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Kayalar AE, Yaltırık CK, Kalyoncu E, Bolat B, Temiztas BA, Etli MU, Çalışaneller AT, Naderi S. Maximum Safety Limits of Laminectomy of the C1 Vertebra for Chiari Malformation Surgery: A Finite Element Analysis. Indian J Orthop 2023; 57:884-890. [PMID: 37214376 PMCID: PMC10192479 DOI: 10.1007/s43465-023-00870-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 03/10/2023] [Indexed: 05/24/2023]
Abstract
Background The treatment of Chiari malformations generally consists of posterior fossa decompression. C1 laminectomy is required in selected cases. However, cases of iatrogenic anterior arch fractures at C1 without high-energy trauma have been reported. Developing theoretical models of atlas C1 bones that have undergone a laminectomy can help researchers identify the regions where fractures may occur as a result of sudden loads. Methods In this study, we created a detailed three-dimensional solid finite element model of the human atlas bone (C1) using geometric data. The loadings of the laminectomy dimension were evaluated on the basis of three groups. Group I comprised atlas bones that had not undergone a laminectomy. For Group II, the lateral border of the laminectomy was determined as the projection of the lateral mass medial border on the lamina. For Group III, the bilateral sulcus arteriosus was determined as the border for the lateral border of the laminectomy. The analysis results, which are in good agreement with those of previous reports, showed high concentrations of localized stress in the anterior and posterior arches of the atlas bone. Results The analysis results showed that the stress increased in the laminectomy models. The maximum stress observed was consistent with the clinical observations of fracture sites in previous studies. Conclusion In the treatment of patients with Chiari malformations, C1 laminectomy is often required. The width of this laminectomy can lead to iatrogenic anterior arch fractures. This is the first study to evaluate C1 laminectomy width using finite element modeling.
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Affiliation(s)
- Ali Erhan Kayalar
- Department of Neurosurgery, Health Sciences University, Haydarpasa Training and Research Hospital, Uskudar, Istanbul, Turkey
| | - Cumhur Kaan Yaltırık
- Department of Neurosurgery, Health Sciences University, Umraniye Training and Research Hospital, Umraniye, Istanbul, Turkey
| | - Enes Kalyoncu
- Department of Machinery, Istanbul Gelisim Vocational School, Istanbul, Turkey
| | - Berna Bolat
- Faculty of Mechanical Engineering, Yıldız Technical University, Istanbul, Turkey
| | | | - Mustafa Umut Etli
- Department of Neurosurgery, Siverek State Hospital, Şanlıurfa, Turkey
| | - Arif Tarkan Çalışaneller
- Department of Neurosurgery, Health Sciences University, Haydarpasa Training and Research Hospital, Uskudar, Istanbul, Turkey
| | - Sait Naderi
- Department of Neurosurgery, İstanbul Brain and Spine Center, Istanbul, Turkey
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Palancar CA, García-Martínez D, Radovčić D, Llidó S, Mata-Escolano F, Bastir M, Sanchis-Gimeno JA. Krapina atlases suggest a high prevalence of anatomical variations in the first cervical vertebra of Neanderthals. J Anat 2020; 237:579-586. [PMID: 32436615 DOI: 10.1111/joa.13215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/26/2020] [Accepted: 04/20/2020] [Indexed: 01/22/2023] Open
Abstract
The first cervical vertebra, atlas, and its anatomical variants have been widely studied in Homo sapiens. However, in Neanderthals, the presence of anatomical variants of the atlas has been very little studied until very recently. Only the Neanderthal group from the El Sidrón site (Spain) has been analysed with regard to the anatomical variants of the atlas. A high prevalence of anatomical variants has been described in this sample, which points to low genetic diversity in this Neanderthal group. Even so, the high prevalence of anatomical variations detected in El Sidrón Neanderthal atlases needs to be confirmed by analysing more Neanderthal remains. In this context, we analysed the possible presence of anatomical variants in the three Neanderthal atlases recovered from the Krapina site (Croatia) within the Neanderthal lineage. Two of the three Krapina atlases presented anatomical variations. One atlas (Krapina 98) had an unclosed transverse foramen and the other (Krapina 99) presented a non-fused anterior atlas arch. Moreover, an extended review of the bibliography also showed these anatomical variations in other Middle and Upper Pleistocene hominins, leading us to hypothesise that anatomical variations of the atlas had a higher prevalence in extinct hominins than in modern humans.
