Anatomical data on the craniocervical junction and their correlation with degenerative changes in 30 cadaveric specimens

Abstract

<jats:p content-type="fine-print">&gt;<jats:italic>Object.</jats:italic> The goal of this project was to measure vertebral dimensions at the craniocervical junction and to investigate degenerative changes in this region and their correlations with the anatomical data. These studies will assist in an understanding of biomechanical conditions in this region, which are clinically relevant in cases of cervicogenic headaches and vertigo.</jats:p> <jats:p content-type="fine-print"><jats:italic>Methods.</jats:italic> The authors examined 30 cadaveric specimens obtained from patients ranging in age from 24 to 88 years at death. Measurements of angles of the vertebrae were conducted using an imprint method. Microsections of osseous endplates and articular cartilage were graded according to their degrees of degeneration by using the Petersson classification (0, no sign of degeneration; I, superficial degeneration with several fragmentations; II, deeper degeneration with cartilaginous disintegration and penetrating ulceration; or III, complete cartilaginous degeneration with the appearance of subchondral bone in &gt; 50% of the articular surface).</jats:p> <jats:p content-type="fine-print">The authors found Grade I changes in 100% of the occiput specimens. In the superior articular cartilage of C-1 no changes (Grade 0) were found in two specimens, whereas 6% of the specimens exhibited Grade II changes and 89% exhibited Grade I changes. In the inferior articular cartilage of C-1, 57% of the specimens displayed Grade I changes, 14% Grade II, and 20% Grade III changes. In the superior articular cartilage of C-2, 62.5% of the specimens displayed Grade I changes and 25% Grade II changes. At the occiput—C1 level the authors found a higher frequency of degeneration at the upper left articular surface of the atlas (Quadrants 1 and 3), and at the C1–2 level they found a higher frequency of degeneration at the upper left and upper right articular surfaces of the axis (Quadrants 2 and 3, respectively). Using the McNemar test, the authors investigated the frequency of affection of single quadrants in a left—right side comparison (lateral reversal). Significant differences were identified for Quadrant 2 of the upper left articular surface of C-2 and Quadrant 3 of the upper right articular surface of C-2. These results correlate with the analysis of single articular surfaces of the axis, but contradict the results for the atlas, in which no significant difference in the left—right side comparison was found.</jats:p> <jats:p content-type="fine-print"><jats:italic>Conclusions.</jats:italic> Severe degeneration in the atlantooccipital joints appears to be a rare condition, with no Grade II or III degeneration found in the occipital condyles and 6% Grade I, 89% Grade II, but no Grade III changes in the superior articular cartilage of the atlas. Degeneration of the inferior articular cartilage of C-1 and the superior articular cartilage of C-2 indicates that the atlantoaxial joint faces more intense mechanical exposure, which is increased at the upper joint surfaces.</jats:p>

Surface area congruence of atlas superior articulating facets and occipital condyles

“…Because of the advanced ages of the subjects, an analysis of the amount of degenerative joint disease present was completed. Severe degeneration of the A/O joints was rare, which is in agreement with the findings of Konig et al 11 Grade 0 (no sign of degeneration) and grade I (superficial degeneration) were observed in all 12 A/O joint surfaces. No grade II (cartilaginous disintegration) or grade III degeneration (appearance of subchondral bone in 50% of the articular surface) was observed using the Petersson classification.…”

“…No grade II (cartilaginous disintegration) or grade III degeneration (appearance of subchondral bone in 50% of the articular surface) was observed using the Petersson classification. 11,12 This study was reviewed by the Sherman College institutional review board and was found to be exempt from regulations mandated by US Federal guidelines relative to the use of live human subjects.…”

Morphometric Study of Axis Vertebra in Subjects of Indian Origin

“…Table 2 reveals that there is similarity between the values of the present study and most of the previous studies. Konig et al [17] has used a grid system to measure the dimensions which might have lead to higher values. Cattrysse et al [18] evaluated pairs of atlas and axis vertebrae from same spine and found that the C1 IAF has lower APD than the SAF of C2.…”

Surgical Considerations of Rheumatoid Disease Involving the Craniocervical Junction and Atlantoaxial Vertebrae

“…These true synovial joints allow articulation with the occipital condyles and the axis respectively. The atlantooccipital joints orientation at caudal angles of 129 degrees from lateral to medial limits the rotation possible, compared with the atlantoaxial joint with a cranially biased angulation of between 130-135 degrees, where much greater rotation is possible (Konig et al 2005). A posterior tubercle is found in the midline posteriorly providing attachment for the rectus capitis and the ligamentum nuchae.…”

“…The greater occipital nerve of Arnold is found 15mm off the midline, the importance of preservation through a strict subperiosteal surgical approach lying in posterior scalp numbness or neuralgia should the nerve be damaged (Vital et al 1989). The occipital condyles, which function as skull-base weight-bearing facets, angle medially and inferiorly at average angles of 55 and 117.5 degrees when viewed from behind (Konig et al 2005). These shape of these condyles positioned on either side of the foramen magnum allow the skull articulate with the cervical spine, whilst the angles prevent excessive axial rotation at the craniocervical junction (Noble & Smoker 1996).…”