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Anatomy and biomechanics of normal craniovertebral junction (a) and biomechanics of stabilization (b)

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Abstract

Introduction

A knowledge of the bony configuration, ligamentous attachments, joint articulations, vascular supply, muscle function, and lymphatic drainage as well as the kinetic anatomy of the craniocervical junction is necessary to understand the etiology of abnormalities in this area and their treatment.

Results and discussion

The craniovertebral junction (CVJ) is the most mobile of the upper cervical spine especially in children. It is uniquely adapted for stability and motion. The bony anatomy and the normal biomechanics of the CVJ in children are presented and subsequently the biomechanics of complex stabilization. Our review of more than 600 children who required stabilization is presented.

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References

  1. Aufdermaur M (1974) Spinal injuries in juveniles: necropsy findings in twelve cases. J Bone Joint Surg 56B:513–519

    CAS  Google Scholar 

  2. Bailey DK (1952) The normal cervical spine in infants and children. Radiology 59:712–719

    PubMed  CAS  Google Scholar 

  3. Bhatnagar M, Sponseller PD, Carroll C IV, Tolo VT (1991) Pediatric atlantoaxial instability presenting as cerebral and cerebellar infarcts. J Pediatr Orthop 11:103–107

    PubMed  CAS  Google Scholar 

  4. Blaw ME, Langer LO (1969) Spinal cord compression in Morquio–Brailsford’s syndrome. J Pediatr 74:593–600

    Article  PubMed  CAS  Google Scholar 

  5. Bonadio W (1993) Cervical spine trauma in children: Part 1. General concepts, normal anatomy, radiographic evaluation. Am J Emerg Med 11:158–165

    Article  PubMed  CAS  Google Scholar 

  6. Bonadio W (1993) Cervical spine trauma in children: Part 2. Mechanisms and manifestations of injury, therapeutic considerations. Am J Emerg Med 11:256–278

    Article  PubMed  CAS  Google Scholar 

  7. Brasch JC (1958) Cunningham’s manual of practical anatomy. Oxford University Press, London, pp 258–295

    Google Scholar 

  8. Calvy TM, Segall HD, Gilles FH, Bird CR, Zee CS, Ahmadi J, Biddle R (1987) CT anatomy of the craniovertebral junction in infants and children. Am J Neuroradiol 8(3):489–494

    PubMed  CAS  Google Scholar 

  9. Dickman CA, Crawford NR, Tominaga T, Brantley AG, Coons S, Sonntag VK (1994) Morphology and kinematics of the baboon upper cervical spine. A model of the atlantoaxial complex. Spine 19(22):2518–2523

    PubMed  CAS  Google Scholar 

  10. Dickman CA, Lekovic GP (2005) Biomechanical considerations for stabilization of the craniovertebral junction. Clin Neurosurg 52:205–213

    PubMed  Google Scholar 

  11. Fielding JW, Cochron GB, Lawsing JR III, Hohl M (1974) Tears of the transverse ligament of the atlas. A clinical and biomechanical study. J Bone Joint Surg (Am) 56:1683–1691

    CAS  Google Scholar 

  12. Fielding JW, Griffin PP (1974) Os odontoideum: An acquired lesion. J Bone Jt Surg Am 56:187–190

    CAS  Google Scholar 

  13. Gaskill SJ, Marlin AE (1990) Custom fitted thermoplastic Minerva jackets in the treatment of cervical spine instability in preschool age children. Pediatr Neurosurg 16:35–39

    Article  PubMed  Google Scholar 

  14. Gilles RH, Bina M, Sotrel A (1979) Infantile atlanto-occipital instability: The potential danger of extreme extension. Am J Disabled Child 133:30–37

    CAS  Google Scholar 

  15. Gladstone J, Erickson-Powell W (1914–1915) Manifestation of occipital vertebra and fusion of atlas with occipital bone. J Anat Physiol 49:190–199

    Google Scholar 

  16. Glasauer FE, Cares HL (1973) Biomechanical features of traumatic paraplegia in infancy. J Trauma 13:166–170

    PubMed  CAS  Google Scholar 

  17. Godersky JC, Menezes AH (1989) Optimal management for children with spinal cord injury. Contemp Neurosurg 11:1–6

    Google Scholar 

  18. Goel VK, Clark CR, Gallaes K, Liu YK (1988) Movement–rotation relationships of the ligamentous occipito-atlanto-axial complex. J Biomech 21(8):678

    Article  Google Scholar 

  19. Grisel P (1930) Enucleation des l’atlas et torticollis nasopharyngien. Presse Med 38:50

    Google Scholar 

  20. Grob D, Crisco JJ III, Panjabi MM, Wang P, Dvorak J (1992) Biomechanical evaluation of four different posterior atlantoaxial fixation techniques. Spine 17(5):480–490

