Applied Anatomy and Biomechanics of the Atlantoaxial Joint Complex

  • Bin Ni
  • Yuan Deng
Part of the Translational Medicine Research book series (TRAMERE)


Because of the special structure of atlantoaxial complex, there are a series of unique instrumentations for specific diseases in this important region. A thorough understanding of these relationships allows for a safe access to the cervical spine while minimizing complications. The first section of this chapter discusses the anatomy of the atlantoaxial joint complex, including bony, ligamentous, vascular, and nerval anatomy. The second section describes the outline of biomechanics of the atlantoaxial joint. The special biomechanical characters of the atlantoaxial joint arise from its unique anatomical construction. Therefore, appreciating the anatomical character of the atlantoaxial joint will provide the reader with a better understanding of its biomechanical character. Finally, the chapter describes several normal atlantoaxial fixation techniques, including anterior and posterior fixation, and motion-preserving devices.


  1. 1.
    Gehweiler JA Jr, Daffner RH, Roberts L Jr. Malformations of the atlas vertebra simulating the Jefferson fracture. AJR Am J Roentgenol. 1983;140:1083–6.CrossRefPubMedGoogle Scholar
  2. 2.
    Hasan M, Shukla S, Siddiqui MS, et al. Posterolateral tunnels and ponticuli in human atlas vertebrae. J Anat. 2001;199:339–43.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Young JP, Young PH, Ackermann MJ, et al. The ponticulus posticus: implications for screw insertion into the first cervical lateral mass. J Bone Joint Surg Am. 2005;87:2495–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Hong JT, Lee SW, Son BC, 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. 2008;8:230–6.CrossRefPubMedGoogle Scholar
  5. 5.
    Konig SA, Goldammer A, Vitzthum HE. Anatomical data on the craniocervical junction and their correlation with degenerative changes in 30 cadaveric specimens. J Neurosurg Spine. 2005;3:379–85.CrossRefPubMedGoogle Scholar
  6. 6.
    Cattrysse E, Provyn S, Gagey O, et al. In vitro three dimensional morphometry of the lateral atlantoaxial articular surfaces. Spine (Phila PA 1976). 2008;33:1503–8.CrossRefGoogle Scholar
  7. 7.
    Panjabi M, Dvorak J, Crisco JJ 3rd, et al. Effects of alar ligament transection on upper cervical spine rotation. J Orthop Res. 1991;9:584–93.CrossRefPubMedGoogle Scholar
  8. 8.
    Panjabi M, Dvorak J, Crisco J 3rd, et al. Flexion, extension, and lateral bending of the upper cervical spine in response to alar ligament transections. J Spinal Disord. 1991;4:157–67.CrossRefPubMedGoogle Scholar
  9. 9.
    Zhang H, Bai J. Development and validation of a finite element model of the occipito-atlantoaxial complex under physiologic loads. Spine (Phila PA 1976). 2007;32:968–74.CrossRefGoogle Scholar
  10. 10.
    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). 2003;28:888–95.Google Scholar
  11. 11.
    Dong Y, Hong MX, Jianyi L, et al. Quantitative anatomy of the lateral mass of the atlas. Spine (Phila PA 1976). 2003;28:860–3.Google Scholar
  12. 12.
    Richter M, Schmidt R, Claes L, et al. Posterior atlantoaxial fixation: biomechanical in vitro comparison of six different techniques. Spine (Phila PA 1976). 2002;27:1724–32.CrossRefGoogle Scholar
  13. 13.
    Ahmed R, Traynelis VC, Menezes AH. Fusions at the craniovertebral junction. Childs Nerv Syst. 2008;24:1209–24.CrossRefPubMedGoogle Scholar
