The vertebral artery, in its course from the subclavian artery
to the basilar artery, is vulnerable to damage or distortion
from external factors such as bony, ligamentous or muscular
structures (Mehalic & Farhat, 1974; Parkin et al. 1978;
Schellhas et al. 1980; Braun et al. 1983; Dunne et al. 1987;
Fast et al. 1987). In the atlas vertebra, the retroarticular
canal and the lateral bridge are examples of bony outgrowth
or exostosis which may cause external pressure on the
vertebral artery as it passes from the foramen transversarium
of the vertebra to the foramen magnum of the skull. If this
pressure is severe enough, as may occur during the extreme
rotatory movements carried out during therapeutic manipulation
of the cervical spine, the vertebral artery may be
compressed (Lamberty & Zivanovich, 1973), reducing its
cross-sectional area, and compromising its blood flow (Taitz
& Nathan, 1986). Vertebrobasilar ischaemia from compression of
the vertebral arteries by osteophytes is an
uncommon occurrence under normal circumstances
(Warlow, 1996).
There are few studies of the lateral bridge of the atlas
reported in the literature (MacAlister, 1869, 1893; Lamberty
& Zivanovic, 1973; Saunders & Popovich, 1978; Taitz &
Nathan, 1986). The lateral bridge was first described by
MacAlister (1869, 1893) as a variety of the ‘posterior
glenoid process’ (the retroarticular canal), which he termed
the ‘gleno-transverse bony arch’. As its name implies, it is
a
lateral outgrowth of bone from the superior articular facet
or lateral mass to the posterior root of the transverse process
of the atlas (MacAlister, 1869, 1893; Lamberty & Zivanovic,
1973; Saunders & Popovich, 1978; Taitz & Nathan, 1986).
The retroarticular canal is formed by an exostosis passing
from the posterior surface of the lateral mass to the
posterior margin of the vertebral artery groove of the atlas.
Thus the lateral bridge forms another arch, secondary to the
retroarticular canal, through which the vertebral artery
must pass (MacAlister, 1869).