We finished with the bony part of the head which was the skull ,,today we will speak about

the bony framework in the neck ,,which is made by the cervical vertebrae and as you all know that the cervical vertebrae are part of the vertebral column ,,vertebral column is made up of 33 vertebrae .. they are divided into : - 7 in the cervical region - 12 thoracic - 5 lumbar - 5 sacral - 4 coccygeal The last two the sacral & coccygeal >> they usually fuse with each other ,,the sacral 5 vertebrae fuse to form the sacrum ,,& the coccygeal fuse to form the coccyx

..

So our lecture today will be related to those 7 cervical vertebrae ,,before we start we have to know some general information about vertebral column to understand the formation & the shape of cervical vertebrae ,,when we look to the vertebral column development during fetal period as the fetus is sleeping over itself so the all vertebral column will be carved more anteriorly (y3ne concave anteriorly ) ,,this is what we refer to it as the primary curvature of vertebral column

) << concave

anteriorly during fetal period ,,however after birth some changes happening : First change when the baby start to crawling

) he is always trying to left his

head up ,,when he start to left his head up the curvature in the cervical region now become concave posteriorly instead of anteriorly also when the kid starts to stand up ,,assuming his up in right position & start to walk the concavity in the lumbar region is changed to become posteriorly ,, SO in this case we call these curvatures secondary curvatures of the vertebral column ,,because they changed after birth ,,from the primary one which was concave anteriorly to after birth to become concave posteriorly .. So secondary curvatures be9ero bs bmn68ten : **cervical >> when the kid start to left his head up

**lumbar >> when the kid start to stand up on his legs SO the primary curvatures remain after birth in two areas : in the thoracic region it still concave anteriorly in the sacral region ( pelvic region sacrum + coccyx) concave anteriorly **thoracic & sacral (pelvic) >> PRIMARY curvatures **cervical & lumbar >> SECONDARY curvatures

So the 7 cervical vertebrae are primary or secondary ? secondary :) In addition to these two normal curvatures,, they are normal because of the resilience of the vertebral column ,,it must be resilience (mshan ysma7 b7rket ljethe3)>> tlef ymen shmal tn7ne.. In addition to these normal there could be some abnormal curvatures ,, abnormal m3nato yntoj bsabb developmental anomaly aw bsabb pathological process ,, (fe mr9 adda lha aw fe anomaly genetic abnormalities ) lead to this kind of abnormal curvatures..

Abnormal curvatures mainly 3 : 1- Kyphosis

) ,,increase in thoracic curvature (hunch

back) bsabb t2akl al26raf alamamyeh mn lthoracic vertebrae,, there will be an erosion of anterior part of the vertebrae in the thoracic region.. **this is because of osteoporosis (pathological process )

,,

(
people)

),,its mainly happen in the geriatric people (old

2- Lordosis ,,increase lumbar curvature (secondary),, lmma bzed bsmoh hollow back ,, hollow >> fa9e ,, the back of the patient is too much concave posteriorly .. Can be seen in temporary cases as in late pregnancies in women >> weight of the fetus is very heavy producing pressure on the vertebral column

increasing this kind of curvature temporary lordosis because after delivery it will be demolished .. also it can be seen in some people whose suffering from muscular weakness >> especially in the anteriolateral abdominal muscles external oblique, internal oblique, transverses abdominus those muscles come from vertebral column all the way back then turn anteriorly to reach the rectus abdominus muscle ,, homeh hdol shadat lvertebral column >> when those muscles become weak they will relax paralysis r7 yr5o l pulling of the vertebral column ,,so the vertebral column goes more anteriorly .. 3- Scoliosis (curved back) : jeha a6wal mn jeha bl vertebral column ,,fbkon **** (sorry cant hear) patient.. for many causes : ** developmental anomaly : half of the vertebrae didnt developed . ** asymmetric paralysis : in one side of the intrinsic path muscles 39lat shadeh l3mod lf8re ,, one side is paralysis so bn7ne to the opposite side . ** difference in the lengths of the lower limbs . SO vertebral column is made up of 33 vertebrae & the joints between them called secondary cartilaginous because there is intervertebral discs made of fibrocartilage ,, located between each vertebrae & another .. Intervertebral disc is very important because its function is shock absorption ,,when we look at it superiorly it is made up of two parts : 1- Annulus fibrosus (fibrous) : external part 9lb jdn fibrocartilagenous ,,lefe annulus >> da2re ,, concentric >> 7l8at ,,fibrosus >> fibrous SO concentric layers of fibrocartilage to strengthen the disc . 2- Nucleus pulposus (gelatinous): Inernal pulp of the disc made of gelatinous material

) ,, nucleus pulposus located in this area is empty

because we have open in the disc ,, it is the central core of the disc & more elastic because of watery content (high water content) SO nucleus pulposus is the main part of shock absorption .