  14. 14.
    Lee MJ, Cassinelli E, Riew KD. The feasibility of inserting atlas lateral mass screws via the posterior arch. Spine (Phila PA 1976). 2006;31:2798–801.CrossRefGoogle Scholar
  15. 15.
    Hays MB, Alker GJ Jr. Fractures of the atlas vertebra. The two-part burst fracture of Jefferson. Spine (Phila PA 1976). 1988;13:601–3.CrossRefGoogle Scholar
  16. 16.
    Heller JG, Alson MD, Schaffler MB, et al. Quantitative internal dens morphology. Spine (Phila PA 1976). 1992;17:861–6.CrossRefGoogle Scholar
  17. 17.
    Xu R, Nadaud MC, Ebraheim NA, et al. Morphology of the second cervical vertebra and the posterior projection of the C2 pedicle axis. Spine (Phila PA 1976). 1995;20:259–63.CrossRefGoogle Scholar
  18. 18.
    Schaffler MB, Alson MD, Heller JG, et al. Morphology of the dens. A quantitative study. Spine (Phila PA 1976). 1992;17:738–43.CrossRefGoogle Scholar
  19. 19.
    An HS, Gordin R, Renner K. Anatomic considerations for plate-screw fixation of the cervical spine. Spine (Phila PA 1976). 1991;16:S548–51.CrossRefGoogle Scholar
  20. 20.
    Wellman BJ, Follett KA, Traynelis VC. Complications of posterior articular mass plate fixation of the subaxial cervical spine in 43 consecutive patients. Spine (Phila PA 1976). 1998;23:193–200.CrossRefGoogle Scholar
  21. 21.
    Borne GM, Bedou GL, Pinaudeau M. Treatment of pedicular fractures of the axis. A clinical study and screw fixation technique. J Neurosurg. 1984;60:88–93.CrossRefPubMedGoogle Scholar
  22. 22.
    Magerl F, Seemann PS. Stable posterior fusion of the atlas and axis by transarticular screw fixation. In: Cervical spine. Vienna: Springer; 1987. p. 217–21.CrossRefGoogle Scholar
  23. 23.
    Panjabi MM, Oxland TR, Parks EH. Quantitative anatomy of cervical spine ligaments. Part I. Upper cervical spine. J Spinal Disord. 1991;4:270–6.PubMedGoogle Scholar
  24. 24.
    Dvorak J, Panjabi MM. Functional anatomy of the alar ligaments. Spine (Phila PA 1976). 1987;12:183–9.CrossRefGoogle Scholar
  25. 25.
    Sato K, Watanabe T, Yoshimoto T, et al. Magnetic resonance imaging of C2 segmental type of vertebral artery. Surg Neurol. 1994;41:45–51.CrossRefPubMedGoogle Scholar
  26. 26.
    Tokuda K, Miyasaka K, Abe H, et al. Anomalous atlantoaxial portions of vertebral and posterior inferior cerebellar arteries. Neuroradiology. 1985;27:410–3.CrossRefPubMedGoogle Scholar
  27. 27.
    White AA, Panjabi MM. Kinematics of the spine. In: Clinical biomechanics of the spine. 2nd ed. Philadelphia: J.B. Lippincott; 1990. p. 85–120.Google Scholar
  28. 28.
    Radcliff KE, Hussain MM, Moldavsky M, et al. In vitro biomechanics of the craniocervical junction-a sequential sectioning of its stabilizing structures. Spine J. 2015;15:1618–28.CrossRefPubMedGoogle Scholar
  29. 29.
    Dvorak J, Schneider E, Saldinger P, et al. Biomechanics of the craniocervical region: the alar and transverse ligaments. J Orthop Res. 1988;6:452–61.CrossRefPubMedGoogle Scholar
  30. 30.
    Henriques T, Cunningham BW, Olerud C, et al. Biomechanical comparison of five different atlantoaxial posterior fixation techniques. Spine (Phila PA 1976). 2000;25:2877–83.CrossRefGoogle Scholar
  31. 31.
    Harms J, Melcher RP. Posterior C1-C2 fusion with polyaxial screw and rod fixation. Spine (Phila PA 1976). 2001;26:2467–71.CrossRefGoogle Scholar
  32. 32.
