Kimmerle anomaliyasi: kashf etilish tarixi, tasnifi va klinik qarashlarning evolyutsiyasi
Kimmerle anomaly: history of discovery, classification, and evolution of clinical concepts
Article Sidebar
Main Article Content
Abstract
Background. Kimmerle anomaly is an anatomical variant of the atlas characterized by formation of a partial or complete osseous bridge over the vertebral artery groove on the posterior arch of C1. Initially regarded predominantly as an anatomical and radiographic curiosity, the anomaly subsequently attracted clinical interest because of its close relationship with the V3 segment of the vertebral artery, the suboccipital nerve, and the surgical anatomy of the craniovertebral junction. Materials and Methods. A structured narrative review of classical and contemporary publications addressing the historical description, terminology, epidemiology, morphological classification, radiological evaluation, vascular relationships, and surgical relevance of Kimmerle anomaly was performed. Historical anatomical and radiographic studies were compared with modern CT, CT angiographic, morphometric, systematic-review, and meta-analytic evidence. Results. Concepts regarding Kimmerle anomaly evolved from recognition of an anatomical bony bridge to radiographic identification, epidemiological characterization, morphological classification, appreciation of C1 instrumentation-related risk, and, more recently, assessment of potential dynamic neurovascular conflict. Classification systems progressed from simple complete/incomplete forms to laterality-based, morphometric, and vascularly oriented phenotypes. Contemporary evidence emphasizes that morphological presence alone does not demonstrate symptom causality. Conclusion. The concept of Kimmerle anomaly has evolved from a simple atlas variant into a patient-specific craniovertebral phenotype with morphological, vascular, neurological, and surgical dimensions. Contemporary clinical interpretation requires separation of incidental anatomy from surgically significant morphology and dynamically verified symptomatic neurovascular conflict.
Article Details
Issue
Section
This work is licensed under a Creative Commons Attribution 4.0 International License.
How to Cite
References
Ahn J., Duran M., Syldort S., Rizvi A., D’Antoni A. V., Johal J., et al. Arcuate foramen: anatomy, embryology, nomenclature, pathology, and surgical considerations. World Neurosurgery. 2018;118:197–202. doi:10.1016/j.wneu.2018.07.038.
Pyo J., Lowman R. M. The ponticulus posticus of the first cervical vertebra. Radiology. 1959;72(6):850–854. doi:10.1148/72.6.850.
Selby S., Garn S. M., Kanareff V. The incidence and familial nature of a bony bridge on the first cervical vertebra. American Journal of Physical Anthropology. 1955;13:129–141. doi:10.1002/ajpa.1330130110.
Kendrick G. S., Biggs N. L. Incidence of the ponticulus posticus of the first cervical vertebra between ages six to seventeen. Anatomical Record. 1963;145:449–453. doi:10.1002/ar.1091450308.
Radojević S., Negovanović B. The vertebral groove and bone rings of the vertebral artery of the atlas: anatomical and radiological study. Acta Anatomica. 1963;55:186–194.
Lamberty B. G. H., Zivanovic S. The retro-articular vertebral artery ring of the atlas and its significance. Acta Anatomica. 1973;85(1):113–122. doi:10.1159/000143987.
Saunders S. R., Popovich F. A family study of two skeletal variants: atlas bridging and clinoid bridging. American Journal of Physical Anthropology. 1978;49:193–203. doi:10.1002/ajpa.1330490207.
Dugdale L. M. The ponticulus posterior of the atlas. Australasian Radiology. 1981;25:237–238. doi:10.1111/j.1440-1673.1981.tb02254.x.
Stubbs D. M. The arcuate foramen: variability in distribution related to race and sex. Spine. 1992;17(12):1502–1504. doi:10.1097/00007632-199212000-00010.
Tubbs R. S., Johnson P. C., Shoja M. M., Loukas M., Oakes W. J. Foramen arcuale: anatomical study and review of the literature. Journal of Neurosurgery: Spine. 2007;6(1):31–34. doi:10.3171/spi.2007.6.1.6.
Paraskevas G., Papaziogas B., Tsonidis C., Kapetanos G. Gross morphology of the bridges over the vertebral artery groove on the atlas. Surgical and Radiologic Anatomy. 2005;27:129–136. doi:10.1007/s00276-004-0300-9.
Kim K. H., Park K. W., Manh T. H., Yeom J. S., Chang B. S., Lee C. K. Prevalence and morphologic features of ponticulus posticus in Koreans: analysis of 312 radiographs and 225 three-dimensional CT scans. Asian Spine Journal. 2007;1(1):27–31. doi:10.4184/asj.2007.1.1.27.
Young J. P., Young P. H., Ackermann M. J., Anderson P. A., Riew K. D. The ponticulus posticus: implications for screw insertion into the first cervical lateral mass. Journal of Bone and Joint Surgery American. 2005;87(11):2495–2498.
Hong J. T., Lee S. W., Son B. C., Sung J. H., Yang S. H., Kim I. S., et al. Analysis of anatomical variations of bone and vascular structures around the posterior atlantal arch using three-dimensional computed tomography angiography. Journal of Neurosurgery: Spine. 2008;8(3):230–236. doi:10.3171/SPI/2008/8/3/230.
Cho Y. J. Radiological analysis of ponticulus posticus in Koreans. Yonsei Medical Journal. 2009;50(1):45–49. doi:10.3349/ymj.2009.50.1.45.
Elliott R. E., Tanweer O. The prevalence of the ponticulus posticus (arcuate foramen) and its importance in the Goel-Harms procedure: meta-analysis and review of the literature. World Neurosurgery. 2014;82(1–2):e335–e343. doi:10.1016/j.wneu.2013.09.014.