SO the intervertebral disc btkawn mn 2 parts annulus fibrosus & nucleus pulposus fra3 kamel y7twe madeh hlamyeh Disc herniation : mar9 ldesk Tearing in annulus fibrosus >> as a result the nucleus pulposus will be drains out of the annulus fibrosus .. **the disc anteriorly is made of a very thick layer of annulus fibrosus however the posterior layer is thinner >> Fl2shal etha 9ar tmzo8 bkon posteriorly so the herniation will happen posteriorly ,,then nucleus pulposus will start to leak posteriorly where there is the vertebral canal which contain the spinal cord ,,,, SOO when the nucleus pulposus enter the vertebral canal it will pressure on the spinal cord it will produce pain on the nerve that originating from that area of the spinal cord . Herniation usually happened between L4-L5 & L5-S1 >> because they are the last two discs & most of the weight on them.. kl ma zad lwzen zad l pressure 3l disc wzad l ability eno ytmz8 l annulus fibrosis

**why there are NO discs between the sacral vertebrae ? Because they are fused & form the sacrum ,, they all as one piece of bone . SO the last disc is between L5 S1 . Sciatic nerve originated from L4,L5,S1,S2,S3 Sciatica : 3er8 lnesa Is happened because of pain in the sciatic nerve root ,, that pain is usually happened because of disc herniation to L4-L5 OR L5-S1 the pain extend from the back to the lower limbs

IV Ligaments (intervertebral ligaments) : To FIX the vertebrae & the discs in their positions ,,there are ligaments supporting the vertebral bodies & ligaments supporting the vertebral arches .

Structure of the vertebra fe elha body mn lamam wby5tlf mn mn68a lmn68a ,,rectangular in cervical ,, arch shape in thoracic ,, kidney shape in lumbar .. Behind the body there is arch composed of 2 pedicels & 2 laminae ,,over them there are 7 processes: 2 transverse, 1 spinous , 2 sub articular processes , 2 inf articular processes Ligaments between Vertebral Bodies : 1. Ant. longitudinal ligament: mn alamam 3la 6ol l3mod lf8re ,, its very strong & broadband (3re9) ,,3la 6ol l anterior surface of the vertebral column from up to down 2. Posterior longitudinal ligament: very narrow ligament posteriorly ,,on the middle aspect of the post. vertebral bodies ,, ant. Ligament is stronger than post. Ligament . Ligaments between arches & processes : 1. Ligamentum flavum: Or flavae aktr mn wa7d flavum mean yellowish >>because it has elastic connective tissue mren ,, between the laminae of the vertebra above & below . 2. Intertransverse lig. : Between transverse process above & transverse process below . 3. Interspinous lig. : Between spinous processes . 4. Supraspinous lig. : On the tip the spinous processes,, between tips of spines . 2 lig. For bodies & 4 lig. For arches **there is additional lig. ONLY in the cervical region : 5. Nuchal Ligament : or ligamentum nochae Nucha is French word means the back of the neck Occipit is the back of the head So this ligament as you see it here its located in the back of the neck bnzel mn lskull from external occipital protuberance n86a wa97a jdn fe nhayt lra2s

Bebda mnha l nuchal lig. Wbenzel 3la 6ol lmnt9af tb3 l occipital bone external occipital crest OR median nuchal line SO it extend from external occipital protuberance & median nuchal line ,,,benzel all the way down wbrtabet m3 el supraspinous lig. Bs bmn6e8et l cervical ,,, It merge with the supraspinous lig. Of the cervical region l7d C7 bynthe 3nd C7 Nuchal lig. >>> support the cervical vertebrae because they are small in size post. Cervical Vertebrae : 7 cervical vertebrae we classify them to typical & atypical upon to specific characteristics as the ribs 4 main characteristics to classify the typical vertebrae if we miss one of them it will be considered atypical ,,
Transverse processes of cervical

