What is the anatomy of the cervical spine relevant to C2 fractures?

Updated: Nov 21, 2018
  • Author: Igor Boyarsky, DO, FACEP, FAAEM; Chief Editor: Jeffrey A Goldstein, MD  more...
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The unique features of C2 anatomy and its articulations make assessment of its pathology challenging. The odontoid process (dens) is a vertical projection that lies just posterior to the anterior arch of C1, has ligamentous attachments to the skull base, and articulates with C1 (atlas).

The C1-C2 articulation (ie, atlantoaxial articulation) is made up of three joints, including the central atlantoaxial joint and the paired lateral atlantoaxial joints. These joints allow rotation of C1 on C2.

The transverse ligament of the atlas stabilizes the central atlantoaxial joint, and, together with the odontoid process, acts as a restraint against horizontal displacement of the atlas. The dentate ligament attaches the apex of the odontoid process to the clivus and the paired alar ligaments, which originate from the transverse ligament and attach to the anterolateral rim of the foramen magnum. These ligaments provide rotational and translational stability.

The lateral atlantoaxial joints articulate at the superior articular facets of C2 and the inferior articular facets of C1. C2 also is composed of inferior facets, pedicles, transverse processes, and a spinal process.

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