The Quantitative Anatomy of the Vertebral Artery Groove of the Atlas and Its Relation to the Posterior Atlantoaxial Approach

Ebraheim, Nabil A.; Xu, Rongming; Ahmad, Muhammad; Heck, Bruce E.

doi:10.1097/00007632-199802010-00007

Cited by 98 publications

(51 citation statements)

References 5 publications

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“…2,18 Another landmark is the groove for the VA over the superior surface of the C-1 posterior arch. This groove has been regarded as the landmark that indicates the exact location of the VA. 8 However, the results of the present study have demonstrated that the VA may run distant from the groove for the VA, making a posterolateral protrusion. Surprisingly, this protrusive course of the VA has rarely been discussed in the literature.…”

Section: Discussioncontrasting

confidence: 57%

“…Thus, the anatomical relationship of the VA to the atlas has attracted the concern of many researchers. 1,2,5,7,8,20,22,23 Past quantitative studies of the VA and C-1 have been mostly performed based on cadavers or dry bones. 1,2,5,7,8,20,23 We used CT scans because they reveal the actual morphological characteristics of the blood-filled and pressurized VA, 22 and may provide more practical information than the use of cadavers or dry bone specimens.…”

Section: Discussionmentioning

confidence: 99%

“…Quantitative anatomical studies have focused on the relationship between the VA and the atlantoaxial vertebrae using dry bones, cadavers, and neuroimaging. 1,2,5,7,8,20,22,23 After exiting the transverse foramen of C-2, the VA courses laterally to pass the transverse foramen of C-1. Subsequently, the VA courses posteromedially in a horizontal groove on the upper surface of the posterior arch of the atlas.…”

mentioning

confidence: 99%

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Posterolateral protrusion of the vertebral artery over the posterior arch of the atlas: quantitative anatomical study using three-dimensional computed tomography angiography

Yamaguchi¹,

Eguchi²,

Kiura³

et al. 2008

SPI

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Object The vertebral artery (VA) often takes a protrusive course posterolaterally over the posterior arch of the atlas. In this study, the authors attempted to quantify this posterolateral protrusion of the VA. Methods Three-dimensional CT angiography images obtained for various cranial or cervical diseases in 140 patients were reviewed and evaluated. Seven patients were excluded for various reasons. To quantify the protrusive course of the VA, the diameter of the VA and 4 parameters were measured in images of the C1–VA complex obtained in the remaining 133 patients. The authors also checked for anomalies and anatomical variations. Results When there was no dominant side, mean distances from the most protrusive part of the VA to the posterior arch of the atlas were 6.73 ± 2.35 mm (right) and 6.8 ± 2.15 mm (left). When the left side of the VA was dominant, the distance on the left side (8.46 ± 2.00 mm) was significantly larger than that of the right side (6.64 ± 2.0 mm). When compared by age group (≤ 30 years, 31–60 years, and ≥ 61 years), there were no significant differences in the extent of the protrusion. When there was no dominant side, the mean distances from the most protrusive part of the VA to the midline were 30.73 ± 2.51 mm (right side) and 30.79 ± 2.47 mm (left side). When the left side of the VA was dominant, the distance on the left side (32.68 ± 2.03 mm) was significantly larger than that on the right side (29.87 ± 2.53 mm). The distance from the midline to the intersection of the VA and inner cortex of the posterior arch of the atlas was ~ 12 mm, irrespective of the side of VA dominance. The distance from the midline to the intersection of the VA and outer cortex of the posterior arch was ~ 20 mm on both sides. Anatomical variations and anomalies were found as follows: bony bridge formation over the groove for the VA on the posterior arch of C-1 (9.3%), an extracranial origin of the posterior inferior cerebellar artery (8.2%), and a VA passing beneath the posterior arch of the atlas (1.8%). Conclusions There may be significant variation in the location and branches of the VA that may place the vessel at risk during surgical intervention. If concern is noted about the vulnerability of the VA or its branches during surgery, preoperative evaluation by CT angiography should be considered.