Atypical vertebrae : C1 the Atlas C2 the Axis C7 Typical vertebrae : C3 , C4 , C5 , C6 **Because they have : 1-rectangular shape body 2-transverse foramina ft7at on the transverse processes

vertebrae have foramina not exist in the remain vertebrae of the body,, because of very important artery ascending from the root of the neck up into the skull to provide blood supply to the post.inf. part of the brain especially cerebellum ,,which is called vertebral artery inside the vertebral column within the cervical vertebrae ,,its a direct branch of subclavian artery that enters the transverse foramina & after passing the first one it goes to foramen magnum of the brain

This vertebral artery passBifid : 2 cervicalONLY exception is C7 it has C7 ,, through heads transverse foramina except

Long process & the brain . process ,, then it enters C6 foramen up to unifid (short bifid spinous process 3-short bifid spinous the transverse foramen of C7 it The cause of that >> if the artery gonna pass in process
has to make a sharp angle so it will block the blood supply to the brain <<< thats the first reason why the C7 is atypical .

although C7 has transverse foramen the artery pass anterior to the transverse

Bifid : 2 heads ONLY exception is C7 it has

Long process & unifid (1 head) process

4-large triangular vertebral foramen vertebral foramen bemr feha l spinal cord ,, between the body & the arch of the vertebrae ,,vertebral foramen akbar eshe btkon bl neck cervical vertebrae,,b3den btbd2 tt9ya8 fl thoracic >>lumbar >>sacrum ,, become narrower as you go down because of tapering of the spinal cord

Because of C7 has long spinous process the physicians count (be3edo) the vertebrae from spinous process of C7 ,,in the root of the neck fe mn6e8a wa97a jdn (bony prominent palpated easily ) >> which is the tip of the spinous process of C7 **SO C7 has along with one head spinous process ,,very easily palpated (bulging beneath the skin),,thats why we depend on this spinous process in counting the vertebrae

Four main characteristics of a typical cervical vertebrae : 1- Rectangular body 2- Transverse foramina 3- Bifid spinous process & short 4- Triangular & large vertebral foramen Exception C7 >> long unifid spious process & has foramen but the vertebral artery doesnt pass in this foramen

Atlas C1 : First cervical vertebra Atypical >> fesh elo body ,,it is a ring shape bone

,,so NO body ,,NO spinous

process,, instead it has only anterior arch & posterior arch ,, & two lateral masses of bone to allow it for articulation up & down,, Fhwa 7l8a (5atam) 3leh 2 small masses of bone for articulatin
why do they call it Atlas ?? in the Greek mythology ,, Greek gad ATLAS ,, whose holding the whole earth in his hands ,, SO referring to this kind of mythology or resembling ,, the Atlas is the first vertebra holding the whole skull up .

Atlas communicate superiorly by 2 joints (ahm 2 joints in cervical region) ,, the first one with the skull superiorly m3 the occipital condyles occipital bone ,, forming atlanto_occipital >> allow the head to move in anterior posterior directions flexion & extension signifying YES ,, this is between the atlas & the skull The other joint inferiorly of the atlas atlanto_axial joint >> for rotational movement of the head signifying NO ,, ma elha 3la8a bl skull betm da5l lf8rat l3n8yeh nfsha ,, there is no movment for the skull there ,,(between atlas & axis) ..

Most two important joint in the cervical vertebrae : 1- Atlanto_occipital 2- Atlanto_axial >> flexion & extension >> lateral movement

Axis C2 : Atypical because of one reason >> on its body it has dense , tooth , axis , Odontoid process It is used to thought by some anatomists that the dense of axis actually used to be the body of atlas but with development & with time it has lost its communication & fusion with atlas to go & fuse with the axis to allow the rotational movement.

Atlas is a ring shape & this is the axis w6ale3 mno ldense ,, al atlas mrtabe6 bl dense wbelf 3leh ,, so the dense or the odontoid process acting as an axis for the atlas producing rotational movement ,, saying NO >> so atlas rotating over the dense of the axis on the atlanto_ axial joint . Atlanto-Occipital Joint : The type , articulation , supporting ligaments & the movement. NOTE : Special characteristics for it not included :) Type : condyloid synovial joint >> condyloid because of the occipital conyles are part of articulation
Codyle : is a smooth round surface ,,help in articulation of the joint ,,always present in the