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Affiliation(s)
- Carlos A Palancar
- Department of Paleobiology, Paleoanthropology Group, Museo Nacional de Ciencias Naturales (CSIC), Madrid, Spain.,Department of Palaeontology, Faculty of Geology, Universidad Complutense de Madrid, Madrid, Spain.,Department of Biology, Faculty of Sciences, Universidad Autónoma de Madrid, Madrid, Spain
| | - Daniel García-Martínez
- Department of Paleobiology, Paleoanthropology Group, Museo Nacional de Ciencias Naturales (CSIC), Madrid, Spain.,Centro Nacional de Investigación sobre la Evolución Humana, Burgos, Spain
| | - Davorka Radovčić
- Department of Geology and Paleontology, Croatian Natural History Museum, Zagreb, Croatia
| | - Susanna Llidó
- Department of Anatomy and Human Embryology, Giaval Research Group, Faculty of Medicine, University of Valencia, Valencia, Spain
| | - Federico Mata-Escolano
- Department of Anatomy and Human Embryology, Giaval Research Group, Faculty of Medicine, University of Valencia, Valencia, Spain
| | - Markus Bastir
- Department of Paleobiology, Paleoanthropology Group, Museo Nacional de Ciencias Naturales (CSIC), Madrid, Spain.,Department of Anatomy and Human Embryology, Giaval Research Group, Faculty of Medicine, University of Valencia, Valencia, Spain
| | - Juan Alberto Sanchis-Gimeno
- Department of Anatomy and Human Embryology, Giaval Research Group, Faculty of Medicine, University of Valencia, Valencia, Spain
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Sanchis-Gimeno JA, Llido S, Perez-Bermejo M, Nalla S. Prevalence of anatomic variations of the atlas vertebra. Spine J 2018; 18:2102-2111. [PMID: 29960109 DOI: 10.1016/j.spinee.2018.06.352] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 06/19/2018] [Accepted: 06/19/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The retrotransverse foramen (RTF), arcuate foramen (AF), unclosed transverse foramen (UTF) and posterior atlas arch defects (PAAD) are anatomic variations of the atlas vertebra that surgeons must be aware of before spine surgery is performed. PURPOSE To analyze the prevalence of the AF, RTF, UTF, and PAAD. STUDY DESIGN Ex-vivo anatomical study. PATIENT SAMPLE Two hundred eighteen atlas vertebrae obtained from 100 Caucasian subjects and 118 sub-Saharan African subjects (48 Sotho subjects, 35 Xhosa subjects and 35 Zulu subjects). METHODS We studied 218 atlas vertebrae from skeletons of the Raymond A. Dart Collection in order to analyze the prevalence of AF, RTF, UTF, and PAAD in both Caucasian and sub-Saharan African subjects. OUTCOME MEASURES Not applicable. RESULTS Sixty-nine (31.2%) atlases presented anatomical variants: 64 (29.3%) presented one anatomical variant, 4 (1.8%) presented two, and 1 (0.5%) presented three. AF, RTF, UTF, Type A and Type E defects were present in 35 (16.1%), 17 (7.8%), 17 (7.8%), 5 (2.3%), and 1 (0.5%) vertebrae, respectively. The vertebrae with two anatomical variants presented a bilateral UTF and a Type A defect, a bilateral AF and a Type A defect, a right UTF and a left AF, and a right UTF and a Type E defect. The vertebra with three anatomical variants presented a bilateral RTF, a left UTF, and a left AF. No sex differences in prevalence of the RTF (p=.775), AF (p=.605), UTF (p=.408) and Type A defects (p=1.000) were found in the sub-Saharan African and Caucasian groups (RTF, p=.306; AF, p=.346; UTF, p=.121; Type A defects, p=.561). Comparison between the sub-Saharan African (all subjects) and the Caucasian group revealed no differences in the UTF (p=.105), AF (p=.144), RTF (p=.542) and Type A defects (p=.521) prevalence. Also, no differences in the prevalence of the UTF (p=.515), AF (p=.278), and RTF (p=.857) between Zulu, Xhosa and