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With regard to the anatomy of the subaxial cervical spine, which of the following statements is TRUE?
Rotation is greatest at more caudal levels
The vertebral artery traverses the foramen transversarium at all levels in the subaxial spine in the majority of patients
The orientation of the superior articular facets transitions from posterolateral facing to posteromedial facing as one travels caudal
When viewed on axial imaging, the inferior articular process is anterior to the superior articular process
In the majority of patients all subaxial cervical vertebrae have a foramen transversarium
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Of the statements listed, only answer 5 is true. In the majority of patients all subaxial cervical vertebrae have a foramen transversarium.
Pal et al., performed an anatomic study to look at the orientation of the superior articular facets in relation to their inclination in the sagittal and transverse planes. They found that all vertebrae at C3 level displayed posteromedially facing superior articular facets. As you moved caudally, the orientation transitions to posterolaterally facing superior articular facets. The level of change in orientation, from posteromedial to posterolateral facing superior facets, was not constant and occurred anywhere between C4 (C3/C4 joint) and T1 (C7/T1 joint).
Illustration A shows the posterior facing orientation of the superior facet articular surface on sagittal images. Illustration B demonstrates the orientation of the superior facets articular surface at each cervical level (notice the transition from posteromedial to posterolateral). Illustration C shows how at each facet joint, the superior articular process from the caudal vertebrae is located anterior to the inferior articular process of the cephalad vertebrae.
Answer 1: False Statement - Range of motion is greatest at more cephalad levels, owing to the orientation of the facet joints.
Answer 2: False Statement - Although C1-C7 exhibit a foramen transversarium, the vertebral artery enters at C6 and exits at C1, leaving the foramen at C7 vacant in the majority of patients.
Answer 3: False Statement - The orientation of the superior articular facets transitions from posteromedial facing to posterolateral facing as one travels caudal.
Answer 4: False Statement - When viewed on axial imaging, the superior articular process is anterior to the inferior articular process
Pal GP, Routal RV, Saggu SK
J. Anat.. 2001 Apr;198(Pt 4):431-41. PMID: 11327205 (Link to Abstract)
Pal, JANAT 2001
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A 3-year old male falls from a table and is brought to the emergency room with neck pain, but no neurologic deficits. Cervical spine radiographs show a synchondrosis separating the odontoid process from the body of the axis. Which of the following best describes this radiographic finding?
a normal physiologic finding
radiographic findings represent a developmental abnormality due to delayed ossification
radiographic findings represent a developmentall abnormality due to early ossification
radiographic findings represent a type 1 traumatic odontoid fracture
radiographic findings represent a type 3 traumatic odontoid fracture
A synchondrosis separating the odontoid process from the body of the axis is a normal radiographic finding in a 3 year old. The evaluation of children with cervical spine disorders requires an understanding of the anatomic and developmental features that are particular to the pediatric spine. The cited reference by Copley et al is an excellent review of the embryology and injuries of the cervical spine in children. They state "the axis (C2) is derived from five primary ossification centers: the two neural arches or lateral masses, the two halves of the dens, and the body. The two halves of the odontoid are generally fused at birth but may persist as two centers known as the dens bicornis. The dens is separated from the body by a dentocentral, or basilar, synchondrosis which remains open in all children up to age 3 years, is present in half by age 4 to 5 years, and is absent in most by age 6 years. The tip of the dens is not ossified at birth but appears at age 3 years and fuses to the dens by age 12 years. Occasionally, it remains as a separate ossiculum terminale persistens and is of little clinical significance."
Copley LA, Dormans JP
J Am Acad Orthop Surg. 1998 Jul-Aug;6(4):204-14. PMID: 9682083 (Link to Abstract)
Copley, JAAOS 1998
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This video is a crash course on the anatomy, examination and radiological interp...
HPI - This man showed up in outpatient clinic complaining about neck and shoulder(right) pain. We conducted an AP & Lateral x-ray just to check his cervical spine. At the lateral view we noted a small long bone at the rear end of the cervical spine (at c6-c7). Never seen this before. We asked him if he put his hand or anyone else tried to help him, but he denied everything. He was alone in the x-ray room with his hands down.
What's this bone?