Articulations : atlas with occipital codyles Movement : flexion & extension ,,also help in lateral flexion ,,myzoha 3n elrotational flexion . **lateral flexion : atlas btlef 3l axis wl axis 3l C3 wl C3 3l C4 m3 b39 ,, btebda bl atlanto_occipital & continue within the cervical vertebrae ,, bending of your head . Ligaments : Two important membranes : 1. Ant. atlanto-occipital memb. from the anterior arch of atlas to anterior margin of foramen magnum 2. Post. atlanto-occipital memb. From the posterior arch of atlas to the posterior margin of foramen magnum occipital bone ,,B6al3 3leh mn wra b7me l joint post. ***SO both of them extend from the arches of atlas to the margins of foramen magnum

Atlanto-Axial Joints : 3 Atlas articulating with the axis in the 3 joints **First 2 lateral atlanto_axial laterally located between the lateral masses of atlas with superior articular facets of axis ,, Type >> synovial gliding joints Atlas with lateral masses & Axis with facets . **Median atlanto_axial joint :

In the middle ,, the most important ,, classified as pivot synovial joint ,, pivot means axial ,, so the movement is rotation ,, rotation start Between the anterior arch of atlas along with the dense of axis Articulation : Anterior arch of atlas , the dense of axis , posterior there is a ligament >>transverse ligament of atlas . The transverse ligament of atlas begin from lateral mass of atlas in one side to the lateral mass of atlas in the another side ,, so its the stick to keep the dense attached firmly against the anterior arch of atlas ,, & thats why it considered as part of articulation .

SOOO : 1- Anterior arch of atlas 2- The dense of axis 3- Transverse ligament of atlas

Imagine this ligament is rupture ,,if there is tearing to this ligament that means the dense will leave the anterior arch of atlas ,, so there will be a posterior displacement of the dense of axis & HERE the dangerous situation If it posteriorly displaced this is what we call it Atlanto-axial dislocation its minor >> subluxation (again dense of axis go posteriorly away of the atlas) Behind the dense of axis there is the spinal cord ,, & above the atlas directly the skull (foramen magnum) ,, at the level of foramen magnum usually the last part of the brain medulla oblongata sometimes if

) benthe 3la 7eft l foramen magnum w bbda2 l spinal cord ,,, so

if this tearing happen the dense will be go post. wby9rb emma l medulla oblongata aw mmken y3ml enjry bl spinal cord .

Medulla oblongata has a very important centers >> the cardiovascular center & the respiratory center ,, if the tear hit those two centers that will result in direct death

Quadriplegia

More lucky situation if the dense go back & hit the spinal cord only that will result in paralysis in all nerves that the spinal cord supply,, kl la6raf tb3 l person btnshal . 80% of car accidents death happen because of tearing in transverse ligament of atlas . Web lash injuries

) : as the driver driving in very high

speed &

he just hit the break ,, his head will go ant. & post. web lashing ,,when the head comes back huge force has been gathered cause a tearing in the transverse ligament & the dense hit the medulla oblongata .

Supporting Ligaments of atlanto_axial joint : 1- Cruciate Lig Or cross ligament ,,Come posteriorly ,,howeh nfsoh l transverse ligament of atlas ,,the horizontal part of it is the transverse ligament of atlas ,, but in order to strengthen it by6l3 mno 2 vertical branches (2 lig. Attach to the skull ,,the ant. Margin of foramen magnum) ,,one of them descend to attach the body of the dense post. ,,,,,,SO one from above & another from below . Just remember that this ligament mainly is an expansion of transverse ligament of atlas . 2- Apical Lig You dont see it here,, you have to cut the cruciate lig. ,,its at the apex of the axis Attach the tip of the dense along with the ant. Border of foramen magnum. 3-Alar Lig.s they are going to the sides ,,dense of axis by6l3 mno lig. From the tip bro7 ll23al called apical ,,by6l3 2 one to the RT & one to the LF those called the alars ,, so we have apical & 2 alars .

4- Tectorial Membrane Be36e all the ligaments ,,if you cut it you will see post. the cruciate lig. & when you cut the cruciate you will see the alars & the apical

**tectorial membrane is a continuation of post. longitudinal lig. Tb3 l vertebral column ,, when the post. longitudinal lig. Reach Behind C2 & C1 then it name will be tectorial . AGAIN the tectorial lig. Is the post. longitudinal lig. itself .

Your colleague :) Malak abuaqulah