title: Anatomic Consideration of the C1 Laminar Arch for Lateral Mass Screw Fixation via C1 Lateral Lamina : A Landmark between the Lateral and Posterior Lamina of the C1.
abstract: OBJECTIVE
  To clarify the landmark for deciding the entry point for C1 lateral mass screws via the posterior arch by using 3-dimensional (3D) computed images.
  
  
  METHODS
  Resnick insisted that the C1 posterior arch could be divided into pure posterior and lateral lamina (C1 pedicle). Authors studied where this transition point (TP) is located between the posterior lamina and the C1 pedicle and how it can be recognized. The 3D computed images of 86 cadaver C1s (M : F=45 : 41) were used in this study.
  
  
  RESULTS
  The superior ridge of the C1 posterior arch had 2 types of orientation. One was in the vertical direction in the C1 posterior lamina and the other was in the horizontal direction in the C1 pedicle. The TP was located at the border between the 2 areas, the same site as the posterior end of the groove of the vertebral artery. On posterior-anterior projection, the posterior arch was sharpened abruptly at TP. We were unable to identify the TP in 6.4% of specimens due to complete or partial osseous bridges. A total of 93.8% of the TP were located between the most enlarged point of the spinal canal and the medial wall of the vertebral artery.
  
  
  CONCLUSIONS
  The anatomic entry zone of C1 lateral laminar screws was clarified and identified based on the TP by using preoperative 3D computed images.
authors.affiliation: Department of Neurosurgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
authors.forename: Jung-Hwan
authors.initials: JH
authors.lastname: Kim
authors.forename: Dai-Soon
authors.initials: DS
authors.lastname: Kwak
authors.forename: Seung-Ho
authors.initials: SH
authors.lastname: Han
authors.forename: Sung-Min
authors.initials: SM
authors.lastname: Cho
authors.forename: Seung-Hoon
authors.initials: SH
authors.lastname: You
authors.forename: Moon-Kyu
authors.initials: MK
authors.lastname: Kim
keywords: Atlas; Entry point; Lamina; Landmark; Lateral mass screw; Preoperative computed tomography
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