Sotho subjects were found. Neither were found sex differences in the prevalence of UTF, RTF and AF in Zulu (p=.805, p=.234, p=.129), Xhosa (p=.269, p=.181, p=.309), and Sotho subjects (p=.062, p=.590, p=.106). CONCLUSIONS The present study has revealed no sex differences in the prevalence of AF, UTF, RTF or PAAD in both Caucasian and sub-Saharan African subjects. This research has also indicated no differences in the prevalence of the UTF, AF and RTF between Zulu, Xhosa and Sotho subjects. In addition, this study has revealed no differences in the Type A, UTF, AF, and RTF prevalence between the sub-Saharan African (all subjects) and the Caucasian subjects. These variations may be known by surgeons before spine surgery for better planning.
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Affiliation(s)
- Juan A Sanchis-Gimeno
- Department of Anatomy and Human Embryology, Faculty of Medicine, University of Valencia, Avda Blasco Ibanez 15, E46010 Valencia, Spain.
| | - Susanna Llido
- Department of Anatomy and Human Embryology, Faculty of Medicine, University of Valencia, Avda Blasco Ibanez 15, E46010 Valencia, Spain
| | - Marcelino Perez-Bermejo
- Department of Nursing, Catholic University San Vicente Martir, C/Espartero 7, E46007 Valencia, Spain
| | - Shahed Nalla
- Department of Human Anatomy and Physiology, Faculty of Health Sciences, University of Johannesburg, 7304e, John Orr Building, Johannesburg, South Africa
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Ríos L, Palancar C, Pastor F, Llidó S, Sanchís-Gimeno JA, Bastir M. Shape change in the atlas with congenital midline non-union of its posterior arch: a morphometric geometric study. Spine J 2017; 17:1523-1528. [PMID: 28571788 DOI: 10.1016/j.spinee.2017.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 04/04/2017] [Accepted: 05/08/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The congenital midline non-union of the posterior arch of the atlas is a developmental variant present at a frequency ranging from 0.7% to 3.9%. Most of the reported cases correspond to incidental findings during routine medical examination. In cases of posterior non-union, hypertrophy of the anterior arch and cortical bone thickening of the posterior arches have been observed and interpreted as adaptive responses of the atlas to increased mechanical stress. PURPOSE We sought to determine if the congenital non-union of the posterior arch results in a change in the shape of the atlas. STUDY DESIGN/SETTING This study is an analysis of the first cervical vertebrae from osteological collections through morphometric geometric techniques. METHODS A total of 21 vertebrae were scanned with a high-resolution three-dimensional scanner (Artec Space Spider, Artec Group, Luxembourg). To capture vertebral shape, 19 landmarks and 100 semilandmarks were placed on the vertebrae. Procrustes superimposition was applied to obtain size and shape data (MorphoJ 1.02; Klingenberg, 2011), which were analyzed through principal component analysis (PCA) and mean shape comparisons. RESULTS The PCA resulted in two components explaining 22.32% and 18.8% of the total shape variance. The graphic plotting of both components indicates a clear shape difference between the control atlas and the atlas with posterior non-union. This observation was supported by statistically significant differences in mean shape comparisons between both types of vertebra (p<.0001). Changes in shape were observed in the superior and inferior articular facets, the transverse processes, and the neural canal between the control and non-union vertebrae. CONCLUSIONS Non-union of the posterior arch of the atlas is associated with significant changes in the shape of the vertebra.
