The effect of translation of the C1-C2 on the spinal canal

The stability of the atlantoaxial articulation depends fundamentally on the integrity of the odontoid process and the ligaments. Ligament stability mostly is maintained by two ligaments: the transverse ligament and the alar, apical ligaments. Failure of the transverse ligament can result in anterior translation of the atlas on the axis. The anteroposterior diameter of the ring of the atlas is approximately 3 cm. The spinal cord and the odontoid process are each approximately 1 cm in diameter, approximately 1/3 the diameter of the ring. According to Steel's rule of thirds, the remaining centimeter of free space allows for some degree of pathologic displacement. The current anatomic study showed that the space available for the spinal cord was limited. The sagittal diameter C1-C2 canal is 18.71 +/- 2.88 mm (excluding 10 mm thickness of the dens and 2.91 +/- 0.69 mm thickness of transverse ligament), with the spinal cord occupying 7.73 +/- 0.87 mm of the available space. Space available for spinal cord at the level of the atlas is 3.44 +/- 1.19 mm plus 1.01 +/- 0.20 mm space anterior to the cord (anterior epidural space) and 5.64 +/- 2.22 mm space posterior to the cord (posterior epidural space), which is approximately in agreement with the normal diameter by Steel's rule of thirds.