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Copyrighted Material C01 10/31/2017 11:23:53 Page 1 1 1 The Normal Anatomy of the Neck David Bainbridge Introduction component’ of the neck is a common site of pathology, and the diverse forms of neck The neck is a common derived characteristic disease reflect the sometimes complex and of land vertebrates, not shared by their aquatic conflicting regional variations and functional ancestors. In fish, the thoracic fin girdle, the constraints so evident in this region [2]. precursor of the scapula, coracoid and clavi- Unlike the abdomen and thorax, there is no cle, is frequently fused to the caudal aspect of coelomic cavity in the neck, yet its ventral part the skull. In contrast, as vertebrates emerged is taken up by a relatively small ‘visceral on to the dry land, the forelimb separated from compartment’, containing the larynx, trachea, the head and the intervening vertebrae speci- oesophagus and many important vessels, alised to form a relatively mobile region – the nerves and endocrine glands. However, I neck – to allow the head to be freely steered in will not review these structures, as they do many directions. not represent an extension of the equine ‘back’ With the exception of the tail, the neck in the same way that the more dorsal locomo- remains the most mobile region of the spinal tor region does. column in modern-day horses. It permits a wide range of sagittal plane flexion and exten- sion to allow alternating periods of grazing Cervical Vertebrae 3–7 and predator surveillance, as well as frontal plane flexion to allow the horizon to be scan- Almost all mammals, including the horse, ned, and rotational movement to allow possess seven cervical vertebrae, C1 to C7 nuisance insects to be flicked off. Among (Figure 1.1). While C1 and C2 are extremely domestic animals the equine neck is rela- modified for their particular functions, C3 to tively long and the head relatively heavy, C7 are more homogenous in structure. C3, C4 and so the neck has becomeCOPYRIGHTED strong, muscular and C5MATERIAL in particular are usually thought of as and massive. This is enhanced by the fact that the ‘typical’ cervical vertebrae (Figure 1.2). regular, forceful movements of this region Vertebrae C3–C7 consist of an approxi- must also occur to maintain balance when mately cylindrical body or centrum, a struc- horses are running [1]. However, the length ture present in all jawed vertebrates to resist and flexible nature of the neck may also cause longitudinal compression of the spinal col- problems in the passage of foals through the umn. The centra of the equine neck are the birth canal. longest in the body, but become progressively In this chapter I will briefly review the smaller caudally. Those of C3–C7 possess a anatomy of bones, joints, ligaments and distinctively convex cranial surface, the head, muscles of the equine neck. The ‘locomotor and a correspondingly concave caudal Equine Neck and Back Pathology: Diagnosis and Treatment, Second Edition. Edited by Frances M.D. Henson. © 2018 John Wiley & Sons, Ltd. Published 2018 by John Wiley & Sons, Ltd. C01 10/31/2017 11:23:53 Page 2 2 Equine Neck and Back Pathology: Diagnosis and Treatment which are either statically or dynamically ste- notic, is thought to be a cause of equine cervical ‘wobbler syndrome’ [3]. The centrum and arch are adorned with a variety of bony processes for the attachment of ligaments and muscles, and which often develop as secondary centres of ossification. These vertebral processes are a feature evolved by land vertebrates to permit complex movements in three dimensions and resist torsional forces. a) The single dorsal midline spinous process is distinctively short in equine C3–C5. Figure 1.1 Lateral view of an articulated osteologi- b) In contrast, all equine cervical vertebrae cal preparation of the neck of a young horse. bear a characteristically large ventral crest, often with a pronounced caudal tubercle. surface, the fossa. Thus the intervertebral c) The bilateral transverse processes are large joints, which are far more mobile than in but squat, and thought to incorporate ves- the trunk, may be thought of functionally as tigial ribs, sometimes yielding the name ball-and-socket joints, although their constit- ‘costotransverse processes’.InC3–6, the uent parts are very structurally different from processes are bifid and slanted, with a cranial those of synovial ball-and-socket joints. ventral tubercle and caudal dorsal tuber- Dorsal to the centrum is the neural arch, cle. The transverse processes of C1–6are formed from bilateral bony laminae, which perforated by a large transverse foramen, surrounds and protects the spinal cord and its which conveys the vertebral artery and vein. associated structures. The vertebral canal d) Lateral to the neural arch lie the large, formed by successive arches is relatively irregular articular processes, with their wide in the neck, especially cranially, to allow smooth ovoid