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Topic

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C (Cervical spine)

The cervical spine consists of the seven cervical vertebrae (C1–C7) forming the superior segment of the vertebral column. It supports the head, protects the upper spinal cord, and provides a wide range of motion including flexion, extension, rotation, and lateral bending.

The cervical spine is a critical anatomical and radiological region due to its mobility, proximity to the brainstem, and vulnerability to trauma, degenerative change, and congenital anomalies.

Synonyms

  • C-spine

  • Cervical vertebral column

Location

  • Extends from the base of the skull to the upper thoracic spine

  • Superior boundary: Occipital bone and atlanto-occipital joints

  • Inferior boundary: C7–T1 intervertebral level

  • Situated between the head and thorax

  • Anterior to the posterior cervical muscles

  • Posterior to the pharynx, larynx, and trachea

Anatomical components

  • Vertebrae:

    • C1 (atlas)

    • C2 (axis)

    • C3–C7 (typical cervical vertebrae)

  • Intervertebral discs:

    • Present from C2–C3 to C7–T1

  • Joints:

    • Atlanto-occipital joints

    • Atlanto-axial joints

    • Facet (zygapophyseal) joints

  • Ligaments:

    • Anterior longitudinal ligament

    • Posterior longitudinal ligament

    • Ligamentum flavum

    • Interspinous and supraspinous ligaments

  • Neural structures:

    • Cervical spinal cord

    • Cervical nerve roots

  • Vascular structures:

    • Vertebral arteries within transverse foramina (C1–C6)

Relations

Anteriorly:

  • Pharynx and larynx

  • Trachea and esophagus

  • Prevertebral muscles

Posteriorly:

  • Posterior cervical muscles

  • Nuchal ligament

Laterally:

  • Carotid sheath structures

  • Brachial plexus (lower cervical levels)

Superiorly:

  • Foramen magnum and occipital bone

Inferiorly:

  • Upper thoracic spine (T1)

Function

  • Support: Bears the weight of the head

  • Mobility: Allows flexion, extension, rotation, and lateral bending

  • Protection: Encloses and protects the cervical spinal cord

  • Conduit: Transmits neural and vascular structures between brain and body

X-ray appearance

Plain radiographs (AP, lateral, odontoid views):

  • Vertebral bodies: Rectangular with increasing size from C3 to C7

  • Alignment: Smooth cervical lordosis on lateral view

  • Intervertebral disc spaces: Preserved and uniform

  • Spinous processes: Bifid from C2 to C6 (typically)

  • Odontoid view: Dens centered between lateral masses of C1

  • Facet joints and uncovertebral joints: Well outlined

CT appearance (pre-contrast)

Non-contrast CT:

  • Cortical bone: High-density outer cortex of vertebral bodies and posterior elements

  • Cancellous bone: Lower-density trabecular pattern within vertebrae

  • Vertebral alignment: Clearly demonstrated in axial, sagittal, and coronal planes

  • Intervertebral discs: Soft-tissue density between vertebral bodies

  • Spinal canal: Well-defined bony margins

  • Transverse foramina: Clearly visible with vertebral artery canals

  • Best modality for: Osseous detail, fractures, alignment, and congenital anomalies

MRI appearance

T1-weighted images:

  • Vertebral marrow: High signal due to fatty marrow (age dependent)

  • Cortical bone: Low signal

  • Intervertebral discs: Intermediate-to-low signal

  • Spinal cord: Intermediate signal intensity

  • Ligaments: Low signal linear structures

T2-weighted images:

  • Intervertebral discs: High signal in nucleus pulposus

  • Spinal cord: Intermediate signal

  • CSF: Bright high signal surrounding the cord

  • Facet joints: Intermediate signal articular cartilage

STIR:

  • Bone marrow: Suppressed fat with low background signal

  • Ligaments and soft tissues: Intermediate signal

  • Excellent for: Highlighting edema in vertebrae, discs, ligaments, and paraspinal soft tissues

CT image

Cervical Spine ct anatomy Location and Imaging Appearance -img-00000-00000

X-Ray image

X Ray cervical spine