By Lord Brain
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Extra resources for Cervical Spondylosis and Other Disorders of the Cervical Spine
30 Case 10 (Abdullah). Right brachial plexus (fixed in situ). Note the gross sinuosity of the vertebral arteries and acute angulation of the lower roots of the plexus due to shortening of the vertebral canal following degenerative changes to the intervertebral discs and vertebral bodies. 1 = Vertebral artery. 2 = C5 contribution to the plexus. 3 = Ascending cervical artery. 4 = Tl acutely angulated. 53 54 Cervical spondylosis Movements of the Cervical Spine Movements at the atlanto-occipital joints The two atlanto-occipital joints are best considered as a single oval condyloid articulation with a large central deficiency in its surfaces (Barnett, Davies and MacConaill, 1961).
Degenerative changes were present in the joints of these cases and narrowing of the intervertebral foramen might possibly be responsible for the high proportion (28 out of 60) in which the two ostia were level. It is not possible to determine whether this was induced by narrowing of the foramina, but it is clear that this position would aggravate any tendency to neural damage by antero-posterior compression of the root sleeve. Segmental vessels and nerves supply the dura at every level. The recurrent branches of the spinal nerves divide into ascending and descending branches and have been traced in serial sections to the dura itself and the adventitia of vessels by Pedersen et al.
The upper-most and stoutest process is attached to the dura inside the posterior cranial fossa behind the canal for the hypoglossal nerve. The lowermost one is at about the level of the 1st lumbar vertebra. The upper "teeth" are attached almost perpendicularly, and lower down in the cervical region the processes are more slender and obliquely placed. The fibres in the ligament are arranged in a rhomboid mesh, some converging to the point of attachment of the ligament. If tension is increased in the ligaments, the mesh enlarges.