The cervical spine is usually the most flexible part of the spine. The two vertebrae closest to the skull have proper names: Atlas ("Nicker") and the Axis ("Dreher"), due to their design, which differs from the usual structure of a vertebra. This upper part of the cervical spine together with the base of the skull forms the head joints . Five more cervical vertebrae follow. In healthy people, the cervical spine has an arch to the front, which is known as physiological lordosis .
The cervical spine consists of seven cervical vertebrae in almost all mammals as well as humans . In the shrew , the individual cervical vertebrae are accordingly a few millimeters long, while in the giraffe they can be over 40 cm long (entire cervical spine between 2 and 3 m). Round-tailed sea cows and the Hoffmann two-toed sloth (Choloepus hoffmanni) are the only mammals to have only six cervical vertebrae. Three to four thoracic vertebrae are displaced in three-toed sloths, which is why up to ten cervical vertebrae were assumed for a long time.
In humans, the first cervical vertebra, the atlas, lies directly below the foramen magnum of the skull . This is named after Atlas from Greek mythology . The atlas carries the skull and includes the tooth of the second cervical vertebra, the lathe (lat. Axis ). The joints between the base of the skull and the axis together form two head joints , which guarantee about 70% of the mobility of the head in relation to the trunk.
The other cervical vertebrae have the usual shape of a vertebra with the vertebral body and the vertebral arch encompassing the spinal cord , on the lateral extensions of which the vertebral arch joints or facet joints are located to the right and left of the vertebral canal .
The 7th cervical vertebra of the human spine is referred to as the vertebra prominens (protruding vertebra) because its spinous process protrudes a little further back than that of the other six cervical vertebrae. Therefore, the spinous process of the 7th cervical vertebra can usually be felt well from the outside at the lower end of the cervical furrow and serves as an anatomical reference point.
As with the rest of the spine, there are intervertebral discs between the vertebral bodies of the cervical vertebrae . The cervical spine is supported by the neck and back muscles and several ligaments .
Eight nerve cords, the spinal nerves, arise from the spinal cord in the area of the cervical spine on each side . The top four (C1 – C4) together form the cervical plexus ( plexus cervicalis ), which innervates the neck and the neck muscles, but also the diaphragm . This means that independent breathing is no longer possible if the spinal cord is injured at the level of the fourth vertebral body (or higher). The bottom four (C5 – C8; note: there are seven cervical vertebrae, but eight cervical nerves ) together with the nerves of the first thoracic vertebra (Th1) form the arm plexus ( brachial plexus ), which innervates the chest and arm muscles as well as the associated skin .
Continue to pull through the cervical spine, the vertebral arteries ( vertebral arteries ), which extend through the transverse processes of the cervical spine and, together with the internal carotid arteries ( arteries carotidiae internae ) to supply the brain with blood to make sure.
Cervical spine examinations
As with all research includes investigating the cervical spine, a medical history , emergency range also a foreign anamnesis, for example, to the happening of a car accident . Typical complaints in rear-end collisions , known as whiplash , are headaches , exhaustion, dizziness and nausea .
In the event of third-party negligence, the injured party is entitled to compensation for pain and suffering . In particularly mild cases, the causality or the extent of the pain is often disputed and legal proceedings may arise. Limits of the probability of injury after rear-end collisions are known. After simulated rear-end collisions in which the car was only supposedly accelerated but not actually accelerated at all, a significant proportion of test persons complained of complaints (the term “injuries” is avoided by doctors in this context) in the area of the cervical spine, which can last a few days . Obviously pain is expected and it will come.
If a fracture of the cervical vertebrae is suspected , a rigid cervical splint should be applied and examinations such as palpation (palpation) for abnormal mobility, crepitations or steps should be avoided as there is a risk of spinal cord injury. Spinal cord lesions - depending on their height and severity - lead to numbness and paralysis in the arms and trunk and, in the case of high cross sections, to paralysis of the diaphragm and thus of breathing. Whereas in the past an x-ray in four levels of the cervical spine was arranged to examine the cervical spine after trauma , computed tomography and magnetic resonance tomography are the methods of choice today .
In the case of rare degenerative diseases of the spine, neurological examinations are carried out, the blood is examined for signs of a rheumatoid disease and, in the case of osteoporosis or suspected tumors, bone scintigraphy or computed tomography are carried out.
Diseases and injuries of the cervical spine
Diseases of the cervical spine are often wear and tear caused by people walking upright. Herniated discs are common in those over the age of 30 and are very often clinically silent. Likewise, these intervertebral discs, which are 95 percent water, are healed by the body within a year at worst. Surgery is only necessary in exceptional cases and should be the last resort. This is indicated for "red flag" symptoms:
- Osteoporosis and minor trauma
- Tumor history
- Weight loss
- Pain intensification at night
- Progressive nerve failure
- Decreasing pain and paresis
- Kauda Syndrome
- Micturition disorder (typically urinary retention, overflow bladder, possibly incontinence)
See also herniated disc
- Eastern chondrosis on the cervical spine - wear and tear on the intervertebral discs and vertebral bodies
Under a osteochondrosis is meant a change in the spinal disc cartilage (Greek. Chondron = cartilage) with a concomitant reaction of the vertebral body (Gr. = Osteon bone). Typically, in the case of osteochondrosis, x-rays show a decrease in the height of the disc space . Eastern chondrosis on the cervical spine. This is a normal symptom of old age and occurs in almost everyone in the second half of their life and is often associated with no symptoms.
