The Ponticulus Posticus as Risk Factor for Screw Insertion into the First Cervical Lateral Mass

Arslan, Dilek Efe; Özer, Mehmet Asım; Gövsa, Figen; Kitiş, Ömer

doi:10.1016/j.wneu.2018.02.100

Cited by 20 publications

(19 citation statements)

References 31 publications

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“…Three studies in Turkey on different populations also showed wide variations, which were 9.4%, 14.3%, and 43%. However, one of them was a cadaver study, and another focused on orthodontic patients 14–16 . Another study that investigated180 3D‐CT images showed incidences of 5.8%, 14.2%, and 5.0% in Chinese, Indian, and Malaysian populations, respectively 17 .…”

Section: Discussionmentioning

confidence: 99%

Multiple Fractures of Cervical Vertebrae Combined with Arcuate Foramen and Vertebral Artery Occlusion: A Case Report and Literature Review

Wang

Liu

Guo

et al. 2020

Orthopaedic Surgery

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Background The arcuate foramen is a complete or partial bony bridge over the vertebral artery groove of atlas. The mechanism of the arcuate foramen is not clearly understood. Omission of the arcuate foramen sometimes causes lethal iatrogenic injury during spinal surgery. Case Presentation We describe a patient who was diagnosed with multiple fractures of the cervical vertebrae, arcuate foramen, and right vertebral artery occlusion based on clinical and radiological exams. After conservative treatment, he resumed a normal and productive life. Conclusions Arcuate foramen is a common variation that causes symptoms such as dizziness, headache, and migraine. If the patient does not develop severe symptoms, conservative treatment can achieve very good results without the necessity to remove the bone bridge. When serious symptoms occur, surgical treatment to resect the bony ridges can relieve the symptoms dramatically.

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Section: Discussionmentioning

confidence: 99%

Multiple Fractures of Cervical Vertebrae Combined with Arcuate Foramen and Vertebral Artery Occlusion: A Case Report and Literature Review

Wang

Liu

Guo

et al. 2020

Orthopaedic Surgery

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“…It has been reported that the only advantage of this variation is the low risk of fracture, and it has also been reported that it usually leads to dissection by stretching the VA, vertebrobasilar ischemia during strong interventions in the cervical spine, complications in cases where C1-C2 stabilization is required, and Barre Lieou syndrome mostly by causing neurovascular compression (1,5,7,14,15,18,19,(22)(23)(24)(25)(26)(27).…”

Section: Discussionmentioning

confidence: 99%

The Importance of Arcuate Foramen, A Variation of the Atlas: A Microsurgical Cadaveric Study and Review of the Literature

Keser¹,

Çıkla²,

Özaydın³

et al. 2019

Istanbul Med J

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Amaç: Arkuat foramen (AF) atlasın posterior arkındaki vertebral arter (VA) oluğunda (sulkus arteriae vertebralis) bulunan, prevalansı bölgesel ve etnik faktörler nedeni ile değişebilen osseöz bir varyasyondur. AF'nin içindeki yapılara bası oluşturarak vertebrobaziler yetmezlik bulgularına neden olduğu düşünülse de bu kliniği açıklayacak yeterli sayıda kadavra çalışması yoktur. Yöntemler: AF varyasyonun insidansını ve içinden geçen VA ile olan ilişkisini değerlendirmek için renkli silikon enjekte edilmiş ve rastgele olarak seçilmiş 10 kadavranın 20 tarafı Wisconsin Üniversitesi Nöroanatomi Laboratuvarı'nda mikroşirürjikal yöntem ile incelendi. Bulgular: Örneklerin %30'unda atlasta komplet tipte AF varyasyonu saptandı. Bu varyasyon iki olguda sağda tek taraflı iken bir olguda bilateraldi. AF'nin ortalama boyutları sağda D1=6 mm, D2=5,5 mm, solda D1=7,5 mm, D2=6,5 mm, VA'nın ortalama çapı ise foramen öncesi, foramen içi ve foramen sonrası sırası ile sağda 4 mm, 2,5 mm ve 3 mm, solda 6 mm, 4 mm ve 5 mm idi. Olguların hepsinde suboksipital sinir AF içerisinde VA'ya eşlik ediyordu. Sonuç: Bu varyasyonun yüksek insidansının olabileceğinin bilinmesi kraniyoservikal bileşke ameliyatlarından önce ameliyat stratejisinin belirlenmesini ve hayati tehlike yaratabilecek arter yaralanmalarının engellenmesini sağlayabilir. Ayrıca, AF boyutlarının VA'nın rahatlıkla geçişine uygun olmasına karşın foramen içinden geçen diğer yapılar nedeni ile arteryel bası oluşturduğunun görülmesi foramen dekompresyonu ile olguların çoğunun rahatlama nedenini de açıklayabilir. Anahtar Kelimeler: Arkuat foramen, atlas, kadavra çalışması, osseöz anomali, vertebral arter, vertebrobaziler yetmezlik Introduction: Arcuate foramen (AF) is an osseous variation located on the vertebral artery (VA) groove (sulcus arteriae vertebralis) at the posterior arch of the atlas. Its prevalence may vary due to regional and ethnic factors. Although it is thought that it causes compression of the structures inside AF and causes vertebrobasilar insufficiency, there are not enough cadaver studies to explain this clinical condition. Methods: To evaluate the incidence of AF variation and its relationship with VA, 20 sides of 10 randomly selected and silicone injected cadaveric heads were examined by microsurgical method at the University of Wisconsin Neuroanatomy Laboratory. Results: Complete AF variation in atlas was detected in 30% of the samples. This variation was unilateral on the right side in two cases and bilateral in one case. The mean dimensions of AF were D1=6 mm and D2=5.5 mm on the right, and D1=7.5 mm and D2=6.5 mm on the left. The mean pre-foraminal, foraminal and post-foraminal diameters of VA were 4 mm, 2.5 mm and 3 mm, respectively, on the right, and 6 mm, 4 mm and 5 mm, respectively, on the left. In all cases, the suboccipital nerve was accompanying VA in the AF. Conclusion: Being aware that this variation may have a high incidence may help to determine surgical strategy before craniocervical junction surgery and prevent life-threatening arterial injuries...

