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INTRODUCTION

The cervical spine provides the greatest range of motion (ROM) among the sections of the spinal column. However, the spinal cord is the most vulnerable to injury in this location. Because of the important role the cervical vertebrae have in protecting the spinal cord and spinal nerve roots, injury to this area can be catastrophic. Even noncatastrophic injury to the neck region can have an impact on an individual’s daily life.

Similar to low back pain, the origin of cervical spine pain is frequently nonspecific, in that the involved structures cannot be identified. Approximately one-third of the population will experience cervical pain during their lives. A systematic examination that leads to specific treatment options is required for proper patient care.1

CLINICAL ANATOMY

Cervical Spine

Carrying only the weight of the head, the vertebral bodies of the cervical vertebrae are much smaller than the other sections of the spinal column (Fig. 14-1). The cervical transverse processes include a transverse foramen through which the vertebral artery and vein pass; this structure is not found in the thoracic or lumbar vertebrae. Each vertebra articulates with its adjacent vertebrae via an interbody articulation and superior and inferior facet (zygapophyseal) articulations that project from the pars interarticularis. The uncinate processes on the posteromedial margin of the body’s endplates give the superior surface a concavity and increase the joint surface of the vertebral body. The uncinate processes on the inferior vertebrae articulate with the uncus process on the superior vertebrae to form the uncovertebral joints from C3 to C7.

FIGURE 14-1

C4 and C5 cervical vertebrae. 1, uncinate process; 2, intervertebral foramen (spinal nerve foramen); 3, superior intervertebral notch; 4, transverse foramen; 5, posterior tubercle of transverse process; 6, anterior tubercle of transverse process; 7, C4–C5 disc; 8, spinous process.

The first two vertebrae of the cervical spine are unique. The first cervical vertebra, the atlas, has no vertebral body and supports the weight of the skull through two concave facet surfaces articulating with the occiput, forming the atlanto-occipital joint. The primary movement at the junction between the atlas and the skull (the C0–C1 articulation) is flexion and extension, such as when nodding the head “yes.” A slight amount of lateral flexion also occurs at the C0–C1 articulation. At the C1 vertebra, the transverse processes are exceptionally long, and no true spinous process exists.

The second cervical vertebra, the axis, has a small body with a superior projection, the dens. The articulation between the anterior arch of the atlas and the dens forms the atlanto-axial joint (Fig. 14-2). This joint provides the most cervical rotation, as when shaking the head “no.” The C0–C1 and C1–C2 articulations are entirely synovial joints that are lacking the substantial bony facet ...

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