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Section: Discussioncontrasting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Posterolateral protrusion of the vertebral artery over the posterior arch of the atlas: quantitative anatomical study using three-dimensional computed tomography angiography

Yamaguchi¹,

Eguchi²,

Kiura³

et al. 2008

SPI

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“…Careful scrutiny of preoperative CT imaging will identify cases where such screw trajectories are dangerous or impossible, such as abnormal positioning of the transverse www.intechopen.com Surgical Considerations of Rheumatoid Disease Involving the Craniocervical Junction and Atlantoaxial Vertebrae 287 foraminae or aberrant vertebral artery (Ebraheim et al 1998, Golanki & Crockard 1999, Nagaria et al 2009. We routinely use stealth neuronavigation when planning screw trajectories to minimise the risk to both vertebral arteries and neural structures.…”

Section: C1c2 Transarticular Screwsmentioning

confidence: 99%

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

Murphy¹,

McEvoy²,

Bolger³

2012

Rheumatoid Arthritis - Etiology, Consequences and Co-Morbidities

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“…the atlas 7 , and dissected off the bone. There was no need to dissect the artery from the surrounding veins.…”

Section: B1: Lateral C-spine X-ray Demonstrating a Severe C1-c2 Sublmentioning

confidence: 99%

C1 lateral mass screws for posterior segmental stabilization of the upper cervical spine and a new method of three-point rigid fixation of the C1-C2 complex

Vilela

Jermani²,

Braga³

2006

Arq. Neuro-Psiquiatr.

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-Objective: To describe our experience with C1 lateral mass screws as part of a construct for C1-2 stabilization and report an alternate method of C1-C2 complex three-point fixation. Method: All patients that had at least one screw placed in the lateral mass of C1 as part of a construct for stabilization of the C1-C2 complex entered this study. In selected patients who had a higher chance of nonunion an alternate construct was used: transarticular C1-C2 screws combined with C1 lateral mass screws. Results: Twentyone C1 lateral mass screws were placed in 11 patients. In three patients the alternate construct was used. All patients had a demonstrable solid and stable fusion on follow-up. Conclusion: C1 lateral mass screws are safe and provide immediate stability. The use of C1-C2 transarticular screws combined with C1 lateral mass screws is a feasible and also an excellent alternative for a three-point fixation of the C1-C2 complex.KEY WORDS: C1 lateral mass, C1 lateral mass screws, C1-C2 instability, C1-C2 transarticular screws, atlantoaxial stabilization, cervical spine instrumentation. Parafusos na massa lateral de C1 para instrumentação segmentar da coluna cervical alta e um novo método de fixação em três pontos do complexo C1-C2RESUMO -Objetivo: Descrever nossa experiência com o uso de parafusos na massa lateral de C1 como parte de uma montagem para estabilização do complexo C1-C2 e relatar uma fixação alternativa em três pontos do complexo C1-C2. Método: Todos os pacientes em que pelo menos um parafuso na massa lateral de C1 foi colocado como parte de uma montagem para estabilização C1-C2 entraram neste estudo. Em certos pacientes com maior chance de não-união, uma montagem alternativa foi usada: parafusos transarticulares C1-C2 associados a parafusos na massa lateral de C1. Resultados: Foram colocados 21 parafusos na massa lateral de C1 em 11 pacientes e em três pacientes foi usada a montagem alternativa. Todos os pacientes evoluíram para uma união sólida e estável. Conclusão: Parafusos na massa lateral de C1 são seguros e conferem estabilidade imediata. Parafusos na massa lateral de C1 combinados a parafusos transarticulares são exequíveis e também excelente alternativa para fixação rígida em três pontos do complexo C1-C2. PALAVRAS-CHAVE: massa lateral de C1, parafusos na massa lateral de C1, instabilidade C1-C2, parafusos transarticulares C1-C2, estabilização atlantoaxial, instrumentação da coluna cervical.Atlantoaxial instability can be caused by trauma, infection, tumors, arthritis, congenital anomalies, iatrogenic (odontoidectomy) or other less common conditions. Most commonly instability at the C1-C2 complex requires internal fixation not only for immediate stability but also to provide long-term immobility so as to attain a solid fusion. Wiring techniques such as the Gallie, Brooks and modified Brooks are known to provide less than optimal immobilization of the C1-C2 complex not only for axial rotation but also for lateral bending and flexion-extension 1,2 . Newer internal fixation technique...

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The Quantitative Anatomy of the Vertebral Artery Groove of the Atlas and Its Relation to the Posterior Atlantoaxial Approach

Abstract: The results of this study suggest that dissection on the posterior aspect of the posterior ring should remain within 12 mm lateral to the midline, and dissection on the superior aspect of the posterior ring should remain within 8 mm of the midline.

Cited by 98 publications

References 5 publications

Posterolateral protrusion of the vertebral artery over the posterior arch of the atlas: quantitative anatomical study using three-dimensional computed tomography angiography

Posterolateral protrusion of the vertebral artery over the posterior arch of the atlas: quantitative anatomical study using three-dimensional computed tomography angiography

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

C1 lateral mass screws for posterior segmental stabilization of the upper cervical spine and a new method of three-point rigid fixation of the C1-C2 complex

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