Atlas and Axis

Anatomy Review
• Bony landmarks
• Tissue layers
• Blood supply
• Nerve innervation
• Muscles
• Ligaments
• Joint classifications
Overview
Comparative Anatomy
• Owls
• Reptiles

Pathology
• Atlantoaxial instability
• Whiplash injuries
C1
C2
Blood Supply
Vertebral arteries
• Originating from the subclavian
• Travel through transverse
foramen
• Becomes basilar artery after
passing through foramen
magnum
Anterior spinal artery
• Runs through anterior surface
of the vertebral foramen,
supplying the spinal cord

Posterior spinal artery

• Runs along the posterior
surface of the vertebral
foramen, supplying the spinal
cord

Segmental medullary artery

• Supplies blood to inside and
surface of the spinal canal
 Vertebral Veins
• descend through the transverse foramina
Blood Drainage of cervical vertebrae
Vertebral venous plexus
• network of veins that run along the entire
vertebral column
Nerve innervation
• Cervical nerves C1,
C2, and C3 innervate
atlas and axis,
controlling forward,
backward, and side to
side movement of the
head and neck.
 Joints & Classifications
Atlanto-occipital joint
• Synovial ellipsoid joint, diarthrotic movement
• Between occipital condyles of the skull and the superior articular facets of the atlas
• Allows for nodding movements of the head and neck
Atlantoaxial joint
• Synovial plane/pivot joint, movement
• Between atlas and the dens of the axis vertebrae
• Allows for rotation of the head and neck.
Articulated Facets ( Sup./Inf. cervical joints)
• Apophyseal joints with gliding motion
 Ligaments
Cruciform ligament (cross-shaped)
• Superior and inferior longitudinal fibers and transverse
ligament
• Restricts posterior displacement of C2
Transverse ligament of atlas
• Arches across ring of atlas
• Anchors dens to atlas, and restricts flexion and anterior
displacement of the atlas
Alar ligament
• Apex of dens to occipital condyles
• Restricts excessive axial rotation
Posterior longitudinal ligament (cut)
• Tectorial membrane at superior end
• Stabilizes the vertebrae of the spinal column
Apical ligament of dens
• Remnant of the notochord, and doesn’t contribute to
stability
• Apex of dens to anterior surface of foramen magnum
 In articulation
Craniovertebral Junction
Motions and their Muscles
Flexion
• Sternocleidomastoid
• Anterior scalene
• Longus capitis
• Longus colli
• Rectus capitis anterior
• Rectus capitis lateralis
Extension
• Semispinalis capitis
• Splenius capitis

• Semispinalis cervicis
• Splenius cervicis
• Longissimus cervicis
• Interspinales cervicis
(assists)
Lateral flexion
• Semispinalis capitis
• Splenius capitis

• Splenius cervicis
• Longissimus cervicis

• Longissimus thoracis

• Scalene anterior, middle and posterior

Rotation
• Obliquus capitis inferior
• Splenius capitis
• Longissimus capitis

• Splenius cervicis
• Longissimus cervicis

• Longissimus thoracis
 Anatomy Review
• Bony landmarks
• Tissue layers
• Blood supply
• Nerve innervation
• Muscles
• Ligaments
• Joint classifications
Overview
Comparative Anatomy
• Owls
• Reptiles

Pathology
• Atlantoaxial instability
• Whiplash injuries
 Owl Vertebrae
Key differences:
• Origin of rotation in
between C5 and C6

• Double the cervical

vertebrae as humans,
increasing flexibility

• Lacking spinous
processes
• Allow neck extension
for up to 180 degrees
• Vertebral foramen are 10
times larger in diameter
• This creates a larger area for
the vertebral artery to move
around while the owl rotates
it’s neck up to 270 degrees

• Maxillary and mandibular

arteries are highly elastic
• Pooling of blood here allows
continuous blood flow during
rotation
 Anatomy Review
• Bony landmarks
• Tissue layers
• Blood supply
• Nerve innervation
• Muscles
• Ligaments
• Joint classifications
Overview
Comparative Anatomy
• Owls
• Reptiles

Pathology
• Atlantoaxial instability
• Whiplash injuries
Atlantoaxial Instability
Atlantoaxial instability
• Alar, apical and transverse ligaments between atlas and axis
experience a trauma causing lacking integrity of reinforcement of
dens
• Very common, and characterized by pain in the upper neck, vertigo
dizziness, headaches, and tinnitus

• Cervical immobilization is required,

through posterior cervical spinal fusion
Whiplash
Whiplash
• Blunt force causing sudden and forced flexion and extension of the
neck
• Primarily affects the alar ligament, loosening the connect between the
occipital condyles and the dens of the axis
• Physical therapy, pain medication, heating and icing, rest
 References
Humans

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3535240/
• https://www.proquest.com/docview/2464209333?parentSessionId=ybtWeR3SXUU%2BtslEciFZkB4VpoGPGQpTumjkHBk0%2FQw%3D&pq-origsite=su
mmon&accountid=14506

• https://www.ncbi.nlm.nih.gov/books/NBK557555/
Owls
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5472525/
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4519302/
• https://www.baltimoresun.com/health/bs-xpm-2013-02-22-bs-hs-hopkins-owl-study-20130222-story.html