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Cervical Spine fractures… Cervical Anatomy Biomechanically Specialized Support of “large” Cranial mass Large range of motion Flexion/extension Axial rotation Unique osteological characteristics C1 - Atlas No body 2 articular pillars Flat articular surface Vertebral artery foramen 2 arches Anterior Posterior Vertebral artery groove Function – The Atlas Transition zone between head and c-spine Important anatomical points Superior articular processes allow flex/ext Inferior articular processes are important for rotation Notch for vertebral artery is a common fracture site C2 Anatomy Dens Embriological C1 body Base poorly vascularized Osteoporotic Flat C1-2 joints Vertebral artery foramena Inferomedial to superolateral Anatomy – The Axis Important transition point for forces within the c-spine Important anatomical points Superior and inferior articular processes are “offset” in the AP direction- due to different functions at each articulation Pars interarticularis- due to this transition is a frequent fracture site Odontoid process- the “pivot” for rotation Anatomy – The Ligaments Allow for the wide ROM of upper C-spine while maintaining stability Classified according to location with respect to vertebral canal Internal: Tectorial membrane Cruciate ligament – including transverse ligament Alar and apical ligaments External Anterior and posterior atlanto-occipital membranes Anterior and posterior atlanto-axial membranes Articular capsules and ligamentum nuchae AtlantoAxial Anatomy Tectorial Membrane AtlantoAxial Anatomy occiput C1 C2 Tranverse Ligament C1-C2 joint Alar Ligament AtlantoAxial Anatomy Transverse Ligament Facet for Occipital Condyle AtlantoAxial Anatomy Vertebral Artery APPROACH TO C-SPINE INJURIES Following trauma or complaint of neck pain Obtain lateral AP, and odontoid views The lateral view is only adequate if T1 can be visualized If there is any doubt of fracture or prevertebral swelling , obtain oblique views and consider CT All patients with sign