse processes and because
of how it courses through the cervical spine,
certain motions could limit the blood flow
and could also put the blood vessel at risk.
And so, the vertebral arteries come off the subclavian
artery and then enter the transverse processes
usually at the level of C6 and 7.5% of
the cases could enter at the level of C7
It does preceeds superiorly then through
the transverse processe up to C1.
At C1 what happens, it travels across the posterior arch
of the atlas and then enters the foramen of magnum.
So it almost makes a 90 degree turn
and then comes up.
So inside the skull, the vertebral artery
then joins and forms the basal artery.
Sometimes when you have overextension
or too much side bending rotation,
it could actually compress that verteral
artery and put the blood flow to head at risk.
So, it is really important to understand
how the anatomy of that blood vessel
could potentially affect
blood flow to the head.
Looking at the muscles
of the cervical spine,
in general, there are a lot more thicker, heavier
muscles in the posterior aspect of the neck
than the anterior
portion of the neck.
So, our neck resist forward flexion a lot
more than extension.
So a lot of times we could have an imbalance
of the neck muscles
and that could cause problems in
So the superficial muscles in the
posterior aspect of the neck
start with the trapezius, erector spinae muscles, that's
a continuation from the thoracic and lumbar spine.
More intermediate muscles could be noted here
in terms of the splenius cervicis and capitis
And you have these deep posterior neck muscles,
these muscles tend to be more of a factor
in contributing to type II somatic
dysfunctions in the neck.
This includes the rectus capitis, posterior major and
minor, obliquus and the interspinales and intertransversii.
There are some anterior muscles that attach
to the deep portion of the cervical spine.
And so these you could note how one's anteriorly
and again a lot thinner, not as strong.