Abstract
A precise knowledge anatomy not only allows a surgeon to find an optimal approach to a pathological lesion while avoiding damage to surrounding structures but also determines what options are available for reconstruction of upper cervical spine (UCS) and craniovertebral junction (CVJ). A careful analysis of the anatomical situation, structures available for fixation, and the motion to be controlled, all lead the appropriate choice of reconstructive strategy.
The goal of surgical anatomy is to avoid the descriptive aspect of “pure anatomy.” On the other hand, it emphasizes important structures with respect to the pathological condition and surgical approach.
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References
Blagg, S.E., Don, A.S., Robertson, P.A.: Anatomic determination of optimal entry point and direction for C1 lateral mass screw placement. J Spinal Disord Tech 22, 233–239 (2009)
Cacciola, F., Phalke, U., Goel, A.: Vertebral artery in relationship to C1-C2 vertebrae: an anatomical study. Neurol India 52, 178–184 (2004)
Cassinelli, E.H., Lee, M., Skalak, A., et al.: Anatomic considerations for the placement of C2 laminar screws. Spine (Phila Pa 1976) 31, 2767–2771 (2006)
Christensen, D.M., Eastlack, R.K., Lynch, J.J., et al.: C1 anatomy and dimensions relative to lateral mass screw placement. Spine (Phila Pa 1976) 32, 844–848 (2007)
Currier, B.L., Maus, T.P., Eck, J.C., et al.: Relationship of the internal carotid artery to the anterior aspect of the C1 vertebra: implications for C1-C2 transarticular and C1 lateral mass fixation. Spine (Phila Pa 1976) 33, 635–639 (2008)
Debreuil-Chambardel, L.: Variations sexuelles de l’Atlas. Bull Soc Anthropologie de Paris 5, 399 (1907)
Doherty, B.J., Heggeness, M.H.: The quantitative anatomy of the atlas. Spine (Phila Pa 1976) 19, 2497–2500 (1994)
Duan, S., Lv, S., Ye, F., et al.: Imaging anatomy and variation of vertebral artery and bone structure at craniocervical junction. Eur Spine J 18, 1102–1108 (2009)
Dvorak, J.: Rotation of the cervical spine by using computerized-tomography (CT). Spine (Phila Pa 1976) 13, 595–597 (1988)
Dvorak, J., Panjabi, M.M.: Functional anatomy of the alar ligaments. Spine (Phila Pa 1976) 12, 183–189 (1987)
Ebraheim, N.A., Lu, J., Biyani, A., et al.: An anatomic study of the thickness of the occipital bone. Implications for occipitocervical instrumentation. Spine (Phila Pa 1976) 21, 1725–1729 (1996). discussion 1729–1730
Fine, A.D., Cardoso, A., Rhoton Jr., A.L.: Microsurgical anatomy of the extracranial-extradural origin of the posterior inferior cerebellar artery. J Neurosurg 91, 645–652 (1999)
Francis, C.C.: Variations in the articular facets of the cervical vertebrae. Anat Rec 122, 589–602 (1955)
Grob, D., Dvorak, J., Panjabi, M.M., et al.: The role of plate and screw fixation in occipitocervical fusion in rheumatoid arthritis. Spine (Phila Pa 1976) 19, 2545–2551 (1994)
Gupta, T.: Cadaveric morphometric anatomy of C-1 vertebra in relation to lateral mass screw placement. Surg Radiol Anat 30, 589–593 (2008)
Hawkins, T.D., Melcher, D.H.: A meningeal artery in the falx cerebelli. Clin Radiol 17, 377–383 (1966)
Heggeness, M.H., Doherty, B.J.: The trabecular anatomy of the axis. Spine (Phila Pa 1976) 18, 1945–1949 (1993)
Heller, J.G., Alson, M.D., Schaffler, M.B., et al.: Quantitative internal dens morphology. Spine (Phila Pa 1976) 17, 861–866 (1992)
Hong, X., Dong, Y., Yunbing, C., et al.: Posterior screw placement on the lateral mass of atlas: an anatomic study. Spine (Phila Pa 1976) 29, 500–503 (2004)
Hong, J.T., Lee, S.W., Son, B.C., et al.: Analysis of anatomical variations of bone and vascular structures around the posterior atlantal arch using three-dimensional computed tomography angiography. J Neurosurg Spine 8, 230–236 (2008)
