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Related Concept Videos

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In addition to being held together by the intervertebral discs, adjacent vertebrae also articulate with each other at synovial joints formed between the superior and inferior articular processes called zygapophysial joints (facet joints). These are plane joints that provide for only limited motions between the vertebrae. The orientation of the articular processes at these joints varies in different regions of the vertebral column and serves to determine the types of motions available in each...
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Unsymmetrical bending occurs when the bending moment applied to a structural member does not align with its principal axis. This misalignment leads to complex stress distributions and deflection patterns that differ from symmetrical bending, which are essential for designing structures to withstand different loading conditions.
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Unstable Upper Cervical Spine Injury with Concomitant Bilateral Ponticulus Posticus: A Case Report.

Masashi Fujisawa1, Sota Wakahara1, Joji Inamasu1

  • 1Department of Neurosurgery, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan.

Asian Journal of Neurosurgery
|August 25, 2025
PubMed
Summary

Ponticulus posticus (PP) presents surgical challenges for upper cervical spine injuries. Alternative fixation methods, avoiding C1 lateral mass screws, are crucial to prevent vertebral artery injury.

Keywords:
arcuate foramenlateral mass screwponticulus posticusupper cervical spine injuryvertebral artery

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Area of Science:

  • Neurosurgery
  • Orthopedic Surgery
  • Anatomy

Background:

  • Ponticulus posticus (PP), an anatomical variation of the atlas (C1), involves ossification of the posterior atlanto-occipital membrane.
  • The V3 segment of the vertebral artery (VA) traverses this foramen, posing a risk during C1 lateral mass screw placement.

Observation:

  • A 70-year-old male with an unstable upper cervical spine injury (traumatic C2 spondylolisthesis and C3-4 facet dislocation) presented with bilateral PP.
  • Preoperative imaging confirmed bilateral PP, necessitating modification of the planned posterior fixation surgery.

Findings:

  • The surgical team abandoned the standard C1 lateral mass screw fixation due to the presence of bilateral PP.
  • An alternative fixation strategy was successfully employed, utilizing a laminar hook on one side and a C1 posterior arch screw on the other.

Implications:

  • This case highlights the importance of tailoring surgical fixation techniques for upper cervical spine instability in patients with PP.
  • Careful preoperative assessment and individualized surgical planning are essential to mitigate the risk of vertebral artery injury in such cases.