Bayrakdar I. S., Miloglu O., Altun O., Gumussoy I., Durna D., Yilmaz A. B. Cone beam computed tomography imaging of ponticulus posticus: prevalence, characteristics, and a review of the literature. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. 2014;118(6):e210–e219.
Geist J. R., Geist S. M. R. Y., Lin L. M. A cone beam CT investigation of ponticulus posticus and lateralis in children and adolescents. Dentomaxillofacial Radiology. 2014;43(5):20130451. doi:10.1259/dmfr.20130451.
Chen C. H., Chen Y. K., Wang C. K. Prevalence of ponticuli posticus among patients referred for dental examinations by cone-beam CT. The Spine Journal. 2015;15(6):1270–1276. doi:10.1016/j.spinee.2015.02.031.
Sekerci A. E., Soylu E., Arikan M. P. Prevalence and morphologic characteristics of ponticulus posticus: analysis using cone-beam computed tomography. Journal of Chiropractic Medicine. 2015;14(3):153–161. doi:10.1016/j.jcm.2015.06.003.
Tambawala S. S., Karjodkar F. R., Sansare K., Motghare D., Mishra I., Gaikwad S., et al. Prevalence of ponticulus posticus on lateral cephalometric radiographs, its association with cervicogenic headache and a review of literature. World Neurosurgery. 2017;103:566–575. doi:10.1016/j.wneu.2017.04.030.
Giri J., Pokharel P. R., Gyawali R. How common is ponticulus posticus on lateral cephalograms? BMC Research Notes. 2017;10:172. doi:10.1186/s13104-017-2494-z.
Saleh A., Gruber J., Bakhsh W., Rubery P. T., Mesfin A. How common is the ponticulus posticus? A computed tomography based analysis of 2917 patients. Spine. 2018;43:E436–E441. doi:10.1097/BRS.0000000000002400.
Pękala P. A., Henry B. M., Phan K., Pękala J. R., Taterra D., Walocha J. A., et al. Presence of a foramen arcuale as a possible cause for headaches and migraine: systematic review and meta-analysis. Journal of Clinical Neuroscience. 2018;54:113–118. doi:10.1016/j.jocn.2018.05.008.
Arslan D., Ozer M. A., Govsa F., Kitis O. The ponticulus posticus as risk factor for screw insertion into the first cervical lateral mass. World Neurosurgery. 2018;113:e579–e585. doi:10.1016/j.wneu.2018.02.100.
Xu X., Zhu Y., Ding X., Yin M., Mo W., Ma J. Research progress of ponticulus posticus: a narrative literature review. Frontiers in Surgery. 2022;9:834551. doi:10.3389/fsurg.2022.834551.
Olszewski R., Issa J., Odri G. A. A new classification of the morphology of complete ponticulus posticus on cone beam computed tomography. Diagnostics. 2023;13(18):3009. doi:10.3390/diagnostics13183009.
Gul E., Atik I. Does ponticulus posticus affect vertebral artery diameter? Surgical and Radiologic Anatomy. 2024;46(9):1517–1524. doi:10.1007/s00276-024-03430-w.
Ordoñez-Cure S., Moreno-Drada J. A., Mier-García J. F., Baena-Caldas G. P. The ponticulus of the atlas vertebra: a systematic review and meta-analysis of its prevalence with its surgical relevance. World Neurosurgery: X. 2025;28:100502. doi:10.1016/j.wnsx.2025.100502.
Valenzuela-Fuenzalida J. J., Cornejo-Peña J., Martinez-Cid J., Rojas-Acuña C., Granite G., Sanchis-Gimeno J. A., et al. Arcuate foramen of the atlas vertebra and its correlation with clinical implications in the craniocervical region: a systematic review and meta-analysis. World Neurosurgery. 2026;205:124652. doi:10.1016/j.wneu.2025.124652.
Wakao N., Takeuchi M., Nishimura M., Riew K. D., Kamiya M., Hirasawa A., et al. Vertebral artery variations and osseous anomaly at the C1–2 level diagnosed by 3D CT angiography in normal subjects. Neuroradiology. 2014;56(10):843–849. doi:10.1007/s00234-014-1399-y.
Elgafy H., Pompo F., Vela R., Elsamaloty H. M. Ipsilateral arcuate foramen and high-riding vertebral artery: implication on C1–C2 instrumentation. The Spine Journal. 2014;14(7):1351–1355. doi:10.1016/j.spinee.2014.01.054.
Natsis K., Piperaki E. T., Fratzoglou M., Lazaridis N., Tsitsopoulos P. P., Samolis A., et al. Atlas posterior arch and vertebral artery's groove variants: a classification, morphometric study, clinical and surgical implications. Surgical and Radiologic Anatomy. 2019;41:985–1001. doi:10.1007/s00276-019-02256-1.
Zhang X. L., Huang D. G., Wang X. D., Zhu J. W., Li Y. B., He B. R., et al. The feasibility of inserting a C1 pedicle screw in patients with ponticulus posticus: a retrospective analysis of eleven patients. European Spine Journal. 2017;26(4):1058–1063. doi:10.1007/s00586-016-4589-y.
Song M. S., Lee H. J., Kim J. T., Kim J. H., Hong J. T. Ponticulus posticus: morphometric analysis and its anatomical implications for occipito-cervical fusion. Clinical Neurology and Neurosurgery. 2017;157:76–81. doi:10.1016/j.clineuro.2017.04.001.
Lukianchikov V., Lvov I., Grin A., Kordonskiy A., Polunina N., Krylov V. Minimally invasive surgical treatment for vertebral artery compression in a patient with one-sided ponticulus posticus and ponticulus lateralis. World Neurosurgery. 2018;117:97–102.