Our present longitudinal,
retrospective study was carried out over a period of a year - 2012 - in the Radiology Department of the Integrated Ambulatory Service Care of the Infectious Disease Clinic in Cluj - Napoca.
The protocol was approved by the institutional review board of our institution.
We included 462 patients,
276 women,
186 men,
with ages between 4 and 90 years,
who underwent cervical spine radiographs for other symptoms than due to this variant.
The main symptoms in the adult population who referred to our service were chronic neck pain and headache.
Children mostly underwent lateral cervical spine radiographs after traumatic events.
Only the radiographs of patients with clearly visible skull base and no history of craniocervical operation were included in the study.
The radiographs were obtained by conventional X-ray equipment.
The X-ray exposure parameters were73 kV and 12 mA.
Films were
processed automatically with a computed radiograph system and interpreted on a flat screen.
Each radiograph was carefully inspected to look for the presence of a ponticulus posticus and arcuate foramen.
The complete type was defined as a clear bony bridge between the superior articular process and the posterior arch of the atlas,
whereas the partial type included partial posterior ponticuli,
noted as distinct bony spicule extending from the superior articular facet overhanging the dorsal arch.
Because we inspected only a neutral lateral radiograph,
we were not able to determine in all cases on which side ponticulus posticus occurs more often.
Besides the incidence and type of ponticulus posticus,
its distribution by age and gender was also analyzed.
We could not specify that the prevalence of ponticuli in the patients we analyzed would represent that of the normal Romanian population,
because the studied patients addressed our service for certain complaints,
leaving the asymptomatic patients out of the study.