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“…So, under this condition, the pedicle screw of C 1 might be an alternative. PP is the osseous variation of vertebral artery V3 segment and it is also a risk factor for inserting a screw into the atlas 7,[21][22][23][24] , especially for the pedicle screws, since the existence of PP does not make it easy to observe the upper wall of posterior arch of C 1 . For these reasons, when the variation of PP was observed, the entry point of C 1 fixation screws should be selected more cautiously in order to avoid the injury to the VA 25 .…”

Section: Characters Of the Variations In The Region Of V2 And V3mentioning

confidence: 99%

“…But both these two technologies could not display the characters of the blood vessels exactly. So, in recent years, the examination of CTA (computed tomography angiography) became the major technology for the research of the variations of VA [5][6][7][8][9] for because of the advantage of making the bone and the blood vessel visible at the same time.…”

Section: Introductionmentioning

confidence: 99%

“…There are several variations of the VA in both V2 and V3 segments, which could bring more probability of injury. The incidence of every variation is different and with different character, even the incidence of different populations may vary markedly 7,10,11 . Thus, it is important to survey the anatomical variations in a specific population and analyze their influence to the operations in order to ensure the safety of cervical operations 12 .…”

Section: Introductionmentioning

confidence: 99%

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Anatomical Variations of the Vertebral Artery: Analysis by Three‐Dimensional Computed Tomography Angiography in Chinese Population

Wang

Ren

Liang

et al. 2021

Orthopaedic Surgery

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Objective: To analyze the anatomical variations of V3 and V2 segments of the vertebral artery in the Chinese population.Methods: The current retrospective study was an observational, anatomical, radiological research. Between 1 January 2018 to 31 December 2019, the data of 589 continuous head-and-neck three-dimensional computed tomography angiography were observed and analyzed using the open-source software of Horos. There were 415 males and 174 females with an average age of 44.63 AE 2.5(18-74) years. The variations of the V3 segment were defined as persistent first intersegmental artery (PFIA) and paracondylar processes (PP). The variations of V2 segments were unusual vertebral artery entrance transverse foreman (UE-V2S) and midline migration (MM). The incidences of all variations were summarized and the gender, side characters were compared.Results: Among the patients, 4.34% (18/415) males and 4.60% (8/174) females were with the variation of PFIA.Meanwhile, 12.29% (51/415) males and 10.92% (19/174) females were with the variation of PP. Then 18.80% (78/415) males and 16.67% (29/174) females were with UE-V2S. All the variations above were not different in genders. As for the variation of MM, 3.86% (16/415) males and 8.62% (15/174) females were identified, and the difference of genders was significant for this type of variation (P < 0.05). The differences between each side were also observed and analyzed for all variations and no differences were found. Conclusion:There are several variations of V3 and V2 segments of the vertebral artery are associated with the cervical surgeries, most were without differences in genders and sides, except the variation of MM.

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The Ponticulus Posticus as Risk Factor for Screw Insertion into the First Cervical Lateral Mass

Cited by 20 publications

References 31 publications

Multiple Fractures of Cervical Vertebrae Combined with Arcuate Foramen and Vertebral Artery Occlusion: A Case Report and Literature Review

Multiple Fractures of Cervical Vertebrae Combined with Arcuate Foramen and Vertebral Artery Occlusion: A Case Report and Literature Review

The Importance of Arcuate Foramen, A Variation of the Atlas: A Microsurgical Cadaveric Study and Review of the Literature

Anatomical Variations of the Vertebral Artery: Analysis by Three‐Dimensional Computed Tomography Angiography in Chinese Population

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