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Affiliation(s)
- Luis Ríos
- Paleoanthropology Group, Department of Paleobiology, Museo Nacional de Ciencias Naturales, CSIC, José Gutierrez Abascal 2, 28006 Madrid, Spain.
| | - Carlos Palancar
- Paleoanthropology Group, Department of Paleobiology, Museo Nacional de Ciencias Naturales, CSIC, José Gutierrez Abascal 2, 28006 Madrid, Spain
| | - Francisco Pastor
- Anatomical Museum, Department of Anatomy and Radiology, Faculty of Medicine, University of Valladolid, Av. Ramón y Cajal 7, 47005 Valladolid, Spain
| | - Susana Llidó
- Department of Anatomy and Human Embryology, Faculty of Medicine, University of Valencia, Av. Blasco Ibanez 15, E46010 Valencia, Spain
| | - Juan Alberto Sanchís-Gimeno
- Department of Anatomy and Human Embryology, Faculty of Medicine, University of Valencia, Av. Blasco Ibanez 15, E46010 Valencia, Spain
| | - Markus Bastir
- Paleoanthropology Group, Department of Paleobiology, Museo Nacional de Ciencias Naturales, CSIC, José Gutierrez Abascal 2, 28006 Madrid, Spain
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Shimizu T, Otsuki B, Fujibayashi S, Takemoto M, Ito H, Sakamoto T, Adachi T, Matsuda S. Spontaneous anterior arch fracture of the atlas following C1 laminectomy without fusion: A report of three cases and finite element analysis. J Orthop Sci 2016; 21:306-15. [PMID: 26995501 DOI: 10.1016/j.jos.2016.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 02/04/2016] [Accepted: 02/16/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Only four cases of anterior arch fracture after C1 laminectomy without fusion have been previously reported. Although atlas fractures commonly occur in response to high-energy trauma, no obvious trauma that could cause the fracture was observed in these reported cases. The purpose of this study was to elucidate the biomechanical mechanism of anterior arch fracture of the atlas following C1 laminectomy and present three cases of this fracture. METHODS Three cases of fracture of the anterior arch of the atlas following C1 laminectomy were retrospectively reviewed. Three atlas models (an intact model, a laminectomy model, and a transverse ligament-resected model) were created from computed tomography data of each case using a three-dimensional finite element method. Axial load was applied on the superior facet to mimic four conditions (neutral, flexion, extension, lateral bending). The distribution of von Mises stress in the anterior arch and the displacement of the posterior arch were compared among the three models. RESULTS In all three cases, the anterior arch fracture clinically occurred after C1 laminectomy despite there being no obvious inciting trauma. During the finite element analysis, increased stress was observed in all postures of the laminectomy model as compared with the intact model. The stress-concentrated location observed in the finite element model was consistent with the fracture sites that were clinically observed. In terms of loading condition, much higher stress was observed in extension and lateral bending as compared with other postures. There were no significant differences in stress distribution between the laminectomy model and the transverse ligament-resected laminectomy model. CONCLUSIONS Stress distribution concentrates in the anterior arch after C1 laminectomy, leading to fracture of the anterior arch despite no inciting trauma. There may be more frequent occult fractures observed after C1 laminectomy than has been reported. Therefore, surgeons should recognize anterior arch fracture as a possible complication of C1 laminectomy without fusion.
