International Journal of Anatomy and Research



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Type of Article: Original Research

Year: 2015 | Volume 3 | Issue 4 | Page No. 1597-1602

Date of Publication: 30-11-2015

DOI: http://dx.doi.org/10.16965/ijar.2015.296


A MORPHOLOGICAL STUDY OF PONTICULI OF THE HUMAN ATLAS VERTEBRAE AND ITS CLINICAL SIGNIFICANCE

Md. Jawed Akhtar *1, Nasreen Fatima 2, Ritu 3, Vinod Kumar 4.

*1 Senior Resident, Department of Anatomy, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India.

2 Senior Resident, Department of Anaesthesiology, All India Institute of Medical Sciences, Patna, Bihar, India.

3 Senior Resident, Department of Forensic Medicine & Toxicology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India.

4 Head of Department, Department of Anatomy, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India.

Address: Md. Jawed Akhtar, Senior Resident, Department of Anatomy, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India.
E-Mail: drjawedakhtarpmch@gmail.com

Abstract

BACKGROUND: The first cervical vertebra, atlas play an vital role in movement of the 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 unilateral 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.
KEY WORDS: Ponticulus Posterior, Ponticulus Lateralis, Arcuate Foramen, Atlas Vertebra.

References

  1. Last RJ: In Anatomy Regional and applied. 11th Ed. J and A Churchill Ltd. London. 2006;  pp. 443.
  2. Richard LM Newell. “The Back” in Grays Anatomy: The Anatomical Basis of Clinical Practices, S. Standring, H. Ellis, J. C. Healy, D. Jhonson and A. Williams, Eds.; Churchill Livingtone, New York, NY, USA, 40th ed, 2008, pp. 720.
  3. Tubbs RS, Johnson PC, Shoja MM, Loukas M, Oakes WJ, Foramen arcuale: Anatomical study and review of the literature. J Neurosurg Spine. 2007;6(1):31–34.
  4. Taitz C and Nathan H. Some observations on the posterior and lateral bridge of the atlas. Acta Anatomica. 1986;127(3):212-217.
  5. Mehalic T, Farhat SM. Vertebral artery injury from chiropractic manipulation of the neck. Surgical Neurology. 1974;2:125-129.
  6. Sylvia S, Kulkarni S, Hatti A. Bilateral Retro Articular ring in Atlas vertebra – A Case Report. Anatomica Karnataka. 2011;5(1):81-86.
  7. Karau PB, Ogeng’o JA, Hassanali J, Odula PO. Morphometry and Variations of Bony Ponticles of the Atlas Vertebrae (C1) in Kenyans. Int J of Morphology. 2010;28(4):1019-1024.
  8. Lamberty BGH, Zivanovic S.  The Retro-articular vertebral artery ring of the atlas and its significance. Acta Anat. 1973;85:113-122.
  9. Mitchel J. The incidence of the lateral bridge of the atlas vertebra. J of Anat 1998b;193: 283-285.
  10. Dhall U, Chhabra S, Dhall JC. Bilateral asymmetry in bridges and superior articular facets of atlas vertebra. J Anat Soc. India. 1993;42(1):23-27.
  11. Mitchell J. The incidence and dimensions of the retroarticular canal of the atlas vertebra. Acta Anatomica. 1998;163:113–120.
  12. Hasan M, Shukla S, Siddiqui MS, Singh D. Posterolateral tunnels and ponticuli in human atlas vertebrae. J. Anat 2001;199:339-343.
  13. Kavakli A, Aydinlioglu,Yesilyurt H, Kus I, Diyarbakirli, Erdem S et al. Variants and deformities of atlas vertebrae in eastern Anatolian people. Saudi Med J. 2004;25(3): 322-325.
  14. Cakmak O, Gurdal E, Ekinci G, Yildiz E, Cavdar S. Arcuate foramen and its clinical significance. Saudi Med J. 2005;26:1409-1413.
  15. Paraskevas G, Papaziogas B, Tsonidis C & Kapetanos G. Gross morphology of the bridges over the vertebral artery groove on the atlas. Surg. Radiol. Anat. 2005;27(2):129-136.
  16. Krishnamurthy A, Nayak SR, Khan S, Prabhu Latha V, Ramanathan LA, Kumar CG, et al. Arcuate foramen of atlas: Incidence, Phylogenetic and Clinical significance. Romanian J of Morphol and Embryol. 2007;48(3):263-266.
  17. Simsek S, Yigitkanli K. Posterior osseous bridging of C1. J Clin Neurosci. 2008;15:686–688.
  18. Dahiphale VP, Bahetee BH. The retroarticular vertebral artery ring of the atlas and its significance. J Anat Soc. India. 2009;58:149-151.
  19. Zambare BR, Reddy BB. The retroarticular ring of the atlas and its clinical significance. Anatomica Karnatka. 2011;5(2):74-76.
  20. Gupta C, Radhakrishnan P, Palimar V, D”souza AS, Kiruba NL. A quantitative analysis of atlas vertebrae and its abnormalities. J Mophol Sci. 2013;30(2):77-81.
  21. Lalit M, Pilani S, Arora AK, Kullar JS, Sharma T. Incidence of atlas bridges and tunnels: Their phylogeny, ontogeny and clinical implications. Rev Arg de Anat Clin. 2014;6(1):26-34.
  22. Kendrick GA, Biggs NL. Incidence of the ponticulus posticus of the first cervical vertebra between  ages six to seventeen. Anatomical Record. 1963; 145:449-451.
  23. Stubbs DM. The arcuate foramen. Variability in distribution related to race and sex. Spine. 1992;17(12):1502-1504.
  24. Yamamoto A, Kunimatsu Y. Ontogenetic change and geographical variation of atlas bridging in Japanese macaques (Macaca fuscata). Anthropological Science. 2006; 114(2):153-160.
  25. Unur E, Erdogan N, Ulger H, Ekinci N, Ozturk O. Radiographic incidence of complete arcuate foramen in Turkish population. Erciyes Med J. 2004:26(2):50–54.
  26. Cushing KE, Ramesh V, Gardner Medwin D, Todd NV, Gholkar A, Baxter P, Griffiths PD. Tethering of the vertebral artery in the congenital arcuate foramen of the atlas vertebra: a possible cause of vertebral artery dissection in children. Dev Med Child Neurol. 2001;43(7):491–496.

 

Md. Jawed Akhtar, Nasreen Fatima, Ritu, Vinod Kumar. A MORPHOLOGICAL STUDY OF PONTICULI OF THE HUMAN ATLAS VERTEBRAE AND ITS CLINICAL SIGNIFICANCE. Int J Anat Res 2015;3(4):1597-1602. DOI: 10.16965/ijar.2015.296

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