2. STRUCTURE OF THE CERVICAL REGION
Seven vertebrae in total
Morphologically & Functionally – divided into 2 distinct
Upper Cervical Spine – includes occipital condyles &
first two cervical vertebrae (C1 & C2)
Lower Cervical Spine – includes the vertebrae C3 to C7
Typical Cervical Vertebrae – C3 to C6
Atypical Cervical Vertebrae – Atlas, Axis, and C7
Presence of transverse foramen – passage for vertebral
3. CRANIOVERTEBRAL REGION: ATLAS
No vertebral body or spinous process
Shaped like a ring
Presence of lateral masses – formed by zygapophyseal facets
4 articulating facets – 2 superior zygapophyseal facets (kidney
shaped, concave) & 2 inferior zygapophyseal facets (convex,
Transverse process with transverse foramen
Facet on the internal surface of the anterior arch for
articulation with the dense
Cradle the occiput
Transmit forces from the occiput to the cervical vertebrae
4. CRANIOVERTEBRAL REGION: AXIS
Body: Anterior portion extends inferiorly, superior surface of
the body has a vertical projection (Dens)
Dens: Anterior facet for articulation with anterior arch of
atlas & Posterior groove for articulation with the transverse
Arch: Inferior (face anteriorly) & Superior zygapophyseal
facets (face upward & laterally)
Spinous process: Long and elongated with a bifid.
Transmit the combined load of the head and the atlas to the
remainder of the cervical spine.
Provide motion into axial rotation of head and the atlas.
Atlanto-Occipital Joints – 2 concave superior
zygapophyseal facets of the atlas articulating with the two
convex occipital condyles of the skull.
True synovial joints with intra – articular fibroadipose
meniscoids and lie nearly in the horizontal plane.
Atlantoaxial Joints: 3 synovial joints (1 median and 2
lateral atlantoaxial joints)
Median Atlantoaxial Joint:
Between Dens & Atlas.
It’s a synovial trochoid (pivot) joint.
Lateral Atlantoaxial Joints:
Between the superior zygapophyseal facets of the axis
and the inferior zygapophyseal facets of the atlas.
It’s a plain synovial joints – however, the articular
cartilages of both the atlantal & axial facets are convex
(thus – biconvex and filled with meniscoids)
11. THE LOWER CERVICAL REGION: BODY
Lower Cervical Spine – Includes the vertebrae C3 to C7
C3 – C7
12. THE LOWER CERVICAL REGION: BODY
Small, transverse diameter > anterior posterior diameter.
Uncinate process – present at the postero-lateral margins of the
upper surface (concavity in frontal plane)
Inferior projection of the anterior body (concavity in sagittal
13. THE LOWER CERVICAL REGION: ARCHES
Pedicles – Projects posterolaterally
Laminae – Projects posteromedially
Zygapophyseal articular process – Superior facets are flat, oval
and face superiorly & posteriorly; inferior facets face inferiorly
Transverse process – Presence of transverse foramen, Presence
of groove for spinal nerves.
Spinous process – Short, extend horizontally, bifid tip. C2 to C3
(Length decreases slightly), C3 to C5 (Length remains constant),
C7 (Length increases)
Vertebral Foramen – Large, Triangular
15. INTERVERTEBRAL DISK
Annulus Fibrosus – Crescent shape
Cervical discs – Thick anteriorly and taper laterally
Fissures in the disc develops to become cleft by 9 years of age –
becomes joint cavity (Uncovertebral Cleft or Joints of Luschka)
16. INTERBODY JOINTS OF THE LOWER CERVICAL REGION
In sagittal plane, inferior surface of cranial vertebra (concave) and
superior surface of caudal vertebra (convex)
In frontal plane, inferior surface of cranial vertebra (convex) and
superior surface of caudal vertebra (concave)
Predominant motions - Tilting
17. ZYGAPOPHYSEAL JOINTS
True synovial joints
Lie midway between frontal and horizontal plane
Contains fibroadipose meniscoids
Joint capsules are lax – allows larger ROM
Restrict motion at the end of available range
18. KINEMATICS: CERVICAL SPINE
Motion Permitted: Flexion, Extension, Lateral Flexion, Rotations.
It is accompanied by translation – Increases from C2 to C7
Predominant translation – Flexion & Extension (sagittal plane)
19. KINEMATICS: ATLANTOOCCIPITAL JT.
Motion Permitted: Nodding (Flexion / Extension) + Small
amount of Lat. Flexion & Rotation
Combined ROM - 15° (Flexion / Extension) with approx. 3° lat.
flexion and axial rotation
Flexion Occipital condyles slide backward and role
Extension Occipital condyles slide forward and role
Lateral Flexion &
& Axial Rotation
Extremely limited by tension in the joint
20. KINEMATICS: ATLANTOAXIAL JOINT
Motion Permitted: Rotations, lateral flexion, flexion, and
50% approx. – Total rotations of the cervical region occurs at
Remaining 40% - Total rotations of the cervical region evenly
distributed in the lower cervical joints.
Atlas pivots approx. 45° to either side.
22. KINEMATICS: LOWER CERVICAL
Available ROM - Lateral Flexion : 87° ± 22°
Available ROM - Rotation: 144° ± 23°
Rotation and lateral flexion are coupled motions (Lateral flexion is
coupled with ipsilateral rotation)
Ipsilateral side (tilt and slide at interbody joints)
Contralateral side (upslide at zyapophyseal joint)
Interbody Joint: Tilt & Slide to the right
Left Inf. Zygapophyseal Facet: Upslide
Right Inf. Zygapophyseal Facet: Downslide
Sliding of the facets produces slight rotation of the
of the vertebral bodies to the right
Right Inf. Zygapophyseal Facet: Slides posteriorly +
posteriorly + Downslide
Left Inf. Zygapophyseal Facet: Slides anteriorly + Upslide
25. KINETICS: MUSCLE GROUPS
4 functional groups – Superficial Posterior, Deep
Posterior, Superficial Anterior, Deep Anterior.
Trapezius, Levator Scapulae, Splenius
Capitis, Splenius Cervicis
Deep Posterior Multifidi, Suboccipital
Deep Anterior Longus Colli & Longus Capitis
Cervical region bears less weight and are more mobile
Cervical spine is lordotic – anterior shear force
No discs present at atlantooccipital and atlantoaxial articulations – compressive load
Laminae of axis and C7 are large to withstand compressive load
In cervical region from C3 TO C7 – compressive forces are transmitted by 3 columns –
central (major), 2 posterolateral column (one-third)