The atlanto-occipital joint: a concise review of its anatomy and injury

Abstract

The atlanto-occipital joint (AOJ) is an important transitional region, which supports and stabilizes the cranium to the spine

with its surrounding ligamentous structures. An injury to this joint is often accompanied by brain injury and may be fatal. A

good understanding of the anatomy of this joint is required to timely diagnose an AOJ instability and intervene via the means

of an immediate fixation. We discuss the normal anatomy of and anatomical variations within the occipito-atlantoaxial complex,

the classification systems to describe its disruption, and its clinical significance.

Keywords

• anatomy; craniocervical junction; injury; ligaments; trauma

References

1. 1. Bucholz RW, Burkhead WZ, Graham W, Petty C. Occult cervical spine injuries in fatal traffic accidents. J Trauma 1979;19:768–71.
2. 2. Netter F. Atlas of human anatomy. 6th ed. Philadelphia (PA), USA: Saunders; 2014.
3. 3. Naderi S, Korman E, Citak G, Güvençer M, Arman C, Seno¤lu M, Tetik S, Arda MN. Morphometric analysis of human occipital condyle. Clin Neurol Neurosurg 2005;107:191–9.
4. 4. Kandziora F, Schulze-Stahl N, Khodadadyan-Klostermann C, Schröder R, Mittlmeier T. Screw placement in transoral atlantoaxial plate systems: an anatomical study. J Neurosurg 2001;95(1 Suppl):80–7.
5. 5. Tubbs RS, Hallock JD, Radcliff V, Naftel RP, Mortazavi M, Shoja MM, Salter EG, Acakpo-Satchivi L, Wellons JC 3rd, Blount JP, Oakes WJ. Ligaments of the craniocervical junction. J Neurosurg Spine 2011;14:697–709.
6. 6. O'Rahilly R, Meyer DB. The timing and sequence of events in the development of the human vertebral column during the embryonic period proper. Anat Embryol (Berl) 1979;157:167–76.
7. 7. Hall GC, Kinsman MJ, Nazar RG, Hruska RT, Mansfield KJ, Boakye M, Rahme R. Atlanto-occipital dislocation. World J Orthop 2015;6:236–43.
8. 8. Tubbs RS, Kelly DR, Humphrey ER, Chua GD, Shoja MM, Salter EG, Acakpo-Satchivi L, Wellons JC 3rd, Blount JP, Oakes WJ. The tectorial membrane: anatomical, biomechanical, and histological analysis. Clin Anat 2007;20:382–6.

9. 9. Tubbs RS, Stetler W, Shoja MM, Loukas M, Hansasuta A, Liechty P, Acakpo-Satchivi L, Wellons JC, Blount JP, Salter EG, Oakes WJ. The lateral atlantooccipital ligament. Surg Radiol Anat 2007;29:219– 23.
10. 10. Iwanaga J, Sardi J, Voin V, Chapman JR, Oskouian RJ, Tubbs RS. Anatomy of alar ligament part I: morphometrics and variants. World Neurosurg 2017;107:1001–6.
11. 11. Labler L, Eid K, Platz A, Trentz O, Kossmann T. Atlanto-occipital dislocation: four case reports of survival in adults and review of the literature. Eur Spine J 2004;13:172–80.
12. 12. Horn EM, Feiz-Erfan I, Lekovic GP, Dickman CA, Sonntag VK, Theodore N. Survivors of occipitoatlantal dislocation injuries: imaging and clinical correlates. J Neurosurg Spine 2007;6:113–20.
13. 13. Traynelis VC, Marano GD, Dunker RO, Kaufman HH. Traumatic atlanto-occipital dislocation. Case report. J Neurosurg 1986;65:863– 70.
14. 14. Harris JH, Carson GC, Wagner LK, Kerr N. Radiologic diagnosis of traumatic occipitovertebral dissociation: 2. Comparison of three methods of detecting occipitovertebral relationships on lateral radiographs of supine subjects. AJR Am J Roentgenol 1994;162:887–92.
15. 15. Dahdaleh NS, Khanna R, Menezes AH, Smith ZA, Viljoen SV, Koski TR, Hitchon PW, Dlouhy BJ. The application of the revised condyle-C1 interval method to diagnose traumatic atlanto-occipital dissociation in adults. Global Spine J 2016;6:529–34.
16. 16. Anderson PA, Montesano PX. Morphology and treatment of occipital condyle fractures. Spine (Phila Pa 1976) 1988;13:731–6.
17. 17. Tuli S, Tator CH, Fehlings MG, Mackay M. Occipital condyle fractures. Neurosurgery 1997;41:368–76.