    Puttlitz CM, Melcher RP, Kleinstueck FS, et al. Stability analysis of craniovertebral junction fixation techniques. J Bone Joint Surg Am. 2004;86-A:561–8.CrossRefPubMedGoogle Scholar
  33. 33.
    Lehman RA Jr, Dmitriev AE, Wilson KW. Biomechanical analysis of the C2 intralaminar fixation technique using a cross-link and offset connector for an unstable atlantoaxial joint. Spine J. 2012;12:151–6.CrossRefPubMedGoogle Scholar
  34. 34.
    Goel A, Kulkarni AG, Sharma P. Reduction of fixed atlantoaxial dislocation in 24 cases: technical note. J Neurosurg Spine. 2005;2:505–9.CrossRefPubMedGoogle Scholar
  35. 35.
    Li S, Ni B, Xie N, et al. Biomechanical evaluation of an atlantoaxial lateral mass fusion cage with C1-C2 pedicle fixation. Spine (Phila PA 1976). 2010;35:E624–32.CrossRefGoogle Scholar
  36. 36.
    Park J, Scheer JK, Lim TJ, et al. Biomechanical analysis of Goel technique for C1-2 fusion. J Neurosurg Spine. 2011;14:639–46.CrossRefPubMedGoogle Scholar
  37. 37.
    Robertson PA, Tsitsopoulos PP, Voronov LI, et al. Biomechanical investigation of a novel integrated device for intra-articular stabilization of the C1-C2 (atlantoaxial) joint. Spine J. 2012;12:136–42.CrossRefPubMedGoogle Scholar
  38. 38.
    Kim SM, Lim TJ, Paterno J, et al. Biomechanical comparison of anterior and posterior stabilization methods in atlantoaxial instability. J Neurosurg. 2004;100:277–83.PubMedGoogle Scholar
  39. 39.
    Ai FZ, Yin QS, DC X, et al. Transoral atlantoaxial reduction plate internal fixation with transoral transpedicular or articular mass screw of c2 for the treatment of irreducible atlantoaxial dislocation: two case reports. Spine (Phila PA 1976). 2011;36:E556–62.CrossRefGoogle Scholar
  40. 40.
    Xia H, Yin Q, Ai F, et al. Treatment of basilar invagination with atlantoaxial dislocation: atlantoaxial joint distraction and fixation with transoral atlantoaxial reduction plate (TARP) without odontoidectomy. Eur Spine J. 2014;23:1648–55.CrossRefPubMedGoogle Scholar
  41. 41.
    Zhang B, Liu H, Cai X, et al. Biomechanical comparison of modified TARP technique versus modified goel technique for the treatment of basilar invagination: a finite element analysis. Spine (Phila PA 1976). 2016;41:E459–66.CrossRefGoogle Scholar
  42. 42.
    Kasliwal MK, O’Toole JE. Integrated intervertebral device for anterior cervical fusion: an initial experience. J Craniovertebr Junction Spine. 2012;3:52–7.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Zhang BC, Liu HB, Cai XH, et al. Biomechanical comparison of a novel transoral atlantoaxial anchored cage with established fixation technique – a finite element analysis. BMC Musculoskelet Disord. 2015;16:261.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Hu Y, YJ G, He XF, et al. Biomechanical evaluation of stability and three-dimensional movements of the atlantoaxial joint after artificial atlanto-odontoid joint arthroplasty. Orthop Surg. 2010;2:111–8.CrossRefPubMedGoogle Scholar
  45. 45.
    Kato K, Yokoyama T, Ono A, et al. Novel motion preservation device for atlantoaxial instability. J Spinal Disord Tech. 2013;26:E107–11.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. and Shanghai Jiao Tong University Press 2018

Authors and Affiliations

  • Bin Ni
    • 1
  • Yuan Deng
    • 2
  1. 1.Department of OrthopedicsChangzheng HospitalShanghaiChina
  2. 2.Department of OrthopedicsGeneral Hospital of PLABeijingChina

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