• Tarush Rustagi, Joe Iwanaga, Juan P Sardi, Fernando Alonso, Rod J Oskouian, and R Shane Tubbs.
• Seattle Science Foundation, Seattle, Washington, USA; Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, USA; Department of Spine Surgery, Indian Spinal Injuries Centre, New Delhi, India. Electronic address: tarush.rustagi@gmail.com.
• World Neurosurg. 2017 Nov 1; 107: 506-510.

BackgroundDegenerative changes in the upper cervical spine may be age related degeneration or a pathological process such as rheumatoid arthritis. However, to our knowledge, the relationship between the apical and alar ligaments and these anomalies has not been discussed. We present anatomical variations of the anterior atlantodental joint observed during cadaveric dissection of adult craniovertebral junctions, the relationship with the alar and apical ligaments and discuss possible origins and clinical implications.MethodsThe upper cervical spine including part of the occiput was dissected from cadavers whose mean age at death was 78.9 years-old. The anterior atlantodental joint and apical and alar ligaments were observed and any atypical findings were noted.ResultsIn eleven specimens, seven had a dens corona, three had an os odontoideum and one had a dens aureola, which arose from the upper part of the anterior arch of the atlas. Only four specimens had an apical ligament.ConclusionsThe possible etiologies and the clinical applications of these craniovertebral anomalies in a geriatric population should be appreciated by the clinician treating patients with disease in this area or interpreting imaging in the region.Copyright © 2017 Elsevier Inc. All rights reserved.

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