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OBJETIVO establecer la prevalencia de Pontículus Pósticus (PP) en pacientes atendidos en el Servicio de Imagenología de la Universidad Finis Terrae en el periodo 2015-2020. METODOLOGÍA estudio de tipo transversal descriptivo, donde se analizaron 334 telerradiografías laterales (TL) obtenidas del Servicio de Imagenología de la Universidad Finis Terrae entre los años 2015 y 2019 adquiridas mediante el equipo marca SIRONA modelo Orthophos XG, seleccionándolas según criterios de inclusión y exclusión. Se analizó la primera vértebra cervical buscando la presencia de PP consignando: sexo, edad y tipo de osificación según clasificación de Cederberg y Stubbs, asignándoles valores numéricos para posteriormente realizar el análisis estadístico de tipo descriptivo uni y bivariado. RESULTADOS se seleccionaron 320 TL. La prevalencia de PP fue del 31,9% de las TL incluidas, de los cuales el 68,1% correspondió al tipo 1 de la clasificación de Cederberg y Stubbs, el 14,1% al tipo 2, 10,3% al tipo 4 y el 7,5% al tipo 3. La edad media en pacientes con PP presente correspondió a 30,63 años +/ 15,888 D.E con un mínimo de 12 años y un máximo de 78. En cuanto a la presencia de PP y la variable sexo, el 53,9% correspondió al sexo femenino y el 46,1% al sexo masculino, en donde no se encontró una predilección estadísticamente significativa (p = 0,08). CONCLUSIONES el PP es una variante anatómica de prevalencia variada, siendo levemente mayor en esta población chilena en comparación con otros países. Además, su evidencia es escasa y no existe un consenso sobre su prevalencia y diversas variables como el género y la edad, difiriendo en varios estudios. Es importante conocer e investigar más sobre la epidemiología de esta anomalía y su relación con distintos desórdenes neurológicos
OBJETIVE to establish the prevalence of Ponticulus Posticus (PP) in patients attended in Radiology Service of Finis Terrae University between the years 2015 and 2020. METHODOLOGY descriptive cross-sectional study, 334 lateral cephalograms were analyzed obtained from the Radiology Service of Finis Terrae University between the years 2015 and 2020 acquired from SIRONA system model Orthophos XG, selecting them following the inclusion and exclusion criteria. The first cervical vertebrae were analyzed searching for the presence of PP, consigning: Type of ossification by Cederberg and Stubbs classification, Age and Sex, assigning them numerical values to subsequently perform the descriptive statistical analysis uni and bivariate. RESULTS the prevalence of PP found was 31,9% of the 320 included TL, of which 68,1% corresponded to Type 0 of Cederberg and Stubbs classification, 14,1% to Type 1, 10,3% to Type 3 and the 7,5% al Type 2. The average age of present PP patient's was 30,63 years + 15,888 S.D with a minimum of 12 years and a maximum de 78. As for the presence of PP and sex variable, 53,9% corresponded to female sex and 46,1% to males, where no statistically significant predilection was found (p = 0,08). CONCLUSIONS PP is an anatomical variant with varied prevalence worldwide, being slightly higher in Chile, compared to other countries. In addition, their evidence is scarce and there is no consensus on its prevalence and various variables such as gender and age, differing in several studies. It is important to know and research more about the epidemiology of this anomaly and its relationship with different neurological disorder
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Humans , Cervical Atlas/diagnostic imaging , Tomography, X-Ray Computed/methods , Cervical Atlas/abnormalities , Chile/epidemiology , Epidemiology, Descriptive , Prevalence , Sex Distribution , Age DistributionABSTRACT
Background: Arcuate foramen is a variation in the posterior arch of atlas vertebrae. It is commonly called as Kimmerle’s anomaly, also known as Ponticulus Posticus. It is the product of the complete or incomplete ossification of the posterior atlantooccipital membrane over the vertebral artery groove resulting in the formation of arcuate foramen containing the vertebral artery and the posterior branch of the first cervical spinal nerve. Aims: The aim of the present study was to identify the percentage of incidence of arcuate foramen in the atlas and its clinical important. Materials and Methods: The study was conducted in the Department of Anatomy, Katihar Medical College, Katihar, India with 32 adult dried atlas vertebrae. Results: We found four (12.5%) atlas with arcuate foramen. One atlas having complete arcuate foramen and three having partial complete arcuate foramen. Conclusion: Awareness of this type of variation is very important for neurosurgeons and radiologist during their clinical practice. The presence of the arcuate foramen would also complicate screw placement during surgery. Clinical prescreening for signs of vertebrobasilar insufficiency is important for chiropractic and manual therapies.