Howington, J.U., Kruse, J.J., Awasthi, D.: Surgical anatomy of the C-2 pedicle. J Neurosurg 95, 88–92 (2001)
Jian, F.Z., Santoro, A., Wang, X.W., et al.: A vertebral artery tortuous course below the posterior arch of the atlas (without passing through the transverse foramen). Anatomical report and clinical significance. J Neurosurg Sci 47, 183–187 (2003)
Jun, B.Y.: Anatomic study for ideal and safe posterior C1-C2 transarticular screw fixation. Spine (Phila Pa 1976) 23, 1703–1707 (1998)
Kadri, P.A., Al-Mefty, O.: Anatomy of the nuchal ligament and its surgical applications. Neurosurgery 61, 301–304 (2007). discussion 304
Kandziora, F., Schulze-Stahl, N., Khodadadyan-Klostermann, C., et al.: Screw placement in transoral atlantoaxial plate systems: an anatomical study. J Neurosurg 95, 80–87 (2001)
Kazan, S., Yildirim, F., Sindel, M., et al.: Anatomical evaluation of the groove for the vertebral artery in the axis vertebrae for atlanto-axial transarticular screw fixation technique. Clin Anat 13, 237–243 (2000)
Koller, H., Kammermeier, V., Ulbricht, D., et al.: Anterior retropharyngeal fixation C1-2 for stabilization of atlantoaxial instabilities: study of feasibility, technical description and preliminary results. Eur Spine J 15, 1326–1338 (2006)
La Marca, F., Zubay, G., Morrison, T., et al.: Cadaveric study for placement of occipital condyle screws: technique and effects on surrounding anatomic structures. J Neurosurg Spine 9, 347–353 (2008)
Lang, J.: The cranio-cervical junction – Anatomy. In: Voth, D., Glees, P. (eds.) Diseases in the cranio-cervical junction. Anatomical and pathological aspects and detailed clinical accounts, pp. 27–61. Gruyter, Berlin, New York (1987)
Lee, M.J., Cassinelli, E., Riew, K.D.: The feasibility of inserting atlas lateral mass screws via the posterior arch. Spine (Phila Pa 1976) 31, 2798–2801 (2006)
Lee, J.H., Jahng, T.A., Chung, C.K.: C1-2 transarticular screw fixation in high-riding vertebral artery: suggestion of new trajectory. J Spinal Disord Tech 20, 499–504 (2007)
Lu, J., Ebraheim, N.A., Yang, H., et al.: Anatomic considerations of anterior transarticular screw fixation for atlantoaxial instability. Spine (Phila Pa 1976) 23, 1229–1235 (1998). discussion 1236
Madawi, A.A., Casey, A.T., Solanki, G.A., et al.: Radiological and anatomical evaluation of the atlantoaxial transarticular screw fixation technique. J Neurosurg 86, 961–968 (1997)
Madawi, A.A., Solanki, G., Casey, A.T., et al.: Variation of the groove in the axis vertebra for the vertebral artery. Implications for instrumentation. J Bone Joint Surg Br 79, 820–823 (1997)
Moftakhar, P., Gonzalez, N.R., Khoo, L.T., et al.: Osseous and vascular anatomical variations within the C1-C2 complex: a radiographical study using computed tomography angiography. Int J Med Robot 4, 158–164 (2008)
Muthukumar, N., Swaminathan, R., Venkatesh, G., et al.: A morphometric analysis of the foramen magnum region as it relates to the transcondylar approach. Acta Neurochir (Wien) 147, 889–895 (2005)
Naderi, S., Cakmakci, H., Acar, F., et al.: Anatomical and computed tomographic analysis of C1 vertebra. Clin Neurol Neurosurg 105, 245–248 (2003)
Naderi, S., Korman, E., Citak, G., et al.: Morphometric analysis of human occipital condyle. Clin Neurol Neurosurg 107, 191–199 (2005)
Nadim, Y., Lu, J., Sabry, F.F., et al.: Occipital screws in occipitocervical fusion and their relation to the venous sinuses: an anatomic and radiographic study. Orthopedics 23, 717–719 (2000)
Neo, M., Matsushita, M., Iwashita, Y., et al.: Atlantoaxial transarticular screw fixation for a high-riding vertebral artery. Spine (Phila Pa 1976) 28, 666–670 (2003)
