Anatomy of the Cervical Spine

Anatomy of the Neck

The neck or cervical spine is the top part of the spine between the head and shoulders. The cervical spine has seven vertebra of which the bottom five are designed similarly and the top 2 are very different.

Most of the problems or conditions from the neck come from the bottom 5 vertebra (cervical vertebra 3 through cervical vertebra 7 or more commonly called C3-7). Each vertebra has a large body in front separated by a disc and two medium sized joints or facets in back. In the center, there is a large (normally) spinal canal which houses the spinal cord.

Nerves in the Neck

Two nerve roots (one on each side) sprout from the cord at each level and exit between the two adjacent vertebra through a hole on the side of the spine called the foramen. For example, the right C6 nerve root exits the spinal canal between the right C5 and C6 vertebra. The hole the nerve exits out of is made up of four walls which is important as will become apparent later as we discuss problems with the neck. These are the disc wall and uncovertebral joint in front, the pedicle above as the roof, and pedicle below as the floor and the back wall, which is the facet.

These nerve roots deliver their messages to and from the back and sides of the head and down the shoulders and arms to the hands. The spinal cord of course sends and receives messages from the entire lower body and is really an extension of the brain.

Spinal Discs in the Neck

The disc is the shock absorber in the front of the spine wedged between two vertebra. It is designed like a jelly filled donut. The nucleus (jelly) inside is under high pressure and the outer part of the donut is the annulus- essentially 20-30 rings of collagen just like plies of a tire that hold in the jelly.

The discs are named for the vertebra they are sandwiched in-between. For example, the disc wedged between the vertebra C5 and C6 is the C5-6 disc. There is no disc between C1 and C2 nor between the occiput (head) and C1. Every other level has a disc associated down to the pelvis.

The paired joints in back (called the facets) are real joints similar to knee or hip joints. These facets are made up of 2 bony surfaces covered with cartilage (similar to a Teflon substance) and surrounded by a capsule, which is a heavy burlap sack-like material. This capsule keeps the lubricating fluid in (synovial fluid) and provides strength to hold the joint together.

The uncovertebral joint is an interesting structure that develops slowly in all humans after birth and actually is the only joint in the body that is not present during birth. It is located on the very outside of the sides of the disc between 2 vertebra and develops bilaterally (on both sides). It becomes important as a troublemaker with aging as it can develop bone spurs which can narrow the exit hole for the nerve.

Vertebra in the Neck

The first two vertebra are very important as they are responsible for 50% of the motions of bending forward and backwards and turning the head side to side. Their design is very different from the bottom five. During in-utero development, the first vertebra called C1 or the atlas literally donates its body to C2 or the axis. This donation allows C2 to have a peg called the odontoid that the first vertebra rotates around. There is a very thick and important ligament called the transverse ligament that holds C2 to C1 and keeps the two vertebra stable.

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(Click to Enlarge Image) This illustration is a side view of the cervical spine (neck). Here you can see the vertebral bodies with the discs in the front of the spine and the facets in the rear. The nerve roots exit through the sides of the spine.

(Click to Enlarge Image) This is a MRI side (sagittal) view of the cervical spine. It demonstrates good disc spaces, a normal curve (lordosis), plenty of room for the spinal cord and good alignment of the facets.

(Click to Enlarge Image) This illustration demonstrates the anatomy of the annulus. The annulus is made up of about 30 rings of collagen- just like plies of a tire. You can see that the orientation of the fibers alternate with each layer. This makes for a strong and redundant disc wall when the spine is in neutral but with twisting (rotation), half of the fibers undergo tension and the other half become relaxed. The picture on the lower right demonstrates this phenomenon. Rotation of the spine therefore weakens the disc wall and it becomes more susceptible to tearing. Moral of the story- don’t twist when you lift!

Donald Corenman, MD, DC

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81 reviews

Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

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