Article
Anatomical data of the craniocervical junction and their correlation with degenerative changes in 30 specimens
Anatomische Charakteristika des kraniozervikalen Übergangs im Zusammenhang mit degenerativen Veränderungen in 30 Präparaten
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Published: | May 4, 2005 |
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Outline
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Objective
Measurement of vertebral dimensions at the craniocervical junction as well as investigations of degenerative changes and their correlation with anatomical data are of special interest for the understanding of the biomechanical conditions because of the clinical relevance of this region in cases of cervicogenic headaches and vertigo.
Methods
30 cadaveric specimens were examined (age 24 to 88 years). Angle measurements were done by an imprint method. Microsections of the bony endplates and the articular cartilage were assessed regarding the degree of degeneration. Therefor we used the Grading of Peterson.
Results
C0 articular cartilage: grade I changes in 100%. Superior articular cartilage of C1: grade 0 in 2 cases, grade II in 6%, 89% grade I. Inferior articular cartilage of C1: 57% grade I changes, 14% grade II, and 20% grade III. Superior articular cartilage of C2: 62.5% grade I changes, 25% grade II. In C0/C1 we found a higher frequence of degeneration at the left upper articular surface of the atlas (quadrants 1 and 3). At C1/C2 there was a higher frequence of degeneration at the left upper articular surface of the axis (quadrant 2) as well as at the right upper articular surface of the axis (quadrant 3). With the McNemar test we investigated the frequence of affection of single quadrants in a left-right comparison (laterally reversed). Significant differences were found for quadrant 2 of the left upper articular surface of C2 and quadrant 3 of the right upper articular surface of C2. These results correlate with the analysis for single articular surfaces of the axis. This is contrary to the results for the atlas showing no significant differences in the left-right comparison.
Conclusions
Severe degenerative changes in the atlanto-occipital joint seem to be a rare condition with no grade II or grade III changes of the occipital condyles and with 6% grade I degeneration, 89% grade II degeneration but no grade III degeneration of the superior articular cartilage of atlas. Degeneration of the inferior articular cartilage of atlas and of the superior articular cartilage of axis suggest that the atlanto-axial joint is under a more intense mechanical exposure with accentuation of upper joint surfaces. Beside the different patterns of mechanical exposure asymmetric facet joints have been described as a reason of accelerated degeneration of the spine.