Anatomical Basis and Clinical Significance of Atlas Stenosis: a Systematic Review

Mædica - a Journal of Clinical Medicine, 2023 · DOI: https://doi.org/10.26574/maedica.2023.18.4.659 · Published: October 20, 2023

Physiology Surgery Spinal Disorders

Simple Explanation

This review explores atlas stenosis, a narrowing of the spinal canal at the C1 vertebra, and its link to cervical myelopathy. It discusses how congenital abnormalities during embryonic development can cause this condition. The review highlights that atlas stenosis can obstruct cerebrospinal fluid flow, potentially leading to neurological disorders and headaches, showing the condition's broad impact. Diagnosis involves CT and MRI scans, and treatment usually requires surgical decompression through laminectomy or laminoplasty to relieve symptoms and prevent further neurological damage.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Level 4: Systematic Review

Key Findings

1
Congenital atlas anomalies result from embryogenesis failures, impacting the development of the anterior tubercle, anterior arch, posterior arch, and posterior tubercle.
2
A sagittal diameter below 14 mm can cause severe cord compression, and below 10 mm can result in symptoms of myelopathy.
3
Surgical intervention, specifically C1 laminectomy or C1 laminoplasty, is the recommended treatment for symptomatic C1 stenosis to create space for the spinal cord.

Research Summary

This review comprehensively examines atlas stenosis, focusing on its anatomical basis, clinical significance, diagnosis, and treatment. It emphasizes the role of congenital abnormalities and acquired factors in the development of C1 spinal canal stenosis. The authors highlight the importance of considering C1 stenosis in patients presenting with myelopathy symptoms or after mild neck trauma. Diagnostic methods, including MRI and CT scans, are crucial for identifying spinal cord compression and bony defects. Surgical interventions like C1 laminoplasty with C1-C2 fusion have shown effectiveness in improving neurological symptoms and decompressing the spinal cord, offering a promising outlook for patients with C1 stenosis.

Practical Implications

Diagnostic Accuracy

Enhance diagnostic accuracy by using MRI and CT scans to identify soft tissue compression and bony irregularities in patients with suspected atlas stenosis.

Surgical Intervention

Consider surgical options like C1 laminoplasty with C1-C2 fusion to improve neurological symptoms and decompress the spinal cord in symptomatic patients.

Clinical Awareness

Increase awareness among clinicians to consider C1 stenosis as a potential diagnosis in patients with myelopathy symptoms or after mild neck trauma.

Study Limitations

1
Limited availability of literature, mainly case reports, due to the rarity of the condition.
2
The exact reasons for posterior arch defects are still unknown, but genetic factors are believed to play a significant role.
3
C1 laminectomy is only suitable when there is no or minimal atlantoaxial subluxation.

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