Atlas posterior arch and vertebral artery’s groove variants: a classification, morphometric study, clinical and surgical implications

Natsis, Konstantinos; Piperaki, Evangelia-Theophano; Fratzoglou, Moschos; Lazaridis, Nikolaos; Tsitsopoulos, Parmenion P.; Samolis, Αlexandros; Kostares, Michael; Piagkou, Maria

doi:10.1007/s00276-019-02256-1

Cited by 16 publications

(16 citation statements)

References 34 publications

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“…6 The mean height of the posterior arch at the anterior end of the VAG (d7) on the right and left sides was published by some authors. The findings on both sides were 4.13 AE 1.11 and 3.86 AE 0.87 mm, 23 23 The heights of the anterior (d7) and posterior (d8) ends of the VAG were less than those reported in the literature. The difference might also be important during surgery.…”

Section: Discussionmentioning

confidence: 58%

“…Because there are insufficient morphologic data of C1 in the Turkish population, we focused on the measurements and compared them with recent reports (►Table 2). [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] The mean length of the VAG on the axial plane defined as the line connecting the midpoints of the medial and the lateral edges of the groove (d4) was found to be 15 20 The measurements showed that the range was between 1 and 5 mm in the Turkish population. The difference might be important during surgery.…”

Section: Discussionmentioning

confidence: 99%

“…The mean distance between the tip of the posterior arch and the medial inner edge of the groove (d5) was investigated by most authors. AE 1.67 mm,23 12.28 AE 2.6 and 11.54 AE 2.79 mm, 22 10.34 AE 1.94, 10.3 AE 1.72 mm, 21 and 10.73 AE 2.92,9.72 AE 2.56 mm. 20 It was 10.59 AE 2.26 and 10.49 AE 2.20 mm in the present study.…”

mentioning

confidence: 95%

“….42 AE 1.67 mm (right: 15.24 AE 1.69 mm; left: 15.60 AE 1.64 mm) in the present study. In other studies, the findings on the right and left, respectively, were as follows: 11.72 AE 1.8 and 12.47 AE 1.9 mm 13 and 18.9 AE 3.03 and 19.97 AE 2.38 mm 23. The mean distance between the tip of the posterior arch and the medial inner edge of the groove (d5) was investigated by most authors.…”

mentioning

confidence: 97%

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Morphometric Anatomy of the Posterior Aspect of the Atlas and the Vertebral Artery Groove in Relation to Lateral Mass Screw Placement

Aksoy

Yalçın

2021

J Neurol Surg A Cent Eur Neurosurg

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Background Atlantoaxial instability is an important disorder that causes serious symptoms such as difficulties in walking, limited neck mobility, sensory deficits, etc. Atlantal lateral mass screw fixation is a surgical technique that has gained important recognition and popularity. Because accurate drilling area for screw placement is of utmost importance for a successful surgery, we aimed to investigate morphometry of especially the posterior part of C1. Methods One hundred and fifty-eight human adult C1 dried vertebrae were obtained. Measurements were performed directly on dry atlas vertebrae, and all parameters were measured by using a digital caliper accurate to 0.01 mm for linear measurements. Results The mean distance between the tip of the posterior arch and the medial inner edge of the groove was found to be 10.59 ± 2.26 and 10.49 ± 2.20 mm on the right and left, respectively. The mean distance between the tip of the posterior arch and the anterolateral outer edge of the groove was 21.27 ± 2.28 mm (right: 20.96 ± 2.22 mm; left: 21.32 ± 2.27 mm). The mean height of the screw entry zone on the right and left sides, respectively, were 3.86 ± 0.81 and 3.84 ± 0.77 mm. The mean width of the screw entry zone on both sides was 13.15 ± 1.17 and 13.25 ± 1.3 mm. Conclusion Our result provided the literature with a detailed database for the morphometry of C1, especially in relation to the vertebral artery groove. We believe that the data in the present study can help surgeons to adopt a more accurate approach in terms of accurate lateral mass screw placement in atlantoaxial instability.

