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Spine
Diagnosis
Congenital and Genetic Disorders
Congenital
Normal Anatomical Variations
Ponticulus Posticus
Ponticulus Posticus
Kevin R. Moore, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Synonyms

                • Arcuate foramen, sagittal foramen, canalis vertebralis, retroarticular canal, retroarticular/retrocondylar vertebral artery ring, upper retroarticular foramen, and atlantal posterior foramen

              • Definitions

                • Osseous arch connecting retroglenoid tubercle with posterior C1 arch
                • Latin: Little posterior bridge

              IMAGING

              • General Features

                • Radiographic Findings

                  • CT Findings

                    • MR Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Staging, Grading, & Classification

                              • Gross Pathologic & Surgical Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    DIAGNOSTIC CHECKLIST

                                    • Consider

                                      Selected References

                                      1. Arslan D et al: The ponticulus posticus as risk factor for screw insertion into the first cervical lateral mass. World Neurosurg. 113:e579-85, 2018
                                      2. Lo Giudice A et al: Frequency and type of ponticulus posticus in a longitudinal sample of nonorthodontically treated patients: relationship with gender, age, skeletal maturity, and skeletal malocclusion. Oral Surg Oral Med Oral Pathol Oral Radiol. 126(3):291-7, 2018
                                      3. Lukianchikov V et al: Minimally invasive surgical treatment for vertebral artery compression in a patient with one-sided ponticulus posticus and ponticulus lateralis. World Neurosurg. 117:97-102, 2018
                                      4. Saleh A et al: How common is the ponticulus posticus?: A computed tomography based analysis of 2917 patients. Spine (Phila Pa 1976). 43(8):E436-41, 2018
                                      5. Sanchis-Gimeno JA et al: The decreasing prevalence of the arcuate foramen. World Neurosurg. 110:521-5, 2018
                                      6. Giri J et al: How common is ponticulus posticus on lateral cephalograms? BMC Res Notes. 10(1):172, 2017
                                      7. Pękala PA et al: Prevalence of foramen arcuale and its clinical significance: a meta-analysis of 55,985 subjects. J Neurosurg Spine. 27(3):276-90, 2017
                                      8. Song MS et al: Ponticulus posticus: morphometric analysis and Its anatomical Implications for occipito-cervical fusion. Clin Neurol Neurosurg. 157:76-81, 2017
                                      9. Tambawala SS et al: Prevalence of ponticulus posticus on lateral cephalometric radiographs, its association with cervicogenic headache and a review of literature. World Neurosurg. 103:566-75, 2017
                                      10. Bayrakdar IS et al: Cone beam computed tomography imaging of ponticulus posticus: prevalence, characteristics, and a review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol. 118(6):e210-9, 2014
                                      11. OʼDonnell CM et al: Vertebral artery anomalies at the craniovertebral junction in the US population. Spine (Phila Pa 1976). 39(18):E1053-7, 2014
                                      12. Lee SH et al: Posterior C1-2 fusion using a polyaxial screw/rod system for os odontoideum with bilateral persistence of the first intersegmental artery. J Neurosurg Spine. 14(1):10-3, 2011
                                      13. Mellado JM et al: MDCT of variations and anomalies of the neural arch and its processes: part 2--articular processes, transverse processes, and high cervical spine. AJR Am J Roentgenol. 197(1):W114-21, 2011
                                      14. Greiner HM et al: Rotational vertebral artery occlusion in a child with multiple strokes: a case-based update. Childs Nerv Syst. 26(12):1669-74, 2010
                                      15. Koutsouraki E et al: Kimmerle's anomaly as a possible causative factor of chronic tension-type headaches and neurosensory hearing loss: case report and literature review. Int J Neurosci. 120(3):236-9, 2010
                                      16. Sharma V et al: Prevalence of ponticulus posticus in Indian orthodontic patients. Dentomaxillofac Radiol. 39(5):277-83, 2010
                                      17. Kim KH et al: Prevalence and morphologic features of ponticulus posticus in Koreans: analysis of 312 radiographs and 225 three-dimensional CT scans. Asian Spine J. 1(1):27-31, 2007
                                      18. Cakmak O et al: Arcuate foramen and its clinical significance. Saudi Med J. 26(9):1409-13, 2005
                                      19. Young JP et al: The ponticulus posticus: implications for screw insertion into the first cervical lateral mass. J Bone Joint Surg Am. 87(11):2495-8, 2005
                                      20. Cushing KE et al: Tethering of the vertebral artery in the congenital arcuate foramen of the atlas vertebra: a possible cause of vertebral artery dissection in children. Dev Med Child Neurol. 43(7):491-6, 2001
                                      21. Wight S et al: Incidence of ponticulus posterior of the atlas in migraine and cervicogenic headache. J Manipulative Physiol Ther. 22(1):15-20, 1999
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Imaging

                                          • Top Differential Diagnoses

                                            • Pathology

                                              • Clinical Issues

                                                • Diagnostic Checklist

                                                  TERMINOLOGY

                                                  • Synonyms

                                                    • Arcuate foramen, sagittal foramen, canalis vertebralis, retroarticular canal, retroarticular/retrocondylar vertebral artery ring, upper retroarticular foramen, and atlantal posterior foramen