    Article  PubMed  CAS  Google Scholar 

  21. Hadley MN, Rauzzino MJ (1996) Pediatric spinal cord injuries. In: Menezes AH, Sonntag VKH (eds) Principles of spinal surgery. McGraw-Hill, New York, pp 817–840

    Google Scholar 

  22. Hanley EN Jr, Harvell JC Jr (1992) Immediate postoperative stability of the atlantoaxial articulation: A biomechanical study comparing simple midline wiring, and the Gallie and Brooks procedures. J Spinal Disord 5(3):306–310

    PubMed  Google Scholar 

  23. Hanson PB, Montesano PX, Sharkey NA, Rauschning W (1991) Anatomic and biomechanical assessment of transarticular screw fixation for atlantoaxial instability. Spine 16(10):1141–1145

    Article  PubMed  CAS  Google Scholar 

  24. Hawkins RJ, Fielding JW, Thompson WJ (1976) Os odontoideum. Congenital or acquired. J Bone Jt Surg Am 58:413

    CAS  Google Scholar 

  25. Jirout J (1973) Changes in the atlas-axis relations on lateral flexion of the head and neck. Neuroradiology 6:215

    Article  PubMed  CAS  Google Scholar 

  26. Johnson MH, Smoker WR (1994) Lesions of the craniovertebral junction. Neuroimag Clin North Am 4(3):599–617

    CAS  Google Scholar 

  27. Krakenes J, Kaale BR, Rorvik J, Gilhus NE (2001) MRI assessment of normal ligamentous structures in the craniovertebral junction. Neuroradiology 43:1089–1097

    Article  PubMed  CAS  Google Scholar 

  28. Krakenes J, Kaale BR, Moen G, Nordli H, Gilhaus NE, Rorvik J (2003) MRI of the tectorial and posterior atlanto-occipital membranes in the late stage of whiplash injury. Neuroradiology 45(9):585–591

    Article  PubMed  CAS  Google Scholar 

  29. Lufkin T, Mark M, Hart CP, Dollé P, LeMeur M, Chambron P (1992) Homeotic transformation of the occipital bones of the skull by ectopic expression of a homeobox gene. Nature 359:835–841

    Article  PubMed  CAS  Google Scholar 

  30. Mandabach M, Ruge JR, Hahn YS, McLone DG (1993) Pediatric axis fractures: Early HALO immobilization, management and outcome. Pediatr Neurosurg 19:225–232

    Article  PubMed  CAS  Google Scholar 

  31. Menezes AH (1988) Os odontoideum-pathogenesis, dynamics and management. In: Marlin AE (ed) Concepts in pediatric neurosurgery. Karger, Switzerland, pp 133–145

    Google Scholar 

  32. Menezes AH, Muhonen M (1990) Management of occipitocervical instability. In: Cooper P (ed) Management of posttraumatic spinal instability. AANS, Park Ridge, IL, pp 65–76

    Google Scholar 

  33. Menezes AH (1995) Congenital and acquired abnormalities of the craniovertebral junction (Children and Adults). In: Youmans J (ed) Neurological surgery, 4th edn. Saunders, Philadelphia, pp 1035–1089

    Google Scholar 

  34. Menezes AH (2003) Developmental abnormalities of the craniocervical junction. In: Winn RH (ed) Youmans neurological surgery. Saunders, Orlando, pp 3331–3345

    Google Scholar 

  35. Mitchie I, Clark M (1968) Neurological syndromes associated with cervical and craniocervical anomalies. Arch Neurol 18:241

    Google Scholar 

  36. Mubarack SJ, Camp JF, Vuletich RF, Wenger DR, Garfin SR (1989) Halo application in the infant. J Pediatr Orthop 9:612–615

    Google Scholar 

  37. Osenbach RK, Menezes AH (1989) Spinal cord injury without radiographic abnormality in children. Pediatr Neurosci 15:168–175

    Article  PubMed  CAS  Google Scholar 

  38. Osenbach RK, Menezes AH (1992) Pediatric spinal cord and vertebral column injury. Neurosurgery 30:385–390

    PubMed  CAS  Google Scholar 

  39. Panjabi MM, Dvorák J, Duranceau J, Yamamoto I, Gerber M, Rauschning W, Bueff HV (1988) Three-dimensional movements of the upper cervical spine. Spine 13(7):726–730

    Article  PubMed  CAS  Google Scholar 

  40. Panjabi MM, Dvorák J, Crisco JJ III, Oda T, Wang P, Grob D (1991) Flexion, extension and lateral bending of the upper cervical spine in response to alar ligament transactions. J Spinal Disord 4(2):157–167

