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Atlanto-axial articulation

Jayraj Singh Bhatti and Dr Matthew Jarvis et al.

The atlanto-axial articulation is a complex of three synovial joints, which join the atlas (C1) to the axis (C2).

On this page:

Article:

  • Gross anatomy
  • Variant anatomy
  • Related pathology
  • Related articles
  • References

Images:

  • Cases and figures

Gross anatomy

Articulations
  • paired lateral atlanto-axial joints: classified as planar-type joint between the lateral masses of C1 and C2, though somewhat more complex in shape with concavity of the superior axial facets
  • median atlanto-axial (atlanto-dental) joint: pivot joint with anterior and posterior articulations of odontoid process/dens of C2 and anterior arch and transverse ligament of C1
  • fibrous capsules of the lateral and medial joints are thin and provide only minimal support, therefore ligamentous attachments provide the majority of support
Attachments
  • anterior longitudinal ligament : thick fibrous band attaches from inferior border of anterior arch of C1 to the anterior axial body
  • posterior atlanto-occipital membrane (continuation of ligamenta flava): attaches from lower border of atlantal arch (and more superiorly to the occipital bone) and upper borders of lamina of C2
  • cruciform ligaments : superior, transverse and inferior bands posterior to dens; transverse is strongest portion which stabilises odontoid to the lateral mass of C1 limiting lateral motion of C1 over C2 and limiting subluxation of the joint 1
  • accessory atlanto-axial ligament: from posterior body of C2 to lateral mass of C1
  • there are a number of ligaments which attach the axis to the occipital bone including the tectorial membrane , the paired alar ligaments , median apical ligament and the longitudinal parts of the cruciform ligaments
Function

The atlanto-axial joint allows 10-15o of flexion/extension, 30o of axial rotation and only minimal lateral flexion.

Variant anatomy

there are a number of congenital anomalies which can affect the atlas, axis and the joint between the two:

  • aplasias, hypoplasias, and clefts of the atlas arches 
  • split atlas

Abnormalities of the axis tend to affect the odontoid process and include 2:

  • persistent ossiculum terminale
  • odontoid aplasia
  • os odontoideum

Related pathology

  • traumatic and non-traumatic atlanto-axial subluxation /dislocation

Quiz questions

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References

  • 1. Hall GC, Kinsman MJ, Nazar RG et-al. Atlanto-occipital dislocation. World J Orthop. 2015;6 (2): 236-43. doi:10.5312/wjo.v6.i2.236 – Free text at pubmed – Pubmed citation
  • 2. Smoker WR. Craniovertebral junction: normal anatomy, craniometry, and congenital anomalies. Radiographics. 1994;14 (2): 255-77. doi:10.1148/radiographics.14.2.8190952 – Pubmed citation
  • 3. Offiah CE, Day E. The craniocervical junction: embryology, anatomy, biomechanics and imaging in blunt trauma. Insights into imaging. 8 (1): 29-47. doi:10.1007/s13244-016-0530-5 – Pubmed
Anatomy: Spine
  • osteology

    • vertebrae
    • spinal canal
    • cervical spine

      • typical cervical vertebrae
      • atypical cervical vertebrae

        • atlas (C1)
        • axis (C2)
        • vertebra prominens (C7)
    • thoracic spine

      • typical thoracic vertebrae
      • atypical thoracic vertebrae

        • T1
        • T11
        • T12
    • lumbar spine

      • typical lumbar vertebrae
      • atypical lumbar vertebrae

        • L5
    • sacrum
    • coccyx
    • anatomical variants

      • vertebral body
        • hemivertebrae
        • block vertebrae
        • fused vertebrae
        • unfused vertebrae

          • vertebral cleft
        • butterfly vertebrae
        • limbus vertebra
      • neural arch
        • arcuate foramen
        • posterior vertebral fusion anomalies

          • unfused spinous process
      • transitional vertebrae

        • atlanto-occipital assimilation
        • occipital vertebrae
        • cervical rib
        • lumbar rib
        • transitional lumbosacral vertebrae

          • Castellvi classification
      • ossicles
        • accessory ossicle of the anterior arch of the atlas
        • persistent ossiculum terminale
        • os odontoideum
        • nuchal ligament sesamoid ossicle
        • Oppenheimer ossicle
    • ossification centres
  • intervertebral disc

    • annulus fibrosus
    • nucleus pulposus
  • articulations
    • atlantooccipital joint
    • atlantoaxial joint
    • uncovertebral joint
    • intervertebral joint
    • zygapophyseal (facet) joint

      • facet joint capsule
      • retrodural space of Okada
    • sacroiliac joint

      • accessory sacroiliac joint
      • preauricular groove
  • ligaments
    • anterior longitudinal ligament
    • posterior longitudinal ligament
    • posterior ligamentous complex

      • ligamentum flavum
      • interspinous ligament
      • supraspinous ligament
    • cervical spine ligaments

      • anterior atlanto-occipital membrane
      • apical ligament
      • alar ligaments
      • cruciate ligament of the atlas
      • tectorial membrane
      • posterior atlanto-occipital membrane
      • ligamentum nuchae
      • intertransverse ligaments
    • iliolumbar ligament
  • musculature of the vertebral column
    • muscles of the neck
    • muscles of the back
      • suboccipital muscle group

        • rectus capitis posterior major muscle
        • rectus capitis posterior minor muscle
        • obliquus capitis superior muscle
        • obliquus capitis inferior muscle
      • splenius capitis muscle
      • splenius cervicis muscle
      • erector spinae group
      • transversospinalis group
      • quadratus lumborum
  • spinal cord

    • gross anatomy
      • cervical spinal cord

        • craniocervical junction
        • cervical enlargement
      • thoracic spinal cord
      • lumbar spinal cord

        • lumbar enlargement
        • conus medullaris
        • ventriculus terminalis
      • cauda equina
    • white matter tracts  ( white matter )

      • anterolateral columns
        • anterior corticospinal tract
        • medial longitudinal fasciculus
        • spinothalamic tracts

          • lateral spinothalamic tract
          • anterior spinothalamic tract
      • lateral columns
        • lateral corticospinal tract
        • corticorubral tract

          • rubrospinal tract
        • spinocerebellar tract
      • dorsal columns

        • fasiculus gracilis (column of Goll)
        • fasiculus cuneatus  (column of Burdach)
    • grey matter

      • dorsal horn
      • dorsal root ganglion
      • lateral horn
      • ventral horn
    • nerve root
      • conjoined nerve root
    • spinal meninges and spaces

      • epidural space
      • dura mater
      • subdural space
      • arachnoid mater
      • subarachnoid space

        • lumbar cistern
      • pia mater

        • filum terminale
        • denticulate ligaments
      • central canal
    • functional anatomy
      • thoracic autonomic outflow
      • sacral autonomic outflow
    • spinal cord blood supply

      • arteries
        • vertebral artery

          • anterior spinal artery

            • sulcal artery
          • posterior inferior cerebellar artery (PICA)

            • posterior spinal arteries
        • segmental arteries

          • artery of Adamkiewicz
      • veins
        • spinal segmental veins

          • vertebral venous plexus
          • Batson venous plexus
  • sympathetic chain

    • stellate ganglion

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Article information

rID: 35480
System: Spine
Section: Anatomy
Synonyms or Alternate Spellings:

  • Atlanto-axial joint

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Cases and figures

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    Figure 1: alar and cruciform ligament anatomy Figure 1: alar and cruciform ligament anatomy
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    Figure 2: median atlanto-occipital and atlantoaxial joints (Gray’s illustration) Figure 2: median atlanto-occipital and atlantoaxial joints (Gray’s illustration)
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