Cervical anatomy &

biomechanics
 : Contents
anatomy
1. Bone
2. Joints
3. Ligaments
4. Muscles
5. Dermatome , myotome
6. Blood supply
Biomechanics
7. Osteokinematics
8. Arthrokinematics
9. Facet joint orientation
:-Contents
Bone and joints
General functions of cervical spine
Classifications :- Functional classification / According to anatomical shape
Motion segment :
typical vertebrae : parts
Disc : parts / Orientation of annulus lamellae / General functions
Joints of lower cervical spine :Uncovertebral joint / Facet joint
Atypical vertebrae : Atlas / Axis ( Shape / parts )
Joints of Atypical lower cervical spine
  cervical spine
  General functions of cervical spine
• Allow wide degree of mobility for
normal ADL activities in relation to
less mobile lumbar , thoracic spine
• Carry weight of head (average 4 kg )
• Protect spinal cord and part of
medulla oblongata
Classifications :-

1 . Functional classification :
C0 – c2 : Upper cervical
C3 – c7 : lower cervical
OR
Co – c2 Upper
cervical
C3 – c4 middle
cervical
C5 – c7 lower cervical
:-According to anatomical shape

Typical : c3 – c7 Atypical : c0 – c2
Nodding :atlanto occipital
NO MOVEMENT : atlanto axial
 Typical lower cervical
spine
Motion segment

Consists of : 2
vertebrae & disc in
between
parts
:Vertebral body

concave : superior surface convex : superior surface

convex : inferior surface concave : inferior surface
( from Ant. View ) ( from side view )
Disc
The annulus
• The annular fibers are composed
of collagenous sheets (lamellae)
• 65-70° angle from the vertical
• 30 angle from horizontal
• alternate in direction
• vulnerable to injury by rotation
forces
 NB / The disks are thicker anteriorly and
therefore contribute to normal cervical lordosis.

General functions :

They serve as force dissipators

transmitting compressive loads throughout a
range of motion
 Uncovertebral joint
Joint of lushka

• articulation :above and below

, uncinate processes
ancus or anvil 
• Position c3 toc7
• Movement allowed:flexion,extension,limit
lateral flexion
• Function
• Pathology:degenerative
changes,hypertrophic arthritis result in
foramin stenosis
 Facet joint
Zygopophyseal joint

• diarthrodial synovial joints

with fibrous capsules
• Function
• articulation
These joints allow flexion (bend •
forward), extension (bend
backward), and twisting motion.
Certain types of movement are
restricted. The spine is made more
stable due to the interlocking
.nature to adjacent vertebrae
Joints of typical lower cervical
spine
Atypical lower cervical
spine
Atlas C1
Axis C2
 Atlas C1

-The atlas is ring-

shaped
does not have a body
:parts
1. a thick anterior arch,
2. a thin posterior arch,
3. 2 prominent lateral masses,
4. 2 transverse processes.
5. The transverse foramen
6. inter vertebral foramen
: the lat. Mass there are
The superior articular facets:
concave,
face upward and inward.

The inferior articular facets:

flat
face downward and inward
Ant. Tubricle and
dens
Axis C2
: composed of
1. a vertebral body
2. heavy pedicles
3. laminae
4. transverse processes,

( integrated
unit)
Joints of Atypical lower cervical
spine
Cervical ligaments
Contents:
• Anterior longitudinal ligaments
• post. Longitudinal ligaments
• Nuchal ligament
• Ligamentum flavum
• Transverse ligament of the atlas (cruciate)
• Alar ligament
• The inter transverse ligaments
Anterior longitudinal ligaments 

along the anterior surface of the

vertebral bodies and
  intervertebral discs
:function
Limits extension or excessive Lordosis
Reinforces the ant sides of the
intervertebral discs
post. Longitudinal
ligaments

posterior to the vertebral bodies

:function
Limits flexion
Reinforces the post sides of the
intervertebral discs
Nuchal ligament 
interspinous ligament

