ANATOMY

OF
SUBAXIAL
CERVICAL
SPINE
cervical spine consists of
–three atypical and four typical cervical vertebrae.
ATYPICAL VERTEBRAE -C1,C2 and C7
C3–C7 are defined as the subaxial spine.

•Majority of flexion/extension of the neck and lateral bending occur here:

–Maximal flexion occurs at C4/C5 and C5/C6.

–Maximal lateral bending occurs at C2/C3, C3/C4, and C4/C5.

•Lordotic curvature: 16 to 25 degrees.

Landmarks:

–C2/C3: lower border of mandible.

–C3: hyoid bone.

–C4: thyroid cartilage.

–C6: cricoid cartilage

TYPICAL VERTEBRAE - BONY ANATOMY

Vertebral body: − Concave superiorly. − Convex inferiorly.

• Uncinate process: − Directly interacts with adjacent vertebral body above. −

Contain articular surfaces.

• Pedicle: − Angled medially and superiorly. − Pedicles smaller than those in

thoracic and lumbar spine.
BONY ANATOMY

Transverse process: − Contains transverse foramen:

◦ All cervical vertebrae have transverse foramen.

◦ Anterior to nerve root groove.

◦ Allow for passage of vertebral artery. − C6 transverse process (Chassaignac’s

tubercle) is palpable.

• Lamina: − Bridge between lateral masses and spinous process.

• Lateral mass: − Lateral to junction between pedicle and lamina.

BONY ANATOMY

Contains the superior and inferior articular processes:

Creates the facet joint with the adjacent vertebral articular processes.

◦ Superior articular facets exhibit posteromedial orientation, transitioning to

posterolateral with caudal progression: ▪Supports more flexion/extension.

• Spinous process:

− Bifid from C3 to C5.

− C7 exhibits largest spinous process.

LIGAMENTOUS ANATOMY
• Anterior ligamentous complex:
− Anterior longitudinal ligament (ALL):

◦ Traverses along anterior surface of vertebral

bodies. ◦ Resists extension.

− Annulus fibrosis of the intervertebral disk.

•Middle ligamentous complex:

− Posterior longitudinal ligament (PLL):

◦ Traverses along posterior surface of vertebral

bodies.

◦ Resists flexion.
Posterior ligamentous complex:
− Facet capsules:

◦ Support facet joint for adjacent vertebra articulation and resist distractive
forces.

− Interspinous and supraspinous ligament:

◦ Traverse between spinous processes: ▪ Midline avascular plane.

◦ Continuous with the ligamentous nuchae above C7.

− Ligamentum flavum:

◦ Deepest structure posteriorly prior to reaching spinal canal.

◦ Connects the laminas of adjacent vertebrae.

MUSCULAR ANATOMY

• Fascial layers :
− Platysma: ◦ Superficial muscle.

− Superficial layer of deep cervical fascia: ◦ Contains anterior neck muscles

(except longus colli) and trapezius posteriorly.

− Prevertebral layer of deep cervical fascia: ◦ Contains all posterior neck muscles
deep to trapezius. ◦ Covers ALL and longus colli.

− Pretracheal fascia: ◦ Contains thyroid and trachea.

− Carotid sheath: ◦ Contains carotid artery, internal jugular vein, and vagus nerve
(cranial nerve X).
Muscular layers:
− Anterior neck muscles : ◦ Divided into two regions: anterior neck
and anterior cervical triangle: ▪ Anterior cervical triangle primarily
functions to move the hyoid bone.

− Posterior neck muscles: ◦ Divided into three regions: posterior

neck, occipital triangle, and suboccipital triangle:
▪ Posterior neck
▪ Occipital triangle : Borders: sternocleidomastoid (SCM; anterior),
trapezius (posterior), and omohyoid (inferior).
VASCULAR ANATOMY

Cervical region rich in vascular structures.

• Carotid sheath:

− Within carotid triangle of anterior neck: ◦ Formed by SCM laterally, digastric

superiorly, and omohyoid anteriorly.

− Contains carotid artery (anteromedial), internal jugular vein (anterolateral),

and vagus nerve (posterior between artery and vein).
Subclavian artery : −
Originates from aorta (left) or brachiocephalic trunk (right):

◦ Traverses between anterior and middle scalene muscles.

− Branches:

◦ Vertebral artery:

▪Bilateral.

▪Primary arterial supply to cervical vertebrae and cord.

Ascends between anterior scalene and longus
colli muscles.

Four segments: progresses superiorly:

V1: preforaminal:

▪Subclavian artery to transverse foramen

(C6).

▪Despite a vertebral foramen in C7, the

vertebral artery does not travel through it in a
majority of individuals.

◦ V2: foraminal: ▪Transverse foramen (C6) to

C2 vertebrae.

◦ V3: above C2: ▪C2 to dura mater.

◦ V4: intradural: ▪Intradural to basilar artery

Neural Anatomy

• Nerve roots: − Exit anterolateral to superior facet.

− C3–C7 nerve roots exit above the pedicle of their respective vertebrae.

− C8 exits below C7 vertebra (above T1 pedicle).

− Dorsal (posterior) rami provide sensation for majority of posterior neck and head.

− Ventral (anterior) rami form two nerve plexuses:

◦ Cervical plexus.

◦ Brachial plexus.
SUBAXIAL CERVICAL SPINE
INJURIES-

CLASSIFICATION
MANAGEMENT:
Thank you ……