    Article  PubMed  CAS  Google Scholar 

  41. Pappas CT, Rekate HL (1988) Role of magnetic resonance imaging and three-dimensional computerized tomography in craniovertebral junction anomalies. Pediatr Neurosci 14(1):18–22

    Article  PubMed  CAS  Google Scholar 

  42. Parke WW (1978) The vascular relations of the upper cervical vertebrae. Orthop Clin North Am 9(4):879–889

    PubMed  CAS  Google Scholar 

  43. Parke WW, Rothman RH, Brown MD (1984) The pharyngovertebral veins. An anatomical rationale for Grisel’s syndrome. J Bone Jt Surg Am 66:568

    CAS  Google Scholar 

  44. Penning L (1981) Prevertebral hematoma in cervical spine injuries. Am J Roentgenol 136:553–557

    CAS  Google Scholar 

  45. Puttlitz CM, Goel VK, Clark CR, Traynelis VC, Scifert JL, Grosland NM (2000) Biomechanical rationale for the pathology of rheumatoid arthritis in the craniovertebral junction. Spine 25(13):1607–1616

    Article  PubMed  CAS  Google Scholar 

  46. Puttlitz CM, Goel VK, Traynelis VC, Clark CR (2001) A finite element investigation of upper cervical instrumentation. Spine 26(22):2449–2455

    Article  PubMed  CAS  Google Scholar 

  47. Puttlitz CM, Melcher RP, Kleinstueck FS, Harms J, Bradford DS, Lotz JC (2004) Stability analysis of craniovertebral junction fixation techniques. J Bone Jt Surg Am 86:561–568

    Google Scholar 

  48. Rhoton AL Jr (2000) The foramen magnum. Neurosurgery 47(3 Suppl):S155–S193

    Article  PubMed  Google Scholar 

  49. Ruge JR, Sinson GP, McLone DM, Cerullo LJ (1988) Pediatric spinal injury: the very young. J Neurosurg 68:25–30

    PubMed  CAS  Google Scholar 

  50. Schiff DCM, Parke WW (1972) The arterial supply of the odontoid process (dens). Anat Rec 172:399–400

    Google Scholar 

  51. Selecki BR (1969) The effects of rotation of the atlas on the axis: Experimental work. Med J Aust 1:1012

    PubMed  CAS  Google Scholar 

  52. Smoker WR, Keyes WD, Dunn VD, Menezes AH (1986) MRI versus conventional Radiologic examinations in the evaluation of the craniovertebral and cervicomedullary junction. Radiographics 6(6):953–994

    PubMed  CAS  Google Scholar 

  53. Stevens JM, Chong WK, Barber C, Kendall BE, Crockard HA (1994) A new appraisal of abnormalities of the odontoid process associated with atlantoaxial subluxation and neurological disability. Brain 117(Pt 1):133–148

    Article  PubMed  Google Scholar 

  54. Taylor AR, Byrnes DP (1974) Foramen magnum and high cervical cord compression. Brain 97:473

    Article  PubMed  CAS  Google Scholar 

  55. VanGilder JC, Menezes AH, Dolan K (1987) The craniovertebral junction and its abnormalities. Futura, New York, pp 1–255

    Google Scholar 

  56. VonTorklus D, Gehle W (1972) The upper cervical spine: Regional anatomy, pathology and traumatology. In: Verlag GT (ed) Systemic radiological atlas and textbook. Grune & Stratton, New York, pp 1–99

    Google Scholar 

  57. Werne S (1957) The craniovertebral joints. Acta Orthop Scand 23(Suppl):150

    Google Scholar 

  58. Werne S (1957) Studies in spontaneous atlas dislocation. The craniovertebral joints. Acta Orthop Scand 23(Suppl):11–83

    Google Scholar 

  59. White AA III, Panjabi MM (1978) The clinical biomechanics of the occipitoatlantoaxial complex. Orthop Clin North Am 9(4):867–878

    PubMed  Google Scholar 

  60. Yuksel M, Heiserman JE, Sonntag VKH (2006) Magnetic resonance imaging of the craniocervical junction at 3-T: Observation of the accessory atlantoaxial ligaments. Neurosurgery 59:888–893

