Sacralization is not associated with elongated cervical costal process and cervical rib

Lumbarization and sacralization: Domains of their co-occurrence with other costal-vertebral transformations are not identical

OBJECTIVES

This study evaluates whether sacralization of a lumbar vertebra and lumbarization of a sacral vertebra are a paired duality but with opposite expressions; the former is associated with 23 presacral vertebrae (PSV) and the latter with 25 PSV. Are sacralization and lumbarization local phenomena, involving only vertebra (V) 24 and V25, or are they associated with other costal-vertebral transformations?

MATERIALS AND METHODS

Study sample is of skeletonized humans, 431 females and 1405 males, who were 20-49 years of age-at-death and who died in the United States in the 20th and 21st centuries. Data collected are numbers of PSV and sacral vertebrae, presence of rib of V7, position of diaphragmatic vertebra, and transverse process and rib lengths of V5-V9, V18-V19, and V21-V22.

RESULTS

Females and males differ significantly in numbers of PSV. Both sexes show significant differences among individuals with 23 PSV, 24 PSV, and 25 PSV: (1) individuals with 23 PSV have the shortest ribs, whereas those with 25 PSV have the longest ribs, of V18 and V19; and (2) individuals with 23 PSV have the highest frequency of 6 sacral vertebrae, whereas those with 25 PSV have the highest frequency of 5 sacral vertebrae.

DISCUSSION

Individuals with 23 PSV and 25 PSV show posterior and anterior homeotic transformation, respectively, of the thoracic-lumbar and lumbar-sacral boundaries, but only individuals with 25 PSV show transformation of the sacral-coccygeal boundary. As co-occurring costal-vertebral transformations differ between sacralization and lumbarization, inferentially the set of genes that influences these vertebrae also differs.

If you look this way, you will see it: cranial shift in adolescent idiopathic scoliosis

INTRODUCTION

Anatomical variations in the spine can be seen in each transitional border, either toward the skull as 'cranial shifts' or away as caudal shifts. Cranial shifting (CS) occurs when there is presence of occipitalization, C7 cervical costae or prominent transverse processes, thoracolumbar transitional vertebrae (TLTV) at T12 level, L5 sacralization, and sacrococcygeal fusion. We termed the coexistence of sacralization of L5 and absence or remarkable reduction of T12 rib size in AIS as Abul cranial shift (ACS). In this descriptive clinical study, primary aim was to investigate the incidence of ACS in AIS.

METHODS

Retrospective analysis of 187 surgically treated AIS cases was performed. Demographic data were recorded. The incidence of the specific set of anatomic variations including lumbosacral transitional vertebrae, TLTV, transverse process changes in C7 vertebrae, and posterior lumbosacral neural arch cleft formations (NACf) were evaluated in the radiological images.

RESULTS

36 (19%) of 187 cases had ACS. ACS was detected in only 1 of 19 male cases (5%), while in 35 of 168 female cases (21%). Forty-one cases had sacralization of L5 (22%). There were only eleven pair of ribs in 14 (7%) of 187 cases and 10 (28%) of 36 ACS cases. Forty cases had NACf (21%). ACS and NACf coexistence were observed in 8 (22%) of 36 ACS cases.

CONCLUSION

Accurate spinal column assessment is critical in adolescent idiopathic scoliosis (AIS). ACS may be observed in up to one in five AIS cases and its presence should not be neglected to avoid wrong level surgery.