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Background: Atlas, first cervical vertebra bears sulcus over posterior arch for third part of vertebral artery.Sometimes an osseous bridge converts the sulcus into a foramen called as Arcuate foramen. It is commonlycalled as Kimmerle’s anomaly, also known as Ponticulus Posticus. It is the product of the complete or incompleteossification of the posterior atlanto-occipital membrane over the vertebral artery groove resulting in the formationof a foramen (Arcuate foramen) containing the vertebral artery and the posterior branch of the C-1 spinal nerve.This variation has been associated with vertebro-basilar insufficiency symptoms, various types of headaches,and acute hearing loss. The knowledge of this variant prevents complications during lateral mass screw fixation,posterior laminectomy and endovascular surgery.Aims: The aim of the present study was to analyze the percentage of incidence of arcuate foramen and to identifyits clinical significance.Materials and Methods: Hundred dried human atlas bones were used to study the presence of arcuate foramen inthe department of Anatomy at ESIC Medical College and PGIMSR, Rajajinagar, Bangalore.Results: We came across the presence of arcuate foramen in two out of hundred bones. In both the atlas bones,osseous bridge extending from posterior aspect of superior articular facet to the posterior arch of atlas on theleft side, forming arcuate foramen, posterior to foramen transversarium was observed.Conclusion: Arcuate foramen commonly called as Kimmerle’s anomaly where in a groove for vertebral artery isconverted into a foramen by ossification of the ligament. Awareness of osseous bridging is essential in performingcranio-cervical junction surgeries. It also serves as an anthropological data and also identifying the impact ofcomplete arcuate foramen on the signs and symptoms of vertebra-basilar insufficiency.
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Background: Atlas, the first cervical vertebra, has an oblique ligament which bridges the groove for vertebralartery. This ligament may ossify sometimes converting groove into foramen. These foramina are called asponticulus posterior or arcuate foramen of the atlas. The ponticuli can distort vertebral artery. They havetendency to cause vertebra basic insufficiency. During any manipulation of cervical spine, these variations ofatlas should be kept in mind.Objectives: To study the presence of ponticuli, their other features like whether complete or incomplete, unilateralor bilateral, sidedness- right or left.Material and Methods: A total of 50 fully dried adult human atlas were collected from the Department ofAnatomy, Government Medical College, Jammu and from the students of the first year MBBS, Government MedicalCollege, Jammu. Bones were intact and free from osteophytes. The superior surface of posterior arch was observedcarefully in each atlas for presence of ponticulus.Results: In the present study, 50 human atlas vertebrae were observed out of which 4 atlas (8%) had ponticuli. Itwas incomplete in 2 vertebrae (4%) and was complete in 2 atlas vertebrae (4%). It was unilateral in 3 atlasvertebrae (6%) and bilateral in 1 atlas vertebra (2%). 2 ponticuli were on the right side, 1 on left side and 2 werefound on both sides. All were ponticuli posterior except one which was lateral ponticulus.Conclusion: The presence of ponticuli can cause cervical pain and pressurize vertebral artery leading tocerebrovascular accidents. Detailed knowledge about the variations in the cervical region is very helpful toneurosurgeons, orthopaedicians and otolaryngologists to avoid any mishap. Spinal surgeons must be fullyaware about these ponticulus to prevent any complications during surgeries
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BACKGROUND: The first cervical vertebra, atlas plays a vital role in the movement of skull & neck. The anatomy of atlas is complex due to its three dimensional structure. There is a groove on superior surface of posterior arch of atlas for passage of 3rd part of vertebral artery and first cervical spinal nerve (suboccipital nerve). Sometimes the oblique ligament of atlas which is present at the lower border of posterior atlanto-occipital membrane may ossify and convert this groove into a foramen. This foramen may be complete or incomplete, In some cases a bony bridge also extends from lateral masses of atlas to the posterior root of transverse process and form an additional foramen through which vertebral artery travels. The vertebral artery is prone to compression in its entire course between foramen transversarium and foramen magnum during extreme rotation movement of head & neck. This condition may be aggravated by the presence of these ponticuli & results in compromised blood flow and causes vertebrobasilar insufficiency presenting with dizziness, fainting, vertigo, transient diplopia & various neurological disturbances. MATERIALS & METHODS: The present study was carried out on 118 (Male-62, Female-56) dried fully ossified adult human atlas of known sex for the presence of complete or incomplete ring for vertebral artery i.e. different ponticuli on the superior surface of the atlas vertebra. RESULTS: We observed 21.17% cases of ponticulus posterior in which 7.62% specimens had complete ring while 13.55% specimens had incomplete ring & ponticulus lateralis was reported only in 5.93% cases (unilateral: 2.54% & bilateral: 3.39%). Incidence of ponticulus posterior as well as lateralis were more common in male as compared to female. Complete ponticulus posterior was more common in right side, while incomplete ponticulus posterior as well as ponticulus lateralis were more commonly bilaterally. CONCLUSION: As indicated by our study, ponticulus posterior as well as lateralis are not so rare anomaly in the population of Bihar. So, the detail knowledge about these variations is very helpful to the neurophysicians, neurosurgeons, orthopedicians & otolaryngologists who faces regularly the patients complaining about the symptoms of vertebrobasilar insufficiency. These informations are also important for the spine surgeons to prevent vascular complications during spinal surgeries especially in those patients who required screw placements in the lateral mass of atlas.