    Article  PubMed  Google Scholar 

  61. Gallie WF (1939) Fractures and dislocations of the cervical spine. Am J Surg 46:495

    Article  Google Scholar 

  62. Brooks AL, Jenkins EB (1978) Atlanto-axial arthrodesis by the wedge compression method. J Bone Jt Surg 60A:279

    Google Scholar 

  63. Papadopoulos SM, Dickman CA, Sonntag VK (1991) Atlantoaxial stabilization in rheumatoid arthritis. J Neurosurg 74:1

    Article  PubMed  CAS  Google Scholar 

  64. Hanley EN, Harvell JC (1992) Immediate postoperative stability of atlantoaxial articulation: a biomechanical study comparing simple midline wiring and the Gallie and Brooks procedures. J Spinal Disord 5:306

    PubMed  Google Scholar 

  65. Grob D, Crisco JJ, Panjabi MM (1992) Biomechanical evaluation of four different atlantoaxial fixation techniques. Spine 17:480

    Article  PubMed  CAS  Google Scholar 

  66. Menezes AH, Ryken TC (1994) Instrumentation of the craniocervical region. In: Benzel EC (ed) Spinal instrumentation (AANS Neurosurgical Topics). Williams and Wilkins, Baltimore, p 47

    Google Scholar 

  67. Hanson PB, Montesano PX, Sharkey NA, Rauschning W (1991) Anatomic and biomechanical assessment of transarticular screw fixation for atlantoaxial instability. Spine 16:1141

    Article  PubMed  CAS  Google Scholar 

  68. Dickman CA, Crawford NR, Paramore CG (1996) Biomechanical characteristics of C1–C2 cable fixations. J Neurosurg 85:316–322

    PubMed  CAS  Google Scholar 

  69. Puttlitz CM, Goel VK, Traynelis VC, Clark CR (2001) A finite element investigation of upper cervical instrumentation. Spine 26(22):2449–2455

    Article  PubMed  CAS  Google Scholar 

  70. Melcher RP, Puttlitz CM, Kleinstueck FS, Lotz JC, Harms J Bradford DS (2002) Biomechanical testing of posterior atlantoaxial fixation techniques. Spine 27:2435–2440

    Article  PubMed  Google Scholar 

  71. Gorek J, Acaroglu E, Berven S, Yousef A, Puttlitz CM (2005) Constructs incorporating intralaminar C2 screws provide rigid stability for atlantoaxial fixation. Spine 30:1513–1518

    Article  PubMed  Google Scholar 

  72. Oda I, Abumi K, Sell LC, Haggerty CJ, Cunningham BW, McAfee PC (1999) Biomechanical evaluation of five different occipito-atlanto-axial fixation techniques. Spine 24:2377–2382

    Article  PubMed  CAS  Google Scholar 

  73. Hurlbert RJ, Crawford NR, Choi WG, Dickman CA (1999) A biomechanical evaluation of occipitocervical instrumentation: screw compared with wire fixation. J Neurosurg 90:84–90

    PubMed  CAS  Google Scholar 

  74. Sutterlin CE, Bianchi JR, Kunz DN, Zdeblick TA, Johnson WM, Rapoff AJ (2001) Biomechanical evaluation of occipitocervical fixation devices. J Spinal Dis 14:185–192

    Article  Google Scholar 

  75. Currier BL, Papagelopoulos PJ, Neale PG, Andreshak JL, Hokari Y, Berglund LJ, Larson DR, Fisher DR, An K (2003) Biomechanical evaluation of new posterior occipitocervical instrumentation system. Clin Orthop Rel Res 411:103–115

    Article  Google Scholar 

  76. Stock GH, Vaccaro AR, Brown AK, Anderson PA (2006) Contemporary posterior occipital fixation. J Bone Jt Surg Am 88:1642–1649

    Google Scholar 

  77. Doherty BJ, Heggeness MH, Esses SI (1993) A biomechanical study of odontoid fractures and fracture fixation. Spine 18:178

    Article  PubMed  CAS  Google Scholar 

  78. Sasso BC, Heggeness MH, Doherty BJ (1992) Biomechanics of odontoid fracture fixation: a comparison of one and two screw technique. Cervical Spine Research Society Abstracts, p 61

  79. Montesano PX, Anderson PA, Schlehr F, Thalgott JS, Lowrey G (1991) Odontoid fractures treated by anterior odontoid screw fixation. Spine 16:S33

    Article  PubMed  CAS  Google Scholar 

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  1. Department of Neurosurgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 1824 JPP, Iowa City, IA, 52242, USA

    Arnold H. Menezes & Vincent C. Traynelis

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  1. Arnold H. Menezes
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  2. Vincent C. Traynelis
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Correspondence to Arnold H. Menezes.

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Menezes, A.H., Traynelis, V.C. Anatomy and biomechanics of normal craniovertebral junction (a) and biomechanics of stabilization (b). Childs Nerv Syst 24, 1091–1100 (2008). https://doi.org/10.1007/s00381-008-0606-8

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