Atlas (C1)

The atlas (C1) is unique among vertebrae because it has no vertebral body and no spinous process. Instead, it consists of an anterior arch, a posterior arch, and two lateral masses. The superior surfaces of the lateral masses bear concave facets that articulate with the occipital condyles of the skull, forming the atlanto-occipital joint responsible for nodding movements of the head.

The atlas facilitates two key movements. The atlanto-occipital joint (between C1 and the skull base) primarily allows flexion and extension — the 'yes' nodding movement. The atlantoaxial joint (between C1 and C2) is a pivot joint that allows approximately 50% of total cervical rotation — the 'no' shaking movement. Together, these joints provide most of the neck's range of motion.

The most common atlas fracture is a Jefferson fracture, a burst fracture caused by axial loading (vertical compression), typically from a diving accident or a blow to the top of the head. The force causes the occipital condyles to drive down onto the lateral masses of C1, splitting the ring at its weakest points. Jefferson fractures may be stable or unstable depending on whether the transverse ligament is intact.