ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2017
The feasibility of inserting a C1 pedicle screw in patients with ponticulus posticus: a retrospective analysis of eleven patients.
Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 1 of them a synthesis that pooled it.
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Who cites it
17 citing papers in PubMed, 1 synthesis or guideline pooled it, 27 citations in OpenAlex.
- Prevalence of Vertebral artery anomaly in upper cervical and its surgical implications: a systematic review.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2021Pooled it
- Microsurgical Unroofing to Secure a Safe Corridor for C1 Screws in Bilateral Ponticulus Posticus: A Case Report.Cureus · 2026Article
- C1 pedicle screw placement risks in patients with ponticulus posticus: a CTA retrospective simulation study.Journal of orthopaedic surgery and research · 2026Article
- Assessment of failure risks during C2 vertebra pedicle screw insertion using three-dimensional computed tomography angiography analysis: the role of high-riding vertebral artery and narrow pedicles.Surgical and radiologic anatomy : SRA · 2024Article
- Article
- Posterior hybrid surgery for atlantoaxial dislocation coexisting with multilevel cervical spondylotic myelopathy.Frontiers in surgery · 2023Article
- Torticollis, Facial Asymmetry, Local Pain, and Barré-Liéou Syndrome in Connection with One-Sided Ponticulus Posticus: A Case Report and Review of the Literature.Orthopaedic surgery · 2022Review
- Suitability of 3.5-mm screw for the atlas in children: a retrospective computed tomography analysis.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2022Article
- Research Progress of Ponticulus Posticus: A Narrative Literature Review.Frontiers in surgery · 2022Review
- Biomechanical Effects of Lateral Inclination COrthopaedic surgery · 2021Article
- Anatomical Variations of the Vertebral Artery: Analysis by Three-Dimensional Computed Tomography Angiography in Chinese Population.Orthopaedic surgery · 2021Observational
- Clinical Outcomes of Atlantoaxial Dislocation Combined with Osteoporosis Using Posterior Atlantoaxial Rod, Screw Fixation, and Posterior Interfacet Fusion: A Retrospective Study of 21 Cases.Medical science monitor : international medical journal of experimental and clinical research · 2020Article
- Occipitocervical Fusion via Cervical Pedicle Fixation Assisted with O-arm Navigation.Orthopaedic surgery · 2020Article
- Novel unilateral C1 double screw and ipsilateral C2 pedicle screw placement combined with contralateral laminar screw-rod fixation for atlantoaxial instability.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2019Article
- Computed tomographic morphometric analysis of lateral inclination C1 pedicle screw for atlantoaxial instability patients with a narrow C1 posterior arch.The Kaohsiung journal of medical sciences · 2018Article
- Acute headache attributed to whiplash in arcuate foramen and non-arcuate foramen subjects.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2017Article
- Quantitative analysis of unusual entrance of the vertebral artery into the cervical foramen (V2 segment) and its clinical implications.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2016Article
Corrections and comments
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Authors and funding
7 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPonticulus posticus is a common anatomic variation that can be mistaken for a broad posterior arch during C1 pedicle screw placement. When the atlas lateral mass screws are placed via the posterior arch, injury to the vertebral artery may result. To our knowledge, there are few clinical studies that have analyzed the feasibility of C1 pedicle screw fixation in patients with ponticulus posticus, in clinical practice. PURPOSE: To evaluate the feasibility of inserting a C1 pedicle screw in patients with ponticulus posticus.
methodsBetween January 2008 and January 2012, 11 consecutive patients with atlantoaxial instability, and with a ponticulus posticus at C1, underwent posterior fusion surgery in our institution. According to preoperative computed tomography (CT) reconstruction, a complete ponticulus posticus was found unilaterally in nine patients and bilaterally in two. Postoperative CT reconstructive imaging was performed to assess whether C1 pedicle screw placement was successful. Patients were followed up at regular intervals and evaluated for symptoms of ponticulus posticus syndrome.
resultsThirteen C1 pedicles (atlas vertebral artery groove), each with a complete ponticulus posticus, were successfully inserted with thirteen 3.5- or 4.0-mm diameter pedicle screws, without resection of the bony anomaly. No intraoperative complications (venous plexus, vertebral artery, or spinal cord injury) occurred. The mean follow-up period was 21 (range 14-30) months. Postoperative CT reconstructive images showed that all 13 pedicle screws were inserted in the C1 pedicles without destruction of the atlas pedicle cortical bone. In the follow-up period, none of the patients demonstrated clinical symptoms of ponticulus posticus syndrome or developed bone fusion.
conclusionThree-dimensional CT imaging should be considered prior to C1 pedicle screw fixation in patients with ponticulus posticus, to avoid mistaking the ponticulus posticus for a widened dorsal arch of the atlas. If there is no ponticulus posticus syndrome preoperatively, C1 pedicle screw fixation can be successfully performed without removing the bony anomaly.
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