Ponticulus Posticus Symtoms, Causes, Treatment

There is a bony or skeletal bridge in the atlas that connects the lateral mass to the posterior arch. This bridge is called the ponticulus posticus. It is formed by the bone growth of the posterior atlantooccipital ligament of the atlas.

It occurs in the posterior arch of the atlas with respect to the vertebral artery and is a typical structural variant of the atlas vertebrae (C1). It is an inadvertent finding obtained during lateral cephalograms performed for standard orthodontic treatment. 

The Latin term Ponticulus posticus refers to "little posterior bridge." Ponticulus is also known as arcuate foramen, retroarticular foramen, retocondylar foramen, and kimerle anomaly. All of these terms refer to the same anatomical structure. It has been observed that 16.7% of people are affected by ponticulus posticus on a global scale. According to the literature, females were more likely to experience this abnormality than males, and it did not rely on age.

Ponticulus Posticus Symptoms

Ponticulus posticus may have clinical importance because most patients with this finding also report symptoms. According to the findings of a few studies, patients who have ponticulus posticus do not have a significantly increased risk of having negative effects from cervical adjustments that are associated with the development of a posticulus posticus. However, symptoms such as migraine, vertigo, diplopia, shoulder pain, and neck pain may be related to the ponticulus posticus. These symptoms may be brought on by the compression of the vertebral artery.

Ponticulus Posticus Causes

The Ponticulus posticus is a degenerative alteration of the cervical spine that typically occurs with age. It appears as a little osteophyte at the point where the lamina and the posterior cervical vertebral body meet. It is not completely understood what causes ponticulus posticus; nevertheless, it is believed to be caused by degenerative alterations in the intervertebral disc. These alterations result in disc instability, which contributes to microtrauma of the vertebral endplates. This microtrauma results in the development of new bone, which ultimately emerges as a ponticulus posticus. Ponticulus posticus can co-exist with spondylosis or foraminal stenosis in the cervical spine, which are both degenerative alterations of the spine. Ponticulus posticus treatment typically entails conservative techniques like traction or physical therapy. In most cases, surgical intervention is unnecessary.

Ponticulus Posticus Treatment

Ponticulus posticus is normally treated with a combination of conservative and surgical measures. Non-steroidal anti-inflammatory drugs (NSAIDs) may be enough for patients with minor symptoms to lessen pain and inflammation. For more severe cases, the underlying deformity may need to be corrected surgically or with the use of a corticosteroid injection. Typically, injections only work temporarily, but surgery provides a more long-lasting fix. However, there is a higher risk of complications after surgery, such as infection and nerve injury. Before settling on a course of treatment, it is essential to have a conversation with a trained medical professional about the various options that are available.