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Affiliation(s)
- Takayoshi Shimizu
- Department of Orthopedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Bungo Otsuki
- Department of Orthopedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shunsuke Fujibayashi
- Department of Orthopedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Mitsuru Takemoto
- Department of Orthopedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hideo Ito
- Department of Orthopedic Surgery, Kyoto Shimogamo Hospital, Kyoto, Japan
| | - Takeshi Sakamoto
- Department of Orthopedic Surgery, Osaka Red Cross Hospital, Osaka, Japan
| | - Taiji Adachi
- Department of Biomechanics, Institute for Frontier Medical Sciences, Kyoto University, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Possible Further Evidence of Low Genetic Diversity in the El Sidrón (Asturias, Spain) Neandertal Group: Congenital Clefts of the Atlas. PLoS One 2015; 10:e0136550. [PMID: 26418427 PMCID: PMC4587856 DOI: 10.1371/journal.pone.0136550] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 08/05/2015] [Indexed: 12/27/2022] Open
Abstract
We present here the first cases in Neandertals of congenital clefts of the arch of the atlas. Two atlases from El Sidrón, northern Spain, present respectively a defect of the posterior (frequency in extant modern human populations ranging from 0.73% to 3.84%), and anterior (frequency in extant modern human populations ranging from 0.087% to 0.1%) arch, a condition in most cases not associated with any clinical manifestation. The fact that two out of three observable atlases present a low frequency congenital condition, together with previously reported evidence of retained deciduous mandibular canine in two out of ten dentitions from El Sidrón, supports the previous observation based on genetic evidence that these Neandertals constituted a group with close genetic relations. Some have proposed for humans and other species that the presence of skeletal congenital conditions, although without clinical significance, could be used as a signal of endogamy or inbreeding. In the present case this interpretation would fit the general scenario of high incidence of rare conditions among Pleistocene humans and the specific scenariothat emerges from Neandertal paleogenetics, which points to long-term small and decreasing population size with reduced and isolated groups. Adverse environmental factors affecting early pregnancies would constitute an alternative, non-exclusive, explanation for a high incidence of congenital conditions. Further support or rejection of these interpretations will come from new genetic and skeletal evidence from Neandertal remains.
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Congenital posterior atlas arch defects. Spine J 2015; 15:796. [PMID: 25804617 DOI: 10.1016/j.spinee.2014.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 07/29/2014] [Indexed: 02/03/2023]
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Blanco-Perez E, Sanchez-Jurado R, Mata-Escolano F, Sanchis-Gimeno JA. Congenital failure of midline fusion of the posterior atlas arch with an associated unilateral cleft. Spine J 2015; 15:198-9. [PMID: 25200329 DOI: 10.1016/j.spinee.2014.08.450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 08/23/2014] [Indexed: 02/03/2023]
Affiliation(s)
- Esther Blanco-Perez
- Department of Radiology, University Hospital de La Ribera, Carretera de Corbera km 1, 46600, Alzira, Valencia, Spain; Department of Anatomy and Human Embryology, University of Valencia, Av. Blasco Ibanez 15, 46010, Valencia, Spain
| | - Raul Sanchez-Jurado
- Department of Anatomy and Human Embryology, University of Valencia, Av. Blasco Ibanez 15, 46010, Valencia, Spain; Department of Nuclear Medicine, University Hospital General, Avenida Tres Cruces 2, 46018, Valencia, Spain
| | - Federico Mata-Escolano
- CT and MRI Unit, ERESA, Department of Radiology, General University Hospital, Avenida Tres Cruces 2, 46018, Valencia, Spain
| | - Juan A Sanchis-Gimeno
- Department of Anatomy and Human Embryology, University of Valencia, Av. Blasco Ibanez 15, 46010, Valencia, Spain
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Blanco-Perez E, Martinez-Sanjuan V, Sanchis-Gimeno JA. Atlantoaxial subluxation and congenital atlas arch defect. Spine J 2014; 14:3049. [PMID: 25086424 DOI: 10.1016/j.spinee.2014.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 07/03/2014] [Indexed: 02/03/2023]
Affiliation(s)
- Esther Blanco-Perez
- Department of Radiology, General University Hospital, Av Tres Cruces, 2, 46014 Valencia, Spain; Department of Anatomy and Human Embryology, University of Valencia, Faculty of Medicine, Av. Blasco Ibanez, 15, 46010 Valencia, Spain
| | - Vicente Martinez-Sanjuan
- ERESA, Department of Radiology, CT and MRI Unit, General University Hospital, Av Tres Cruces, 2, 46014 Valencia, Spain
| | - Juan A Sanchis-Gimeno
- Department of Anatomy and Human Embryology, University of Valencia, Faculty of Medicine, Av. Blasco Ibanez, 15, 46010 Valencia, Spain
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