CRANIOVERTEBRAL JOINTS AND REMOVAL OF THE HEAD

SKELETON OF SUBOCCIPITAL REGION

ATLAS
Most superior (first) cervical vertebra Named for the Atlas of Greek mythology
y

Supports the globe of the head

Practically no body or spine Appears as a bony ring with two transverse processes Upper surface two kidney-shaped facets that unite with the occipital condyles of the skull

ANTERIOR ARCH

Anterior
Convex Anterior

tubercle for the attachment of the Longus colli muscles and the anterior longitudinal ligament

Posterior
Concave Marked

by a smooth, oval or circular facet (fovea dentis), for articulation with the dens of the axis

POSTERIOR ARCH

Give origin to the Recti capitis posteriores minores and the ligamentum nuchae Diminutive size of this process prevents any interference with the movements between the atlas and the skull

SUPERIOR ARTICULAR FACETS

One of two concave articular surfaces on the superior aspect of the lateral masses of the atlas Articulate with occipital condyles

TRANSVERSE PROCESSES

Have "transverse foramina", which serve as passageways for arteries leading to the brain

AXIS
Bears a tooth-like "odontoid process" on its body Projects upward Lies in the ring of the atlas As the head is turned from side to side, the atlas pivots around the odontoid process

OCCIPITAL BONE

OCCIPITAL CONDYLE
Undersurface facets of the occipital bone in vertebrates Function in articulation with the superior facets of the atlas vertebra

ATLANTO-OCCIPITAL JOINT
Articulation between the atlas and the occipital bone Consists of a pair of condyloid joints Synovial joint

TRANSVERSE LIGAMENT OF ATLAS

Thick, strong band Arches across the ring of the atlas Retains the odontoid process in contact with the anterior arch

RETROPHARYNGEAL SPACE

Space bounded by the buccopharyngeal fascia (anteriorly) and the alar fascia (posteriorly)

CRANIOVERTEBRAL JOINTS

TECTORIAL MEMBRANE
Broad, strong band Covers the dens and its ligaments Appears to be a prolongation upward of the posterior longitudinal ligament of the vertebral column

CRUCIATE LIGAMENT OF ATLAS

Strong ligament that lies posterior to the dens of the axis holding it against the anterior arch of the atlas Consists primarily of

Transverse ligament of the atlas y Longitudinal bands (Superior and Inferior)

y

ALAR LIGAMENTS
Connect the sides of the dens to tubercles on the medial side of the occipital condyle Known as the "check ligament of the odontoid"
y

Function to check sideto-side movements of the head when it is turned

ATLANTO-AXIAL JOINTS

MEDIAN

Considered as double joint

one between the posterior surface of the anterior arch of atlas and the front of the odontoid process y one between the anterior surface of the ligament and the back of the odontoid process
y

LATERAL
Involves the lateral mass of atlas and axis Most bulky and solid parts of the atlas, in order to support the weight of the head Each carries two articular facets, a superior and an inferior It is the origin of the obliquus capitis superior and the insertion of the obliquus capitis inferior

PREVERTEBRAL AND LATERAL VERTEBRAL REGIONS

PREVERTEBRAL FASCIA
Extends medially behind the carotid vessels, where it assists in forming their sheath, and passes in front of the prevertebral muscles Forms a sheath for the brachial nerves and subclavian vessels in the posterior triangle of the neck

SYMPATHETIC TRUNK
Fundamental part of the sympathetic division of the autonomic nervous system Allows nerve fibers to travel to spinal nerves that are superior and inferior to the one in which they originated

CERVICAL SYMPATHETIC GANGLIA

Extension of the thoracic paravertebral sympathetic trunk lying inferiorly Functions

Part of the circuit to distribute sympathetic fibres to the head and neck y Necessary relay as the sympathetic outflow from the spinal cord, via the anterior roots, emerges no more superiorly than the level of T1.
y

CERVICOTHORACIC GANGLION
A sympathetic trunk ganglion behing the subclavian artery near the origin of the vertebral artery, at the level of the seventh vertebra Also called stellate ganglion

MUSCLES

LONGUS COLLI

Medial part
O: bodies of the third thoracic to the fifth cervical vertebrae y I: bodies of the second to fourth cervical vertebrae Superolateral part y O: anterior tubercles of the transverse processes of the third to fifth cervical vertebrae y I: anterior tubercle of the atlas
y

Inferolateral part y O: bodies of the first to third thoracic vertebrae y I: anterior tubercles of the transverse processes of the fifth and sixth cervical vertebrae Action:

Twist neck and flex neck anteriorly Ventral primary rami of cervical spinal nerves (cervical plexus)

Nerve Supply:

LONGUS CAPITIS
Arises from the anterior tubercles of the transverse processes of the third to sixth cervical vertebrae Converges superomedially to insert into the anterior and basilar surface of the occipital bone Innervated by the anterior primary rami of the first to fourth cervical nerves (C1-C4)

Actions:
y y

Acting unilaterally, to:

flex the head and neck laterally

Acting bilaterally, to flex the head and neck

SCALENE
Group of three pairs of muscles in the lateral neck (scalenus anterior, scalenus medius, and scalenus posterior) Originate from the transverse processes from the cervical vertebrae of C2 to C7 Insert onto the first and second ribs Called the lateral vertebral muscles

Action of the anterior and middle scalene:

Elevate the first rib y Laterally flex the neck to the same side Action of the posterior scalene
y

Elevate the second rib Tilt the neck to the same side

Act as accessory muscles of inspiration, along with the sternocleidomastoids

CLINICAL SIGNIFICANCE

CERVICOGENIC DIZZINESS
Cervicogenic vertigo This condition does not produce a true spinning sensation that is characteristic of vertigo Literally means dizziness from the neck Refers to the sense of dizziness that may occur following neck injury or dysfunction.

WHAT ARE THE SYMPTOMS OF CERVICOGENIC DIZZINESS?

Description of unsteadiness or of feeling giddy, often reporting that it feels like the ground is moving underneath them They may feel like they are swaying, rocking or even being pulled to one side Some patients relate this experience to that of being drunk. Feeling spacey, hazy, light-headed, or a sensation of floating or of being disconnected or distant from their own body

Symptoms range from minutes to hours and can range from mild and annoying to severe and debilitating Condition may take days, weeks or even months to appear after the initial neck injury and may last for many months more

TREATMENT
Treatment directed at the neck itself, and in some cases, specialised rehabilitation exercises that improve co-ordination between neck and eye movements Manual therapy approaches for the neck are designed to address restricted mobility due to joint dysfunction Spinal exercises may also be recommended to address faulty movement patterns, and poor posture Specialised neck and eye movement exercises can be taught within the clinic and performed at home