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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. Zhang XL et al: The feasibility of inserting a C1 pedicle screw in patients with ponticulus posticus: a retrospective analysis of eleven patients. Eur Spine J. ePub, 2016
                                      2. Chen CH et al: Prevalence of ponticuli posticus among patients referred for dental examinations by cone-beam CT. Spine J. 15(6):1270-6, 2015
                                      3. Huang DG et al: Ponticulus posticus. Spine J. 15(11):e17-9, 2015
                                      4. Krishnan P et al: Ponticulus posticus: an anatomical curiosity with clinical implications. Neurol India. 63(5):805-6, 2015
                                      5. Sekerci AE et al: Is there a relationship between the presence of ponticulus posticus and elongated styloid process? Clin Imaging. 39(2):220-4, 2015
                                      6. Sekerci AE et al: Prevalence and morphologic characteristics of ponticulus posticus: analysis using cone-beam computed tomography. J Chiropr Med. 14(3):153-61, 2015
                                      7. 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
                                      8. Friedrich RE: Ponticulus posticus is a frequent radiographic finding on lateral cephalograms in nevoid basal cell carcinoma syndrome (Gorlin-Goltz syndrome). Anticancer Res. 34(12):7395-9, 2014
                                      9. Geist JR et al: A cone beam CT investigation of ponticulus posticus and lateralis in children and adolescents. Dentomaxillofac Radiol. 43(5):20130451, 2014
                                      10. 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
                                      11. 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
                                      12. Sharma V et al: Prevalence of ponticulus posticus in Indian orthodontic patients. Dentomaxillofac Radiol. 39(5):277-83, 2010
                                      13. 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
                                      14. Cakmak O et al: Arcuate foramen and its clinical significance. Saudi Med J. 26(9):1409-13, 2005
                                      15. 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
                                      16. 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
                                      17. 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. Zhang XL et al: The feasibility of inserting a C1 pedicle screw in patients with ponticulus posticus: a retrospective analysis of eleven patients. Eur Spine J. ePub, 2016
                                                                          2. Chen CH et al: Prevalence of ponticuli posticus among patients referred for dental examinations by cone-beam CT. Spine J. 15(6):1270-6, 2015
                                                                          3. Huang DG et al: Ponticulus posticus. Spine J. 15(11):e17-9, 2015
                                                                          4. Krishnan P et al: Ponticulus posticus: an anatomical curiosity with clinical implications. Neurol India. 63(5):805-6, 2015
                                                                          5. Sekerci AE et al: Is there a relationship between the presence of ponticulus posticus and elongated styloid process? Clin Imaging. 39(2):220-4, 2015
                                                                          6. Sekerci AE et al: Prevalence and morphologic characteristics of ponticulus posticus: analysis using cone-beam computed tomography. J Chiropr Med. 14(3):153-61, 2015
                                                                          7. 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
                                                                          8. Friedrich RE: Ponticulus posticus is a frequent radiographic finding on lateral cephalograms in nevoid basal cell carcinoma syndrome (Gorlin-Goltz syndrome). Anticancer Res. 34(12):7395-9, 2014
                                                                          9. Geist JR et al: A cone beam CT investigation of ponticulus posticus and lateralis in children and adolescents. Dentomaxillofac Radiol. 43(5):20130451, 2014
                                                                          10. 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
                                                                          11. 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
                                                                          12. Sharma V et al: Prevalence of ponticulus posticus in Indian orthodontic patients. Dentomaxillofac Radiol. 39(5):277-83, 2010
                                                                          13. 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
                                                                          14. Cakmak O et al: Arcuate foramen and its clinical significance. Saudi Med J. 26(9):1409-13, 2005
                                                                          15. 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
                                                                          16. 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
                                                                          17. 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