1. Bones and Joints of the Neck

2. Learning Outcomes After working through these notes and associated reading, you should be able to…
Identify the main features of both typical and atypical cervical vertebrae
Describe the structure and function (movements) of the joints of the cervical spine
Describe the ligaments and how they contribute to the stability of the neck

3. Cervical spine: Osteology

4. Cervical Spine: Left Lateral View Ref: Gilroy, MacPherson & Ross (2008) Atlas of Anatomy

5. Atlas, Axis and Typical Cervical Vertebrae Ref: Gilroy, MacPherson & Ross (2008) Atlas of Anatomy

6. Typical Cervical Vertebra Ref: Drake et al (2005) Gray’s anatomy for students, flash cards

7. Typical Cervical Vertebra: The Body
Small and broad
Anterior surface is convex and slightly overhangs the disc below
Superior surface is concave in the transverse plane with a prominent lip at each side, called the uncinate processes. These articulate with the lateral edges of the vertebra above at the Joints of Luschka. These small synovial joints develop at about 9 – 10 years of age.

8. Typical Cervical Vertebra: Pedicles, Laminae & Vertebral Foramen
The PEDICLES are short and project posterolaterally
The LAMINAE then curve posteromedially
The VERTEBRAL FORAMEN is roughly triangular.
On the inner surface of the laminae, ridges can be seen which are caused by ligamentous pull. Osteophytes may develop at this point.
Q: What ligament attaches here?

9. Typical Cervical Vertebra: SPs & TPs
The SPINOUS PROCESS is short and bifid. It ends at two tubercles, often unequal in size 
Q: What ligament attaches at these tubercles?
The TRANSVERSE PROCESSES begin at the junction of pedicles and laminae, as dorsal and ventral roots or bars. These are located on either side of the transverse foramen
Q: What passes through the transverse foramen?
Lateral to the foramen, the dorsal and ventral bars are joined together by the intertubercular lamella. (This is sometimes called the costotransverse bar, but this is not really an appropriate term). The two bars then continue laterally, ending as the posterior and anterior tubercles. These are important sites of muscle attachment.

10. Typical Cervical Vertebra: Articular Processes and Articular Pillar
The SUPERIOR and INFERIOR ARTICULAR PROCESSES are located at the junction of the laminae and pedicles. The inferior processes are directly below the superior, so, in the articulated spine, they form a continuous column of bone: the articular pillar. This important landmark is palpable posterior to the transverse processes.

11. Atlas and Axis Ref: Marieb & Hoehn , Human Anatomy & Physiology (7th edn)

12. C1: The Atlas
Easily recognised as it forms a ring of bone, with no vertebral body and no true spinous process
It consists of two lateral masses, connected by a short anterior arch and a longer posterior arch.

13. C1: Anterior & Posterior Arches
The ANTERIOR ARCH is slightly convex anteriorly, with a small anterior tubercle in the midline
The POSTERIOR ARCH forms about two fifths of the ring. In the midline, a small posterior tubercle can be seen. This is a rudimentary spinous process
On either side, just posterior to the lateral masses, there is a wide groove. The lateral mass overhangs this groove, sometimes actually forming a tunnel
Q: What runs in this groove?

14. C1: Lateral Masses
Located between the anterior and posterior arches, the LATERAL MASSES are the strongest part of the vertebra
On the superior aspect of each lateral mass, there is a large, concave, kidney-shaped facet
Q: What do these facet articulate with?
On the inferior aspect, there is a smaller, almost circular facet which is flat or slightly concave
On the medial aspect of each lateral mass, a small tubercle can be seen. The transverse ligament attaches here.

15. C1: TPs
The TRANSVERSE PROCESSES (TPs) are long, making C1 the widest of the cervical vertebrae except C7
The tips of the TPs of C1 are palpable just anterior to the mastoid process
The TPs are similar to those of the typical cervical vertebrae in that they have two roots surrounding the transverse foramen, but the apex does not divide into two tubercles

16. C2: Lateral View Ref: Gilroy, MacPherson & Ross (2008) Atlas of Anatomy

17. C2: The Axis: The Dens
The most prominent feature is the DENS or ODONTOID PROCESS. This is a strong, cone-shaped projection from the superior aspect of the body. On its anterior aspect, a small facet can be seen.
Q: What articulates with this facet?
On its posterior aspect, the dens is grooved by the transverse ligament of the atlas. Above this groove, the dens is flattened on each side – this is where the alar ligaments attach. The apical ligament attaches to the pointed apex.

18. C2: Body & Articular Surfaces
The BODY of C2 is obscured superiorly by the dens and the superior articular facets
The lower border of the body projects inferiorly to overhang the disc, as with the typical cervical vertebrae
The SUPERIOR ARTICULAR FACETS are large, flat and oval. They extend from the body partly onto the transverse processes
The INFERIOR ARTICULAR FACETS are located posterior to the superior ones, so they do not contribute to the articular pillar

19. C2: TPs, Transverse Foraminae & SPs
The TRANSVERSE PROCESSES are small, with blunt tips which are comparable to the posterior tubercle on the TPs of typical cervical vertebrae.
The TRANSVERSE FORAMINAE deviate superolaterally. This directs the vertebral artery laterally in order to reach the more widely spaced foramina of C1
The SPINOUS PROCESS of C2 is short and bifid, as with typical cervical vertebrae.

20. C7: Vertebra Prominens
The SPINOUS PROCESS is long and prominent (hence its name). It is thick and it projects almost horizontally, ending in a slight tubercle, to which the ligamentum nuchae attaches. It is palpable at the lower end of the nuchal furrow, but is not necessarily the most prominent SP
The TRANSVERSE PROCESSES are large, especially the posterior root. There is just one tubercle at the tip. The smaller anterior root is sometimes separated, forming a cervical rib. The TRANSVERSE FORAMEN is small and contains only an accessory vertebral vein

21. Joints of the neck

22. Joints of the Upper Cervical Complex
C0/C1: Atlanto-occipital joints
Synovial, condylar joints
C1/2: Atlanto-axial joints
Median A-A joint (synovial, pivot joint)
Lateral A-A joints (synovial, plane joints)

23. Atlanto-Axial (A/A) Joint Ref: Gilroy, MacPherson & Ross (2008) Atlas of Anatomy

24. Upper Cervical Complex: The Ligaments
Apical
Alar
Transverse
Cruciform
Superior longitudinal band
Inferior longitudinal band
Tectorial membrane continuous with PLL
Posterior atlanto-occipital membrane continuous with lig. flavum

25. Upper Cervical Complex: The Ligaments Ref: Gilroy, MacPherson & Ross (2008) Atlas of Anatomy

26. Ref: Kingston, B. Understanding Joints 8 = tectorial membrane 9 = post AA membrane

27. C3-7: The Joints IVDs Apophyseal (facet) joints
Symphysis
Apophyseal (facet) joints
Synovial plane
Uncovertebral joints (joints of Luschka)
Synovial, plane

28. Uncovertebral Joints Ref: Gilroy, MacPherson & Ross (2008) Atlas of Anatomy

29. C3-7: The Ligaments
Ligamentum nuchae
Ligamentum flavum
ALL
PLL