from: occipital protuberance

on the skull
To: to the spinous process of
C7
: function
Limits flexion
Provides an attachment for
 Trapezius and
.Splenius capitis
Ligamentum flavum
fr om : anterior surface of one lamina above
To : posterior surface of the lamina below
function :
preserve the upright posture
It resists excess separation of vertebral
lamina
prevents buckling of the ligament into the
spinal canal during extension, << canal
compression.
Transvergse ligament of the
atlas (cruciate)

from : passes behind the dens

to : medial 2 sides of lat mass
function: Contain dens to ant arch of
atlas
prevent anterior displacement of
the odontoid
Alar ligament

from : Sup aspect of dens c2

to : Medial occipital condyles
function : limit CONTRALAT
side bending , rotation ,flex of
upper cervical
The inter transverse ligaments

between the transverse processes

of the spine.
function : limit lateral flexion of
the spine
Cervical muscles
anatomy
 Cervical muscles anatomy
muscle layers:
Posteriorly
1-trapizius
Superficial layer
Action
side bending same
rotate opposite side
 .
2-Levator scapulae
Action:
side bending same
Rotate same
3-Erector spinae
• CERVICAL FLEXORS
• When it comes to talking about cervical motor control I am confident that we are all familiar with deep neck flexors
(DNF). The literature often refers to the superficial muscles which become overactive in the presence of neck pain
and the deep neck flexors which become dysfunction. It can be easy to continue referring to them as 'superficial'
and 'deep' but to make a bigger impact we need to know exactly which muscles are being referred to.
• The more superficial flexor muscles of the cervical spine include sternocleidomastoid (SCM) and anterior
scalenes (AS):
• Sternocleidomastoid functions bilaterally to create neck flexion and unilaterally to create ipsilateral lateral flexion
and contralateral rotation. The SCM is innervated by a spinal root of the accessory nerve (Cleland, 2005).
• Anterior scalene interestingly functions to elevate the first rib, and similar to SCM it creates ipsilateral lateral
flexion and contralateral rotation. The anterior scalene is innervated by C4, C5, and C6 nerve roots (Cleland, 2005).
• When referring to the deep flexor muscles or deep neck flexors, we are talking about longus colliand longus
capitus. P.S. you can't abbreviate these guys because they would both become LC and so they are collectively called
deep cervical neck flexors DCNF or DNF.
• The function of longus colli and longus capitus is to maintain cervical lordosis and provide segmental control (Fall,
Bilenkij & Jull., 2004).
• When active they create cranio-cervical flexion (CCF) and support cervical lordosis anteriorly (Jull, Sterling,
Treleavan, Falla & O’Leary., 2008).
• Longus capitus is innervated by C1-3 spinal segments and longus colli from C2-6 (Cleland., 2005).
 Laterally

