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The effect of C1 bursting fracture on comparative anatomical relationship between the internal carotid artery and the atlas

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Abstract

Purpose

To describe the effect of the C1 bursting fracture on the location of the internal carotid artery (ICA) around the atlas.

Methods

The authors analyzed the morphology of the atlas and the ICA in 15 patients with C1 bursting fracture and compared with control group (77 patients) without any pathology. All patients were evaluated with CT angiography for the anatomical assessment. The laterality of the ICA, the distances of the ICA from the midline, anterior tubercle, and ventral surface of the C1 lateral mass were compared between two groups. The distance between the lateral margin of the longus capitis muscle and the inner edge of the transverse foramen was also measured.

Results

Medially located ICA was more common in the C1 bursting fracture group than control group (76.7 vs 42.8 %). There were no significant differences between 2 groups for the distance from the midline, anterior tubercle, and ventral surface of the C1 lateral mass, respectively. The distance of the longus capitis muscle to transverse foramen was 2.52 ± 2.09 and 4.15 ± 3.09 mm in each group, and there was statistically significant difference (p < 0.01).

Conclusions

Lateral displacement of the bony structure of C1 bursting fracture changes the relative location of the ICA medially, which increase the injury risk during the bicortical C1 screw insertion. These data suggest that CT angiography or enhanced CT scans can give critical information to choose the ideal fixation technique and the proper trajectory of the screws for C1 bursting fracture.

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Acknowledgments

The authors would like to acknowledge that this study was funded by the St. Vincent’s Hospital Research Program in 2014.

Conflict of interest

None.

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Authors and Affiliations

  1. Department of Neurosurgery, St. Vincent’s Hospital, The Catholic University of Korea, 93-6 Ji-Dong, Paldal-Gu, Suwon, Gyeonggi-do, 442-723, South Korea

    Moon Seok Kim, Jun Young Kim, Il Sup Kim & Jae Taek Hong

  2. Department of Neurosurgery, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Seoul, South Korea

    Kyoung Seok Cho

  3. Department of Neurosurgery, Bucheon St. Mary’s Hospital, The Catholic University of Korea, Seoul, South Korea

    Sang Don Kim

  4. Department of Neurosurgery, Incheon St. Mary’s Hospital, The Catholic University of Korea, Seoul, South Korea

    Ho Jin Lee & Jong Tae Kim

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  1. Moon Seok Kim
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  3. Il Sup Kim
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Correspondence to Jae Taek Hong.

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Kim, M.S., Kim, J.Y., Kim, I.S. et al. The effect of C1 bursting fracture on comparative anatomical relationship between the internal carotid artery and the atlas. Eur Spine J 25, 103–109 (2016). https://doi.org/10.1007/s00586-015-3848-7

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  • DOI: https://doi.org/10.1007/s00586-015-3848-7

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