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James W. DeVocht, DC, PhD

Module 3 Functional Anatomy of the Cervical Spine (Herzog Chapter 3 – by Cramer et al.) Biomechanics (TECH 71613). James W. DeVocht, DC, PhD. Cervical curvature is the least distinct of the spine. Begins before birth, becomes more noticeable at 3-4 months.

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James W. DeVocht, DC, PhD

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  1. Module 3 Functional Anatomy of the Cervical Spine(Herzog Chapter 3 – by Cramer et al.)Biomechanics (TECH 71613) James W. DeVocht, DC, PhD

  2. Cervical curvature is the least distinct of the spine Begins before birth, becomes more noticeable at 3-4 months Absorbs shock by dissipating loads applied to the spine Herzog p 50 Snell p 494 Fig B

  3. Some authors state there are two cervical curves- C0 to C2 (kyphotic)- C3 to C7 (lordotic) Herzog p 52 Herzog Fig 3-1C

  4. Typical cervical (C3-C6) - body is small - lower ones are larger - superior surface: concave L to R, convex A to P - inferior surface: convex L to R concave A to P - lateral lips (uncinate processes) allow flex/ext, inhibit lateral bending - may see uncovertebral joints (of Von Luschka) - compact bone of pedicles continuous with that of articular processes Herzog Fig 3-2A Herzog Fig 3-2C

  5. Transverse Processes: - groove for spinal nerve (between facet and transverse foramen) - foramen of the transverse process (was called foramen transversarium) - vertebral artery enters at C6 goes up through C1 - several veins also go down through - plexus of sympathetic nerves goes along with the artery Herzog Fig 3-2B Herzog Fig 3-2E

  6. Herzog Fig 3-3 Herzog Fig 3-1C Zygapophysial Joints (aka facet or interlaminar joints) - synovial (diarthrodial), planar - angle gets steeper for lower ones - determine motion - collectively form 2 pillars

  7. IntervertebralForamina (IVF):- smallest in the cervicals (none above C2 or C1)- more like neural canal (due to width of pedicles)- many structures traverse IVF (this is where the action is)- note joints of Von Luschka Herzog Fig 3-5

  8. Atlas (Atypical Cervical Vertebra):- Anterior arch- Posterior arch- Lateral masses- Transverse processes (with foramen)- No spinous process Herzog Fig 3-6A Herzog Fig 3-6C

  9. Axis (Atypical Vertebra):- Odontoid process- PediclesSuperior facets almost flush- Laminae- Transverse processes (small, still have foramen) Herzog Fig 3-7A Herzog Fig 3-7E

  10. C7 (Unique Cervical Vertebra):- Vertebra prominens, usually (claim to fame)- Spinous process not bifid- Large transverse process Herzog Fig 3-1C

  11. Articulations of the Upper Cervicals: Atlantooccipitals Lateral atlantoaxials Median atlantoaxial Herzog Fig 3-8B & C

  12. Cervical IVDs: -None between occ & C1 or C1 & C2 - Functional spinal unit - Naming convention - Anterior aspect is strongest - Nerves in anulus, not nucleus - Peak of hydration about age 30 - Cartilaginous end plate Herzog Fig 3-11 Herzog Fig 3-10

  13. Range of Motion of Cervical Spine Approximate Ranges of Motion at the Atlantooccipital joints Direction Amount Combined flex/ext 25° Unilateral lateral flex 5° Unilateral axial rotation 5° Total Ranges of Motion of Lower Cervical (C2-T1) Joints Direction Amount Combined flex/ext 91° Unilateral lateral flex 51° Unilateral axial rotation 33° Approximate Ranges of Motion at the Atlantoaxial joints Direction Amount Combined flex/ext 20° Unilateral lateral flex 5° Unilateral axial rotation 40° Herzog Tables 3-3,4,5 on p 67

  14. Coupled Motion Nordin Fig 11-20 Nordin Fig 11-21 2 motions that are dependent on each other Herzog p 69

  15. Musculature of the Cervical Spine(6 layers, Herzog Table 3-6) Herzog Fig 3-12CD Herzog Fig 3-12AB

  16. Vertebral Artery – enters transverse foramen of C6 & goes up through all the others Herzog p 70

  17. What are the actual risks of chiropractic care? 37 cases of death known to have occurred in the world from all different types of SMT practitioners over 65 year period (1934-1999) 19 of those were related to chiropractors Current Concepts in Vertebrobasilar Complications Following Spinal Manipulation, Terrett AGJ, 2001, p 116 1 case of vertebrobasilar stroke for each group of 25 chiropractors who each practice for 40 years Current Concepts in Vertebrobasilar Complications Following Spinal Manipulation, Terrett AGJ, 2001, p 12 Being associated with does not necessarily mean caused by.

