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The Cervical Spine (neck)

 

The cervical spine is made up of the upper first seven vertebrae in the spine. It starts below the skull and ends above the thoracic spine - mid-back and shoulders. The cervical spine has a lordotic curve, backward C-shaped like the lumbar spine, and is much more mobile than the thoracic and lumbar spine.

 

Unlike the rest of the spine, there are openings on each side of the 6th to 1st cervical vertebrae for the vertebral arteries which carry blood away from the heart to the lower and rear parts of the brain. The upper two vertebrae in the cervical spine, the atlas and the axis, differ from all other vertebrae. The ‘upper neck complex’ provides approximately 50% of the overall rotation of the cervical spine.

 

The atlas is the first cervical vertebra. It is located between the skull and the rest of the spine. It is like a ring, unlike all other vertebrae, it does not have a vertebral body, but a thick forward (anterior) arch and a thinner back (posterior) arch with two prominent sideways masses.

 

The atlas sits on top of the second cervical vertebra - the axis. The axis has a bony peg called the odontoid process at the front, which reaches through the centre hole in the atlas. It is this special arrangement that allows the head to turn from side to side as far as it can. Specific ligaments between the atlas and the axis and the head guarantee a stable position of the atlas on the axis during rotation.

 

The head weighs approximately 5.5 to 6.5 kg and is balanced on top of the atlas at the top of the spine. Since there is relatively limited muscle support in the cervical area, it is like most very flexible joints at risk of injuries from strong, sudden movements, such as ‘whiplash-type’ injuries. Sudden, strong head movements can cause damage to the muscles, ligaments, nerves, bones or even the arteries that carry blood to the brain.

 

Neck pain or a stiff neck are extremely common and can affect life in many ways.  Whether it is sharp neck pain on movement, constant dull muscular ache, headaches, or an inability to fully move the head, neck problems can be very frustrating. It is essential to make an accurate diagnosis of the cause of neck dysfunction and pain so that appropriate treatment can be explicitly directed towards the condition.