                                                  • Definitions

                                                    • Osseous arch connecting retroglenoid tubercle with posterior C1 arch
                                                    • Latin: Little posterior bridge

                                                  IMAGING

                                                  • General Features

                                                    • Radiographic Findings

                                                      • CT Findings

                                                        • MR Findings

                                                          • Imaging Recommendations

                                                            DIFFERENTIAL DIAGNOSIS

                                                              PATHOLOGY

                                                              • General Features

                                                                • Staging, Grading, & Classification

                                                                  • Gross Pathologic & Surgical Features

                                                                    CLINICAL ISSUES

                                                                    • Presentation

                                                                      • Demographics

                                                                        DIAGNOSTIC CHECKLIST

                                                                        • Consider

                                                                          Selected References

                                                                          1. Arslan D et al: The ponticulus posticus as risk factor for screw insertion into the first cervical lateral mass. World Neurosurg. 113:e579-85, 2018
                                                                          2. Lo Giudice A et al: Frequency and type of ponticulus posticus in a longitudinal sample of nonorthodontically treated patients: relationship with gender, age, skeletal maturity, and skeletal malocclusion. Oral Surg Oral Med Oral Pathol Oral Radiol. 126(3):291-7, 2018
                                                                          3. Lukianchikov V et al: Minimally invasive surgical treatment for vertebral artery compression in a patient with one-sided ponticulus posticus and ponticulus lateralis. World Neurosurg. 117:97-102, 2018
                                                                          4. Saleh A et al: How common is the ponticulus posticus?: A computed tomography based analysis of 2917 patients. Spine (Phila Pa 1976). 43(8):E436-41, 2018
                                                                          5. Sanchis-Gimeno JA et al: The decreasing prevalence of the arcuate foramen. World Neurosurg. 110:521-5, 2018
                                                                          6. Giri J et al: How common is ponticulus posticus on lateral cephalograms? BMC Res Notes. 10(1):172, 2017
                                                                          7. Pękala PA et al: Prevalence of foramen arcuale and its clinical significance: a meta-analysis of 55,985 subjects. J Neurosurg Spine. 27(3):276-90, 2017
                                                                          8. Song MS et al: Ponticulus posticus: morphometric analysis and Its anatomical Implications for occipito-cervical fusion. Clin Neurol Neurosurg. 157:76-81, 2017
                                                                          9. Tambawala SS et al: Prevalence of ponticulus posticus on lateral cephalometric radiographs, its association with cervicogenic headache and a review of literature. World Neurosurg. 103:566-75, 2017
                                                                          10. Bayrakdar IS et al: Cone beam computed tomography imaging of ponticulus posticus: prevalence, characteristics, and a review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol. 118(6):e210-9, 2014
                                                                          11. OʼDonnell CM et al: Vertebral artery anomalies at the craniovertebral junction in the US population. Spine (Phila Pa 1976). 39(18):E1053-7, 2014
                                                                          12. Lee SH et al: Posterior C1-2 fusion using a polyaxial screw/rod system for os odontoideum with bilateral persistence of the first intersegmental artery. J Neurosurg Spine. 14(1):10-3, 2011
                                                                          13. Mellado JM et al: MDCT of variations and anomalies of the neural arch and its processes: part 2--articular processes, transverse processes, and high cervical spine. AJR Am J Roentgenol. 197(1):W114-21, 2011
                                                                          14. Greiner HM et al: Rotational vertebral artery occlusion in a child with multiple strokes: a case-based update. Childs Nerv Syst. 26(12):1669-74, 2010
                                                                          15. Koutsouraki E et al: Kimmerle's anomaly as a possible causative factor of chronic tension-type headaches and neurosensory hearing loss: case report and literature review. Int J Neurosci. 120(3):236-9, 2010
                                                                          16. Sharma V et al: Prevalence of ponticulus posticus in Indian orthodontic patients. Dentomaxillofac Radiol. 39(5):277-83, 2010
                                                                          17. Kim KH et al: Prevalence and morphologic features of ponticulus posticus in Koreans: analysis of 312 radiographs and 225 three-dimensional CT scans. Asian Spine J. 1(1):27-31, 2007
                                                                          18. Cakmak O et al: Arcuate foramen and its clinical significance. Saudi Med J. 26(9):1409-13, 2005
                                                                          19. Young JP et al: The ponticulus posticus: implications for screw insertion into the first cervical lateral mass. J Bone Joint Surg Am. 87(11):2495-8, 2005
                                                                          20. Cushing KE et al: Tethering of the vertebral artery in the congenital arcuate foramen of the atlas vertebra: a possible cause of vertebral artery dissection in children. Dev Med Child Neurol. 43(7):491-6, 2001
                                                                          21. Wight S et al: Incidence of ponticulus posterior of the atlas in migraine and cervicogenic headache. J Manipulative Physiol Ther. 22(1):15-20, 1999