Congenital malformations in the vertebral column: associations and possible embryologic origins

Cases of associations between random spinal congenital defects have previously been reported, yet several questions remain unanswered. Firstly, why are associations between what seems to be random combinations of vertebral malformations observed? Secondly, is there a common event or pattern that connects the associated defects? Therefore, this study aimed to identify congenital defects in the vertebral column and also to determine whether any associations, if present, between vertebral malformations exist. This article consequently discusses the possible embryological disruptions that may lead to the formation of various defects in the vertebral column. A random skeletal sample (n=187) was selected from the Pretoria Bone Collection housed in the Department of Anatomy, University of Pretoria (Ethics 678/2018). The sample was evaluated to determine the frequencies of spinal congenital defects in each set of remains. Identifiable congenital malformations were observed in 48.1% (n=90/187) of the sample. The results demonstrated a high probability of association between the different defects observed in the vertebral column. Findings are of value as they provide a reasonable explanation to why seemingly random cases of associations have been reported by several authors. This study is clinically relevant as severe spinal defects have been shown to have high morbidity in patients and mortality in infants.

Cervical Rib Synostosis to the First Rib: A Rare Anatomic Variation

BACKGROUND

Congenital anatomic variations exist in human anatomy, which create both diagnostic and treatment challenges. Understanding the osteologic and radiographic anatomy of supernumerary ribs arising from the cervical spine and recognizing the morphologic variations thereof is of great importance to clinicians, radiologists, and surgeons alike.

CASE DESCRIPTION

This case study describes osteologic morphology and radiologic characteristics of a rare anatomic variant of a cervical rib (CR): a unilateral, right-sided CR synostosis to the first thoracic rib of a 50-year-old South African man of African ancestry. The characteristic features included increased angulation, widening of the body, and shortening of the length of the right-sided first thoracic rib. The synostosis of the CR shaft was at the level of the angle of the first thoracic rib. The widest aspect of the first thoracic rib was close to the site of fusion, namely the angle, with the mediolateral length approximately 34.51 mm. This is in contrast to the contralateral first thoracic rib measuring, at its widest, 26.39 mm. The CR was located approximately 3.34 mm superiorly to the first thoracic rib at the cervical articular facet. The CR presented with a well-defined head, which is small and rounded with the inclusion of an articular facet. Thereafter, it presented with a short neck, just over half the length of the inferiorly placed first thoracic rib, and a similar sized articulating facet at the tubercle. The appearance of the trabecular bone pattern on radiographs is in keeping with the contralateral left first rib, although altered in accordance with the gross osteologic appearance described earlier. Furthermore, the radiographs highlight an elliptical lucent-zone within the trabecular bone demonstrating decreased density centrally with a thin rim of sclerotic cortical bone peripherally. This is consistent with classical rib architecture in cross-section representing the CR shaft site of fusion to the first thoracic rib. The CR synostosis to the first thoracic rib represents a novel complex, termed by the authors as a cervicothoracic rib complex.

CONCLUSION

The present report refers to the osteologic and radiographic description and comparison of a unilateral, right-sided CR synostosis to a first thoracic rib. The clinical implications of CRs may consist of neurologic, vascular complications, and functional deficits of the involved limb associated with thoracic outlet syndrome (TOS). A CR synostosis to the first thoracic rib represents an associated increased risk of vascular injury, with poorer operative outcomes associated with TOS. This case study is of particular importance to vascular surgeons and neurosurgeons involved with surgical planning and intervention strategies relating to CRs and TOS.

Cervical Rib Prevalence and its Association with Thoracic Outlet Syndrome: A Meta-Analysis of 141 Studies with Surgical Considerations

BACKGROUND

Cervical ribs (CR) are supernumerary ribs that arise from the seventh cervical vertebra. In the presence of CR, the boundaries of the interscalene triangle can be further constricted and result in neurovascular compression and thoracic outlet syndrome (TOS). The aim of our study was to provide a comprehensive evidence-based assessment of CR prevalence and their association with TOS as well as surgical approach to excision of CR and surgical patients' characteristics.

METHODS

A thorough search of major electronic databases was conducted to identify any relevant studies. Data on the prevalence, laterality, and side of CR were extracted from the eligible studies for both healthy individuals and patients with TOS. Data on the type of TOS and surgical approach to excision of CR were extracted as well.

