Prevalence of Ponticulus Posticus on Lateral Cephalometric Radiographs, its Association with Cervicogenic Headache and a Review of Literature

• Published in: World neurosurgery Vol. 103; pp. 566 - 575
• Main Authors: Tambawala, Shahnaz S., Dr, Karjodkar, Freny R., Dr, Sansare, Kaustubh, Dr, Motghare, Digvijay, Dr, Mishra, Isha, Dr, Gaikwad, Shuddhodhan, Dr, Dora, Amaresh Chandra, Dr
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2017
• Subjects: Adolescent; Adult; Atlantoaxial instability; Atlas vertebrae; Cervical Atlas - abnormalities; Cervical Atlas - diagnostic imaging; Child; Female; Headache; Humans; India - epidemiology; Lateral cephalogram; Male; Musculoskeletal Abnormalities - diagnostic imaging; Musculoskeletal Abnormalities - epidemiology; Neurosurgery; Ponticulus posticus; Post-Traumatic Headache - epidemiology; Prevalence; Radiography; Retrospective Studies; Sex Distribution; Young Adult; PP; Lateral Cephalography; C; atlantoaxial instability; atlas vertebrae; Not Available; CR; CBCT; Cone Beam Computed Tomography; Cervical Radiography; CT; NA; ponticulus posticus; LC; Computerized Tomography; headache; Lateral cephalogram; Cadaver; Headache; Atlantoaxial instability; Ponticulus posticus; Atlas vertebrae
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2017.04.030

Abstract Objectives The aim of this study was to calculate the prevalence of ponticulus posticus: a small bony bridge on the dorsal aspect of the Atlas on lateral digital cephalometric radiographs and classify it into a complete ring or an incomplete ring. The study also investigated its association with the presence or absence of cervicogenic headache in the examined population if any and presents a literature review on Ponticulus posticus. Methods The presence and types of ponticuli posticus were investigated on 500 digital lateral cephalograms and the same patients were questioned for a history of cervicogenic headache. Results In 500 patients, 79 Ponticulus Posticus: 34 complete and 45 incomplete, were identified on the Lateral Cephalograms; therefore, the prevalence was 15.8%. The distribution of the type of PP in males was 13.1% and females was 17.9% in the studied sample. The overall prevalence of Cervicogenic headache was 6% in the studied sample with significant association between Cervicogenic headache and type of PP. Conclusion The study shows that ponticulus posticus it is a not a rare finding and its association with unexplainable headache, neck pain and other symptoms as well as its importance and implications during management of cervical spine surgical procedures, especially those requiring lateral mass screw placements in the atlas, implies that, radiologists and dentists in general should closely inspect the vertebral region on a lateral cephalogram.