The cervical spine consists of a total of seven vertebrae and is divided into the upper (C1and C2) and lower cervical spine (C3 through C7). The Occiput (CO), also known as the Occipital Bone, is a flat bone that forms the back of the head. Seven vertebrae make
up the cervical spine with eight pairs of cervical nerves. The
individual cervical vertebrae are abbreviated C1, C2, C3, C4, C5, C6
and C7. The cervical nerves are also abbreviated; C1 through C8.
Atlas (C1)
The Atlas is the first cervical vertebra and therefore abbreviated C1.
This vertebra supports the skull. Its appearance is different from
the other spinal vertebrae. The atlas is a ring of bone made up of
two lateral masses joined at the front and back by the anterior arch
and the posterior arch.
Axis (C2)
The Axis is the second cervical vertebra or C2. It is a blunt tooth–like
process that projects upward. It is also referred to as the ‘dens’
(Latin for ‘tooth’) or odontoid process. The dens provides a type
of pivot and collar allowing the head and atlas to rotate around the
dens.
A complex system of ligaments, tendons, and muscles help to support and
stabilize the cervical spine. The vertebrae are also connected by powerful ligaments, resulting in what is overall a very strong but nonetheless highly mobile functional unit. Ligaments work to prevent excessive
movement that could result in serious injury . Muscles also help to
provide spinal balance and stability, and enable movement. Muscles
contract and relax in response to nerve impulses originating in the
brain. Some muscles work in pairs or as antagonists. This means when a
muscle contracts, the opposing muscle relaxes. There are different
types of muscle: forward flexors, lateral flexors, rotators, and
extensors.
There are discs between the vertebral bodies. These act as shock absorbers and are able to distribute shocks evenly across the entire surface of the vertebral body.
Types of cervical spine injury
A distinction is drawn between different types of impact:
Type A = Compression mechanisms
Type B = Injury resulting from the cervical spine being bent too far in one direction
TypeC = Injury or injuries caused by the head and neck being forcefully twisted
In most cases, it is possible to determine the type of impact from
the pattern of injuries. For example, major compression will in most
cases cause fractures in the area of the vertebral body, which can even
be as severe as fragmenting.
Mechanisms causing the cervical spine to be bent too far in one
direction frequently result in torn discs and ligaments. The feared
dislocation of the cervical spine will in most cases result from
forceful twisting movements
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Spinal fusion and instrumentation were developed and applied as independent techniques for treatment of spinal instability in the first half of the 20th century, before the biomechanical principles surrounding spinal instability were understood.
In current practice, bone grafting and instrumentation are often used
concurrently based on the expectation that internal fixation of spine
enhances the success of bone fusion while a successful bone fusion
eliminates the possibility of hardware failure by reducing the chronic
biomechanical stresses on the hardware construct.
Of note, the term "fusion" is used in this article and in spine
literature to refer to the concept of internal stabilization of spine,
generally accomplished by fusion with instrumentation (instrumented
fusion), but also, albeit with decreasing frequency, accomplished by
bone grafting alone.
Spinal Facet Joints
The joints in the spinal column are located posterior to the
vertebral body (on the backside). Facet joints help the spine to bend,
twist, and extend in different directions. Although these joints enable
movement, they also restrict excessive movement such as hyperextension
and hyperflexion (i.e. whiplash).