RESULTS

A total of 141 studies (n = 77,924 participants) were included into the meta-analysis. CR was significantly more prevalent in patients with TOS than in healthy individuals, with pooled prevalence estimates of 29.5% and 1.1%, respectively. More than half of the patients had unilateral CR in both the healthy and the TOS group. The analysis showed that 51.3% of the symptomatic patients with CR had vascular TOS, and 48.7% had neurogenic TOS. Most CR were surgically excised in women using a supraclavicular approach.

CONCLUSIONS

CR ribs are frequent findings in patients with TOS. We recommended counseling asymptomatic patients with incidentally discovered CR on the symptoms of TOS, so that if symptoms develop, the patients can undergo prompt and appropriate workup and treatment.

Proximate cause, anatomical correlates, and obstetrical implication of a supernumerary lumbar vertebra in humans

OBJECTIVES

Three issues are considered on variation in number of presacral vertebrae (PSV) in humans: (1) sexual difference in number of PSV, (2) inactivation of Hoxd-11 gene as etiology for a supernumerary lumbar vertebra, and (3) anatomical correlates of a supernumerary lumbar vertebra, including lumbar-sacral nearthrosis, and pelvic size.

MATERIALS AND METHODS

Sample was 407 skeletonized females and 1,318 males from United States; ages at death were 20 to 49 years. Two subsamples of males were used: (1) 98 with modal numbers of cervical, thoracic, lumbar, and sacral vertebrae (PSV = 24) and (2) 45 with a supernumerary lumbar vertebra but modal numbers for other vertebral segments (PSV = 25). Measurements were taken of ulna, second metacarpal, vertebrae, femur, and pelvis; presence of lumbar-sacral nearthrosis was observed.

RESULTS

Although 90% of females and males have 24 PSV, females have higher frequency of 23 PSV and males have higher frequency of 25 PSV. Compared to males with 24 PSV, males with 25 PSV and supernumerary lumbar vertebra show (1) no difference in anatomies associated with inactivation of Hoxd-11, and (2) higher frequency of lumbar-sacral nearthrosis and smaller pelvic inlet circumference.

DISCUSSION

Sexual difference in number of PSV may be due to tempo of somite formation and Hox gene activation. Hypothesis is not supported that a supernumerary lumbar vertebra is due to inactivation of Hoxd-11. The presence of a supernumerary lumbar vertebra is associated with small pelvic inlet circumference, which can be obstetrically disadvantageous.

Prevalence of C7 level anomalies at the C7 level: an important landmark for cervical nerve ultrasonography

BACKGROUND

Recently, various examination and intervention techniques using cervical nerve ultrasonography have been developed. The specific shapes of the C7 transverse process and vertebral artery in front of the C7 transverse process have become landmarks.

PURPOSE

To determine the prevalence of anomalies and anomalous vertebral artery entrances at the C7 transverse process.

MATERIAL AND METHODS

The records of patients who underwent plain or contrast-enhanced neck or cervical spine computed tomography (CT) were reviewed. The examinations were scored for the anomalous presence of anterior tubercles or cervical ribs as well as vertebral artery entrances in the C7 transverse process. The prevalence of anomalies was compared based on patient sex and age.

RESULTS

Evaluating the examinations from 2067 patients (1046 men; 1021 women), 1% of patients exhibited an anomalous presence of anterior tubercles, and 0.3% of patients displayed cervical ribs at the C7 transverse process. The prevalence of anomalies process was significantly higher in men aged less than 40 years than in older men (P < 0.001), whereas the prevalence was not higher in women aged less than 40 years than in older women. The prevalence of vertebral artery entry into the C7 transverse foramen was 0.6%.

CONCLUSION

Although an anomalous vertebral artery entry into the C7 transverse foramen was rare, the prevalence of an anomaly at the C7 transverse process was higher in men aged less than 40 years. Therefore, we recommend performing CT in younger men before cervical nerve ultrasonographic intervention to avoid misinterpretations at the cervical level.