  18. Risks of Other Methods of Care 225,000 iatrogenic deaths each year in the US (3rd leading cause of death) Starfield B, Is US health really the best in the world? JAMA. 2000; 284:483-485 2,000 deaths from low dose use of aspirin each year in the US Lana A et al. A nationwide study of mortality associated with Hospital admission due to severe gastrointestinal events and those associated with nonsteroidal antiinflammatory drug use. Am J Gastroenterol. 2005; 100:1685-1693

  19. Load displacement response of cervical functional spinal units Herzog Fig 3-14

  20. Orientation of a 3-D Coordinate Systemon a Functional Spinal Unit 6 degrees of freedom (x, y, z, qx, qy, qz) Planes - Sagittal: y-z (Mid Sagittal) - Coronal, Frontal: x-y - Transverse: x-z Herzog Fig 3-15

  21. Stiffness of Upper Cervical Spine as independently measured by Goel and Panjabi Herzog Table 3-10 Goel Panjabi

  22. Differences and Similarities Different values from Goel and Panjabi (Table 3-10) - Panjabi used higher weights - Goel’s cadavers were older Some similarities were noted: - C1-C2 joints have large neutral zones & twisting ROM - Symmetric in lateral bending and twisting - Higher flexion stiffness than ext for C0-C1 - Lateral bending same for C0-C1 and C1-C2 Herzog p 75

  23. Biomechanics of Cervical Motion Segments (Gudavalli et al) Herzog Fig. 3-16

  24. Coefficient of Friction (m)a measure of the difficulty of sliding one object along the surface of another Ft _________________ Fn Ft m = Fn Where: Ft = Tangential force required to initiate movement Fn = Normal inter-body compressive force from White & Panjabi page 155

  25. Given that the weight of a block on a level surface is 40 N, and the coefficient of friction is 0.02 (typical for a synovial joint), how much tangential force must be applied to move the block? Ft _________________ Fn m = Ft = m x Fn Ft = 0.02 x 40 N = 0.8 N Fn deer on ice (1:12) http://video.google.com/videoplay?docid=3525036988151934692&q=dramatic+deer+rescue&ei=eKcMSLmGAp784AKkgpW4BA&hl=en

  26. Lubricants reduce the coefficient of friction between two surfaces. They can be any one of the 3 types of fluids depending on how their viscosity varies with changes in the rate of shear: 1. Newtonian: viscosity is constant2. dilatant: viscosity increases as shear rate increases3. thixotropic: viscosity decreases as shear rate increases from White & Panjabi page 158

  27. Stress/Strain Curve of a Ligament Nordin Fig 3-12

  28. Clinical Considerations * Issues are numerous, complex, often poorly defined* Wide variation of normal anatomy and activity* Balance between spinal structures & neuromuscular control system Herzog p 77

  29. Traumatized Spine(can get injury from minor event - position dependent) Herzog p 77

  30. The Anomalous Spine * Anomalies are common* The body will often adapt to major anomalies * Symptoms from anomalies often don’t appear for some time (could be beyond the 3rd decade)* Trauma often induces symptoms from anomalies Herzog p 78 canine anomaly (1:31) http://video.google.com/videoplay?docid=2322849743749379276

  31. Occipitalization(atlas assimilated into occiput) Herzog p 78 Figs from Dr. McClean

  32. Arnold-Chiari Malformation(displacement of cerebellar tonsils into upper cervical spinal canal) Herzog p 79 Anterior arch C1 Right cerebellar tonsil Herzog Fig 3-17B

  33. Klippel-Feil Syndrome(congenital fusion of any 2 or more cervicals) Herzog p 81 Herzog Fig 3-18B

  34. cervical spondylotic myelopathy (CSM) Spondylotic: any disease of the vertebraMyelopathy: any problem with the spinal cord CSM often used to describe the slow but progressive degeneration of the cervical spine Herzog p 82

  35. The Degenerative Spine * The most common pathological condition is DJD* Changes can occur in many different locations* There is a large ripple effect* Both overuse & disuse can lead to degeneration Herzog p 82

  36. Degenerative Changes Foraminal Encroachment Herzog Fig 3-19 C Uncinate hypertrophy Herzog Fig 3-19B Kyphotic reversal & disc thinning Herzog Fig 3-19 A

  37. C5-C6 IVD intrusion Anterior spurring C6-C7 Herzog Fig 3-20A & B C5-C6 IVD intrusion

  38. What is considered to be appropriate use of spinal manipulation (chiropractic adjustments) is controversial even among chiropractors when trauma or anomalies of the spine are involved. Herzog p 89

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