• Scalene
Anterior
Middle
posterior
• CERVICAL EXTENSORS
• As you can see above, the flexor group consists of SCM, AS and DNF but the extensor group is consists of a
lot more muscles. These can be described or conceptualised in layers. From most superficial to deep there
are 4 layers of cervical extensor muscles (Schomacher & Falla., 2013, p.360-361).
• Layer 1: Levator scapulae and upper trapezius which are primarily considered to be muscles of the shoulder
girdle and yet form a superficial layer over the cervical extensor group. Upper trapezius is innervated by a
spinal root of the accessory nerve and levator scapulae from the dorsal scapula nerve (Cleland., 2005).
• Layer 2: Splenius capitus and cervicis which acts bilaterally as an extensor and ipsilaterally to produce
rotation. Splenius capitus and cervicis are innervated by dorsal rami of the middle cervical spinal nerves
(Cleland., 2005).
• Layer 3: Semispinalis capitus is primarily a cervical extensor and unilaterally to create lateral flexion. Both
semispinalis capitus and cervicis are innervated by dorsal rami of spinal nerves (Cleland., 2005).
• Layer 4: Semispinalis cervicis and multifidus. These are collectively known as the transversospinalis group
and referred to as our deep cervical extensors (DNE or DCNE). Semispinalis cervicis acts a cervical extender
and multifidus as a segmental stabiliser. They provide posterior support of cervical lordosis in synergy with
the deep neck flexors and prevent a forward head position (Jull, Sterling, Treleavan, Falla & O’Leary., 2008).
These muscles are also innervated by dorsal rami of cervical spinal nerves (Cleland., 2005).
• CRANIOCERVICAL EXTENSORS
• These four muscles form the suboccipital muscle group and are assessed and rehabilitated separately to the deep
cervical extensors.
• Suboccipital muscle (courtesy of Google Images)
• Rectus capitus posterior major – head extension and ipsilateral rotation.
• Rectus capitus posterior minor – head extension and ipsilateral rotation.
• Obliquus capitus superior – head extension and side bending.
• Obliquus capitus inferior – ipsilateral head-on-neck rotation.
• The suboccipital muscle group is important to provide proprioception and they have input into the visual and vestibular
systems. They control cranio-cervical lordosis and small head-on-neck movements. Dysfunction results in sensorimotor
impairment, altered kinaesthetic sense such as reduced balance, joint position sense error, altered oculomotor control
and can lead to cervicogenic dizziness. All of these muscles are innervated by the suboccipital nerve C1 (Cleland., 2005).
• Why we are beginning with the clinical anatomy? I think it is clinically very important to be able to mentally visualise
what muscles lie beneath our hands on palpation, their fibre direction and their innervation. Especially when most of
these muscles are innervated by dorsal rami of spinal nerves, it seems fitting that articular dysfunction or nerve injury
can lead to changes in cervical motor control.
• Before looking at the assessment for each of these main groups of muscles, it is important to reflect on what the years
of research have collected about motor control dysfunction in the cervical spine. So that we can assess motor control
with a deeper understanding of what we might expect to find, what normal and abnormal results are and what the
clinical relevance of these findings are.
• There are three main groups of cervical muscles that form a
sleeve around the vertebral column and enable control of
posture and segmental movements:
• The deep cervical flexors - longus colli and longus capitus.
• The deep neck extensors - semispinalis cervicis and multifidus.
• The suboccipital muscles - rectus capitus posterior major &
minor, and obliquus capitus superior and inferior.
Sternocleidomastoid
anteriorly
• Longus capitis
• Longus colli
Dermatome and Myotome
 Dermatome
• Area of skin supplied by single spinal nerve .
• It is important for clinical practice .
• There are eight cervical spinal nerves because of existing the
nerve above atlas, the first cervical spinal nerve exist between
occipit and atlas and the eight exiting cervical spinal nerve exist
between the C7 and T1 .
 Area of skin supplied Spinal
nerve
Occipit of the skull C1
Lateral part of neck C2
Lateral part of neck C3
Supracervical area C4
Lateral upper part of arm and lateral shoulder C5
Lateral lower part of arm and lateral forearm and C6
thumb and index finger
Palmar aspect of middle part of hand and middle C7
finger
Medial part of hand and little and ring finger C8
Medial part of arm and medial part of forearm T1
Assessment of dermatome of
cervical
It is essential part in
neurological examination.
Changes in sensation of
area supplied with spinal
nerve identify pathology at
this level.
Assessment by pinprick or
brush and compered by
sound limb or forehead as a
reference point.
 Myotome

It is muscle supplied by single

spinal nerve
 Muscle supplied Spinal
nerve
Neck flexion,c2:extension C1
Lateral flexion C3
Shoulder elevation C4
Shoulder abduction C5
Elbow flexion and wrist extension C6
Elbow extension and wrist flexion C7
Thumb extension and finger flexion C8
Finger abduction T1
Assessment of myotome of cervical
 Reflexes of cervical spine
C7 : triceps reflex
C5-6 : biceps reflex
The blood supply of neck region
•Brachioradialis refelex
•Brachialis
•Finger reflex
•Supraspinatus reflex
•Knee reflex important
•Ankle reflex,UMNL
As in case of lumber disc,posterolateral compression
Blood supply v important
Contents:
• Carotid arteries:
1. External carotid artery:
2. Internal carotid artery:
• Vertebral arteries
• Other arteries:
a.Inferior thyroid artery
b.Ascending cervical artery
c.Transverse cervical artery
d.Suprascapular artery
• Clinical point of view
• Facet joint referred pain:
causes / symptoms / examples
 The blood supply of neck region