articular surfaces. The cau- the spinal cord, which is wide in this region, to dal facets are directed ventrolaterally, and flex freely. The vertebrae C3–C7 each develop the complementary cranial facets dorso- from three primary centres of ossification – medially. Ventral to the caudal process lies one in the centrum and one in each of the two a notch for passage of the laterally coursing laminae. Formation of cervical neural arches, spinal nerve. Figure 1.2 (A) Lateral view of equine C4 vertebra and (B) cranial view of C5. C01 10/31/2017 11:23:54 Page 3 1 The Normal Anatomy of the Neck 3 Figure 1.3 (A) Lateral view of equine C6 vertebra and (B) cranial view of C7. The sixth cervical vertebra (Figure 1.3) differs cervical vertebrae – with centrum and neural from its cranial neighbours in that it bears pro- arch formed from the same three centres of nounced paired bony sheets, the ventral lami- ossification, as well as the spinous process, ven- nae, which act as a site of attachment and force tral crest and tubercle, caudalarticular facetsand redirection of muscles, especially longus colli. dorsal tubercle of the transverse process. How- Inthehorsetheselaminaeareelaborated ever, the cranial part of the bone is markedly into cranial and caudal tubercles.C6also aberranttoallowtheuniquerotational,trochoid, possesses a longer spinous process than C3, ‘head-shaking’ movement of the atlanto-axial 4and5– areflection of a gradual transition joint. Its unusual shape results from the incor- to a more ‘thoracic’ morphology. poration of embryonic elements of C1. This trend continues in C7 (Figure 1.3), A fourth primary centre of ossification, actu- which has an even longer spinous process, ally the annexed centrum of C1, forms the dens non-bifid transverse processes, and no trans- (‘tooth’)orodontoid process of C2. This cra- verse foramen – the vertebral arteries arise nially directed process is attached ventrally to too far cranially to pass through C7. How- the main centrum of C2 by a base formed from a ever, C7 does possess a caudal notch for further, secondary centre, which represents the the passage of a spinal nerve, but it should cranial epiphysis of C2. The dens articulates be emphasised that the nomenclature of the closely with the ventral part of C1, and thus is spinal nerves in inconsistent. Unlike the rest smooth on its ventral surface, but is roughened of the body, cervical spinal nerves emerge dorsally with a midline gutter to allow attach- cranial to the vertebra of the same number, ment of stabilising ligaments. The smooth artic- and the nerves emerging caudal to vertebra ular region of the dens is continuous with the C7 are named C8, even though there is no large bilateral saddle-shaped cranial articular corresponding C8 vertebra. Finally, the cen- surfaces, which slide across reciprocal surfaces traofC7caudallybearunconvincingcostal on C1 to allow rotation of the joint. These facets for the articulation of the cranial surfaces also develop from their own secondary extremities of the capitula of the first ribs [4]. ossification centres. The axis contains a relatively large amount of trabecular bone compared to the other Atlas and Axis, C1 and C2 cervical vertebrae, and is also characterised by a large spinous process. Equine C2 is also The anatomy of the caudal part of the axis, C2 distinctive in possessing bilateral foramina for (Figure 1.4), is similar to that of the more caudal the passage of the second pair of spinal nerves, C01 10/31/2017 11:23:54 Page 4 4 Equine Neck and Back Pathology: Diagnosis and Treatment Figure 1.4 (A) Lateral view of equine C2 vertebra, and (B) ventral and (C) cranial views of C1. which do not emerge between adjacent verte- dogs. Attached laterally to the arches are the brae, as all the more caudal spinal nerves do. irregular lateral masses, which support the In some texts these are called ‘intervertebral caudal articular surfaces as well as the wide, foramina’, which seems illogical, so the name ovoid and profoundly concave cranial articu- lateral foramina is perhaps preferable. lar surfaces. Also attached laterally are the Theatlas,C1(Figure1.4),isthemostbizarreof large modified transverse processes termed all the vertebrae, due to it performing specialised wings or alae. The wings, distinctively concave movements with both the skull (sagittal plane ventrally in the horse, form the attachment of flexion and extension/‘nodding’/‘yes’ move- several of the long and short muscles of the ment) and the axis (rotation about the long cranial neck, and also contain transverse foram- axis of the spine/‘shaking head’/‘no’ movement). ina similar to those in C2–C6. The alar notches The atlas has no centrum and no neural present on the cranial edge of the wings of the spine, but is instead constituted by one large atlas in some species are entirely enclosed into hollow cylinder formed by dorsal and ventral alar foramina in the horse, and mark the arches of bone.
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