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OBJECTIVE: We sought to examine anatomic variations of the atlas and the clinical significance of these variations. METHODS: We retrospectively reviewed 1029 cervical 3-dimensional (3D) CT images. Cervical 3D CT was performed between November 2011 and August 2014. Arcuate foramina were classified as partial or complete and left and/or right. Occipitalization of the atlas was classified in accordance with criteria specified by Mudaliar et al. Posterior arch defects of the atlas were classified in accordance with criteria specified by Currarino et al. RESULTS: One hundred and eight vertebrae (108/1029, 10.5%) showed an arcuate foramen. Bilateral arcuate foramina were present in 41 of these vertebrae and the remaining 67 arcuate foramina were unilateral (right 31, left 36). Right-side arcuate foramina were partial on 18 sides and complete on 54 sides. Left-side arcuate foramina were partial on 24 sides and complete on 53 sides. One case of atlas assimilation was found. Twelve patients (12/1029, 1.17%) had a defect of the atlantal posterior arch. Nine of these patients (9/1029, 0.87%) had a type A posterior arch defect. We also identified one type B, one type D, and one type E defect. CONCLUSION: Preoperative diagnosis of occipitalization of the atlas and arcuate foramina using 3D CT is of paramount importance in avoiding neurovascular injury during surgery. It is important to be aware of posterior arch defects of the atlas because they may be misdiagnosed as a fracture.
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Humans , Congenital Abnormalities , Diagnosis , Retrospective Studies , SpineABSTRACT
Introduction: Arcuate foramen is less known trait of the human atlas vertebra formed by a delicate bony spiculum, which arches backward from the posterior end of the superior articular process. Method: Examination of 100 human atlas vertebra done. Result: Study revealed that the trait was present in 13% of the samples. The mean length of the arcuate foramen form was 7.16 mm on the left side and 9.99 mm on the right side in bilateral positive samples while it was 8.14 mm and 9.26 mm respectively in unilateral positive samples. The mean vertical height of this foramen was 6.57 mm on the left side and 6.52 mm on the right side in bilateral positive samples while it was 4.91 mm and 5.38 mm respectively in unilateral positive samples. The sides did not show any statistical significant differences. Conclusion: The importance of the arcuate foramen lies in the external pressure it may cause on the vertebral artery as it passes from the foramen transversaium of the first cervical vertebra to the foramen magnum of the skull.
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PURPOSE: Since there has been little reporting on the prevalence or morphologic characteristics of ponticulus posticus in Asians, we retrospectively reviewed cervical 3-dimensional CT scan images and plain radiographs which had been ordered by neurosurgeons or orthopaedic surgeons for evaluation of cervical spine problems to investigate the prevalence and morphologic features of the ponticulus posticus in Koreans. PATIENTS AND METHODS: The presence and types of ponticulus posticus were investigated on 200 consecutive cervical 3-D CT scans. RESULTS: Thirty-one patients, 48 ponticulus posticus, complete or partial, bilateral or unilateral, were identified on the 200 cervical 3-D CT scans; therefore, the prevalence was 15.5% in our patient population. In plain radiographs analysis, the prevalence was 6.95%. CONCLUSION: The ponticulus posticus is a relatively common anomaly in Koreans. Therefore, proper identification of this anomaly on preoperative lateral radiographs should alert surgeons to avoid using the ponticulus posticus as a starting point for a lateral mass screw. Because of its size and shape have wide variation, 3-D CT scanning should be considered before lateral mass screw placement into the posterior arch if its presence is suspected or confirmed on radiographs.