A possible cause is wear and tear, for example due to long-term overloading of the intervertebral disc. One often sees osteochondrosis in patients with scoliosis , i.e. a sideways curvature of the spine . As a result of this lateral bending, the intervertebral disc is stressed too much on one side and worn out over the course of many years. Other causes of osteochondrosis are previous herniated discs. Osteochondrosis can also occur as a long-term consequence after intervertebral disc operations. Osteochondrosis is less common as a result of inflammation of the intervertebral disc.
Nonarthrosis of the cervical spine: This is a lifelong remodeling process of the cervical spine
Non-osteoarthritis is not a classic osteoarthritis, but a remodeling of the bone structure in the area of the uncovertebral joints. This can occur, for example, as a result of changed loads on the cervical spine. In the course of the newly growing uncovertebral joints, the intervertebral foramen can then be narrowed. This is a lifelong remodeling process for the cervical spine
There are also congenital and acquired malformations of the cervical spine such as spina bifida , block and wedge vertebrae, and acquired scoliosis , for example from Scheuermann 's disease or Bechterew's disease .
By far the most common injuries to the cervical spine are caused by accidents, especially traffic accidents. The moderate form of an injury to the spinal cord in the cervical spine is whiplash without injuries to the ligaments. This is completely harmless, even if the symptoms are quite frightening. These accidents can trigger the cervical spine syndrome, which among other things includes complaints of the head joints:
Complaints caused by mobility disorders and instability without enlarging the atlantodental interval of the head joints are like a sphinx.
- Headache and poor concentration
- Ringing in the ears, ear pain, feeling of cotton wool in the ear, dizziness
- Visual disturbances, feeling of pressure in the eye
- Tooth and jaw pain, facial pain
- Furryness and pain of the tongue
- Lumpy sensation in the throat, difficulty swallowing, hoarseness
The reason that the head joints can trigger such complaints lies in their function as the third organ of balance.
If there is no doubt that the cause is the head joints, and the atlantodental interval is normal (<5 mm), then the symptoms are completely harmless, however annoying and worrying they may be, as long as the patient does not know the cause of the complaint. The harmlessness is based on the following facts:
The atlas is the 1st cervical vertebra, which is circular and rotates around the dens axis, i.e. the pin (dens) of the 2nd cervical vertebra. This lies in the anterior section, which is why it articulates with the bony anterior portion of the atlas arch and forms the anterior atlantodental joint. The posterior articular surface of the dens axis only articulates with the cruciform ligamentum transversum atlantis, which is fixed to the right and left of the atlas, as well as up and down on the occiput and the 2nd cervical (fasciculus longitudinalis superior and inferior). The dens axis is also suspended at its tip on the occipital bone and has two lateral wing-shaped ligaments (lig. Alare) that hold it in place. This ensures that the dens axis cannot push backwards on the spinal cord.
Instabilities due to serious accidents can cause serious problems in this area and even lead to death. These injuries are based on ligament damage, primarily lesions or ruptures of the alarm ligaments or the joint capsules in the head joint, comparable to hanging on the gallows. This would be the definition of an unstable head joint, the imaging evidence of an enlarged atlantodental interval or a fracture of the atlas or dens axis, are diagnosed by X-ray or CT and must be treated immediately. The mobility disorders and instabilities mentioned above with a normal atlantodental interval do not belong to this group and are completely harmless.
For the diagnosis of these instabilities caused by accidents or trauma and their symptoms see head joints, damage to the same. Primary tumors of the cervical spine and metastases are also very rare .
- Bodo Kuklinski: T he cervical trauma - causes, diagnosis and therapy. Aurum-Verlag, Bielefeld 2006, ISBN 978-3-89901-068-8
- J. Dvorak, D. Grob: cervical spine - diagnosis and therapy . Thieme Verlag , Stuttgart 1999, ISBN 3-13-116161-2
- Hautier, L. et al .: Skeletal development in sloths and the evolution of mammalian vertebral patterning. In: PNAS 10.1073 / pnas.1010335107, 2010.
- B. Wielke and T. Wielke: Controversial cervical spine injuries after rear-end collisions (interaction of judges - medical SV - technical SV) in: ZVR 5/2000, p. 152 (pdf; 4.7 MB)
- T. Donner-Wielke and B. Wielke: rear-end collision - cervical spine injury - nocebo effect , in: ZVR 3/2004 p. 81 (pdf; 125 kB)
- Mascha Brichta: Health: slipped discs often heal by themselves . July 15, 2009 ( welt.de [accessed October 13, 2019]).
- DocCheck Medical Services GmbH: herniated disc. Retrieved October 13, 2019 .
- Osteochondrosis - Orthopedics Vienna - Vienna - Austria. Retrieved October 13, 2019 .
- DocCheck Medical Services GmbH: non-arthrosis. Retrieved October 13, 2019 .
- DocCheck Medical Services GmbH: Cervical spine syndrome. Retrieved October 13, 2019 .
- Distance, atlantodental. Retrieved October 13, 2019 .
- Spinewell for a better back. Retrieved October 13, 2019 .