the head and neck receive

majority of its blood supply
through main two arteries:
1.Carotid artery
2.Vertebral artery
 Carotid arteries
Two main arteries run latterly and ascend up the
neck:
l Right carotid artery>>>>>get rise from brochio cephalic turnk

l Left carotid artery>>>>>get rise from arch of aorta

at the level of C4 (thyriod cartilage) the arteries splint into :
1. External carotid artery:
supply structure of front of neck and face

2. Internal carotid artery:

supply structure of the cranial cavity
 External Carotid artery
It terminate to two main branches
1. Superficial temporal artery>>
(superficial structure of the face)
2.Maxillary artery>>>>
(deep structure of the face)
then they give Six branches
1.Superior thyriod artery
2.Facial artery
3.Lingual artery
4.Occipital artery
5.Ascending pharyngeal
Artery
6.Posterior auricular artery
 Internal carotid artery
It supply the structure in the cranial
cavity via carotid canal and at the
level of temporal bone it supplies:
• Brain
• Eyes
• Forehead
 Vertebral arteries
*arise from subclavian
arteries
*ascending up at posterior
side of neck through
transverse processes
*enter the cavity through
foramen magnum then give
rise to the basilar arteries
 Other arteries
• The right and left subclavian arteries give rise to the thyro
cervical trunk which give vessels:
a.Inferior thyroid artery>>>thyroid gland
b.Ascending cervical artery>>>prevertebral muscles
c.Transverse cervical artery>>>Trapezius - rhomboid
d.Suprascapular artery>>>posterior shoulder area
 Clinical point of view

• Symptoms of Carotid artery disease.

1. sudden weakness or numbness in face , arm , leg
2. trouble speaking or understanding
3. sudden vision problem
4. dizziness
5. sudden ,sever headache
6. dropping on one side of the face
 Facet joint referred pain
Causes of facet joint pain:
• Stiffness = hypo mobility
(Locking _ arthritis _ spasm)
• Excessive = hypermobility
(fracture _ dislocation)
• Symptoms
Pain not only on neck but also in shoulder and upper arm
Examples:
C2_3>>posterior skull (headache)
C3_4>>posterior lateral aspect of neck
C4_5>>posterior aspect of lower neck
C5_6>>upper shoulder
C6_7>>scapula
biomechanics
Contents :
• Osteo kinematics
• Facet joint orientation
• Arthro kinematics
Osteokinematics:
ROM
arthrokinematics
Facet joint orientation :
Facet joint orientation :
References:
1. Joint structure
2. Kinesiology
3. Green man
4. https://l.facebook.com/l.php?u=https%3A%2F%2Fgoogleweblight.com%2Fi%3Fu%3Dhttps%253A%252F
%252Femedicine.medscape.com%252Farticle%252F1948797-overview%26hl%3Den-EG%26fbclid
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2E7IaF0_0AKYQ9W8-6JHh07i4lJvrnEqzqb4WLsi4VNQ4qJzWTOWBMwlOcovUl50xeYe3KsYIJdfEKo

5. https://l.facebook.com/l.php?u=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles
%2FPMC1250253%2F%3Ffbclid%3DIwAR11WOMKS9otPtHN-
PpzDD2qtK8evaeFLL5Oy2NLN8I4dAFKOk_aQc32GC0%23s2title&h=AT2qh3OMbK2ww3erdtYnBpQNLh51
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6JHh07i4lJvrnEqzqb4WLsi4VNQ4qJzWTOWBMwlOcovUl50xeYe3KsYIJdfEKo
Thank you