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 95%

mentioning

confidence: 97%

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Morphometric Anatomy of the Posterior Aspect of the Atlas and the Vertebral Artery Groove in Relation to Lateral Mass Screw Placement

Aksoy

Yalçın

2021

J Neurol Surg A Cent Eur Neurosurg

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“…[ 7 ] Narrow C1 lamina/pedicle can lead to VA injury (if the VA is not visualized and mobilized and the screw is inserted “blindly”). [ 11 12 13 ] Most experts believe that the thickness of the C1 arch/lamina in the area of pedicle screw implantation <4 mm is a risk factor for VA injury. According to morphometric studies in various populations of adults, from 19.2% to 53.8% had narrow C1 pedicle (<4 mm),[ 2 8 13 14 ]49% had internal pedicle diameter <1 mm, and 38% had no intramedullary canal.…”

Section: Discussionmentioning

confidence: 99%

An alternative way of C1 screwing

Burtsev

Sergeenko

Губин

2021

Journal of Craniovertebral Junction and Spine

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Study Design: This study involves literature review, technical note, and case series. Objectives: The objectives were to analyze indications and contraindications, advantages, and disadvantages for C1 lateral mass screw (LMS) insertion above or partially above the arch, to descript technical features, and to give examples of the practical application of this technique and investigated its safety. Methods: A literature review was carried out in English and Russian in PubMed, Google Scholar, and eLibrary databases. We selected four patients, treated in our clinic, which was carried out partially supralaminar C1 LMS. Results: Only three descriptions of supralaminar C1 LMS were found in the literature. Four adult patients underwent posterior C1–C2 screw fixation with C1 LMS along the superior edge of the C1 arch at our clinic. Partially supralaminar C1 screws were inserted on one of the sides due to the difficulties of using classical techniques. The main reasons for supralaminar screw fixation were narrow C1 lamina, hypertrophied venous plexus, and intraoperative failures of classic techniques application (broken screw trajectory, profuse venous bleeding from the plexus). The average follow-up time for the patients was 2.7 years, no complications were noted, and all had a satisfactory spinal fusion. Conclusions: The proposed types of C1 LMS above or partially above the C1 arch can be useful alternative method of C1 screwing in selected patients. Indications for the use of the supralaminar C1 LMS method can be narrow C1 posterior arch and pedicle, pronounced C1-C2 venous plexus, some V3 segment anomalies at C1 level, small arthritic inferior part of lateral mass, and intraoperative failures of classic techniques application.

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The morphological classification and clinical significance of atlas vertebral artery sulcus based on computed tomography three-dimensional reconstruction

Ding-xiang¹,

Li²,

Chen³

et al. 2023

Surg Radiol Anat

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Objective The purpose of this study was to research the morphological classification and clinical significance of vertebral artery sulcus on atlas based on CT three-dimensional reconstruction. Methods Three-dimensional reconstruction images of 300 adult atlases were collected. A total of 600 atlas vertebral artery sulci were selected in this study. The parameters required for placement of C1 pedicle screw, including depth of grinding drilling (ao), width (cd), length ab), height (H), lateral wall thickness (L1), inner wall thickness (L2), medial angle (∠α), and the cephalad angle to the transverse plane of atlas pedicle (∠β), were measured. Results CT three-dimensional reconstruction images showed that there were five types of atlas vertebral artery sulci: no process type (n = 494 cases, 82.33%), upper process type (n = 29, 4.83%), lower process type (n = 25, 4.17%), double process type (n = 19, 3.17%), and posterior ring type (33, 5.50%). One-way ANOVA tests showed that the five groups differed significantly in the parameter of ao, L2, H, ∠α and ∠β. One-way ANOVA with the LSD post hoc tests showed that the parameter ao of the group of no process type was less than that of the group of upper or lower process type (P < 0.05), and ao of the group of lower process or posterior ring type was less than that of the group of the upper type (P < 0.05). The parameter of ao of the male group was larger than that of the female group. Conclusion No process type of the atlas vertebral artery sulcus was the most common, and the medial angle and cephalad angle of the atlas pedicle in this type were the smallest. When pedicle screws are inserted, the above two angles should not be too large. Male's ao was larger than that of female's. All these findings should be considered to avoid the deviation of the nail track.

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Atlas posterior arch and vertebral artery’s groove variants: a classification, morphometric study, clinical and surgical implications

Cited by 16 publications

References 34 publications

Morphometric Anatomy of the Posterior Aspect of the Atlas and the Vertebral Artery Groove in Relation to Lateral Mass Screw Placement

Morphometric Anatomy of the Posterior Aspect of the Atlas and the Vertebral Artery Groove in Relation to Lateral Mass Screw Placement

An alternative way of C1 screwing

The morphological classification and clinical significance of atlas vertebral artery sulcus based on computed tomography three-dimensional reconstruction

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