Newton, T.H.: The anterior and posterior meningeal branches of the vertebral artery. Radiology 91, 271–279 (1968)
Olivier, G.: Biometry of the human occipital bone. J Anat 120, 507–518 (1975)
Panjabi, M., Dvorak, J., Crisco 3rd, J.J., et al.: Effects of alar ligament transection on upper cervical spine rotation. J Orthop Res 9, 584–593 (1991)
Panjabi, M., Dvorak, J., Crisco 3rd, J., et al.: Flexion, extension, and lateral bending of the upper cervical spine in response to alar ligament transections. J Spinal Disord 4, 157–167 (1991)
Paramore, C.G., Dickman, C.A., Sonntag, V.K.: The anatomical suitability of the C1-2 complex for transarticular screw fixation. J Neurosurg 85, 221–224 (1996)
Resnick, D.K., Lapsiwala, S., Trost, G.R.: Anatomic suitability of the C1-C2 complex for pedicle screw fixation. Spine (Phila Pa 1976) 27, 1494–1498 (2002)
Roberts, D.A., Doherty, B.J., Heggeness, M.H.: Quantitative anatomy of the occiput and the biomechanics of occipital screw fixation. Spine (Phila Pa 1976) 23, 1100–1107 (1998). discussion 1107–1108
Rocha, R., Safavi-Abbasi, S., Reis, C., et al.: Working area, safety zones, and angles of approach for posterior C-1 lateral mass screw placement: a quantitative anatomical and morphometric evaluation. J Neurosurg Spine 6, 247–254 (2007)
Santos-Franco, J.A., de Oliveira, E., Mercado, R., et al.: Microsurgical considerations of the anterior spinal and the anterior-ventral spinal arteries. Acta Neurochir (Wien) 148, 329–338 (2006). discussion 338
Schmidt, H., Fisher, E.: Die okzipitale Dysplasie. Thieme, Stuttgart (1960)
Seal, C., Zarro, C., Gelb, D., et al.: C1 lateral mass anatomy: proper placement of lateral mass screws. J Spinal Disord Tech 22, 516–523 (2009)
Seckin, H., Ates, O., Bauer, A.M., et al.: Microsurgical anatomy of the posterior spinal artery via a far-lateral transcondylar approach. J Neurosurg Spine 10, 228–233 (2009)
Solanki, G.A., Crockard, H.A.: Preoperative determination of safe superior transarticular screw trajectory through the lateral mass. Spine (Phila Pa 1976) 24, 1477–1482 (1999)
Tan, M., Wang, H., Wang, Y., et al.: Morphometric evaluation of screw fixation in atlas via posterior arch and lateral mass. Spine (Phila Pa 1976) 28, 888–895 (2003)
Tokuda, K., Miyasaka, K., Abe, H., et al.: Anomalous atlantoaxial portions of vertebral and posterior inferior cerebellar arteries. Neuroradiology 27, 410–413 (1985)
Tsusaki, T.: Über den Atlas und Epistropheus bei den eingeborenen Formosanern. Folia Anatomica Japonica 2, 221–246 (1924)
Tubbs, R.S., Salter, E.G., Oakes, W.J.: The accessory atlantoaxial ligament. Neurosurgery 55, 400–402 (2004). discussion 402–404
Xu, R., Burgar, A., Ebraheim, N.A., et al.: The quantitative anatomy of the laminas of the spine. Spine (Phila Pa 1976) 24, 107–113 (1999)
Xu, R., Nadaud, M.C., Ebraheim, N.A., et al.: Morphology of the second cervical vertebra and the posterior projection of the C2 pedicle axis. Spine (Phila Pa 1976) 20, 259–263 (1995)
Young, J.P., Young, P.H., Ackermann, M.J., et al.: The ponticulus posticus: implications for screw insertion into the first cervical lateral mass. J Bone Joint Surg Am 87, 2495–2498 (2005)
Zipnick, R.I., Merola, A.A., Gorup, J., et al.: Occipital morphology. An anatomic guide to internal fixation. Spine (Phila Pa 1976) 21, 1719–1724 (1996). discussion 1729–1730
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Suchomel, P., Choutka, O., Barsa, P. (2011). Surgical Anatomy. In: Reconstruction of Upper Cervical Spine and Craniovertebral Junction. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-13158-5_1
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