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Lyrtzis C, Stamati A, Tsitsopoulos PP, Piagkou M, Natsis K. Thickness Asymmetry of the Vertebral Artery Groove: A Dried Vertebrae Study. Cureus 2024; 16:e58206. [PMID: 38741812 PMCID: PMC11090258 DOI: 10.7759/cureus.58206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND The vertebral artery groove (VAG), located on the posterior arch of the first cervical (atlas) vertebra plays a pivotal role in guiding the vertebral artery's (VA) third part (V3). Deviations in VAG morphology and morphometry (dimensions) can influence vascular dynamics and pose clinical implications. AIM The current study delves into the morphometric variants and explores the less-explored morphometric variable of the VAG thickness, highlighting possible laterality (asymmetry). METHODS A morphometric investigation was conducted on 141 dried atlas (73 male and 68 female) vertebrae from a Greek adult population. The VAG's minimum thickness was investigated by considering the laterality (sides' differences), gender, and age impact on it. Measurements were performed by two independent researchers, ensuring the data reliability. RESULTS A significant asymmetry was identified in the VAG thickness between the left (3.9 ± 0.9 mm) and right (4.1 ± 1.1 mm) (p=0.005) sides, with the left side having the mean minimum thickness. Gender had a significant impact on VAG thickness only on the left side, with females presenting a significantly thinner left-sided VAG (3.6 ± 0.9 mm) than males (4.10 ± 0.7 mm) (p=0.001). Age had no significant impact on the VAG thickness. Conclusion: The present study underscores the significance of asymmetry in the VAG thickness in craniocervical interventions. This less-explored morphometric variable warrants careful consideration by surgeons during preoperative planning to minimize potential complications. The current findings highlight the importance of understanding the VAG thickness asymmetry and its clinical implications, as this osseous variable may be an index of a different diameter of the VA by side. It is recommended that surgeons incorporate this variable into their preoperative assessments to improve the safety and efficacy of craniocervical interventions.
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Affiliation(s)
- Christos Lyrtzis
- Department of Anatomy and Surgical Anatomy, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Athina Stamati
- Department of Anatomy and Surgical Anatomy, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Parmenion P Tsitsopoulos
- Department of Neurosurgery, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Maria Piagkou
- Department of Anatomy and Surgical Anatomy, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Konstantinos Natsis
- Department of Anatomy and Surgical Anatomy, Aristotle University of Thessaloniki, Thessaloniki, GRC
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Pękala JR, Tempski J, Krager E, Johansen J, Łazarz DP, Walocha JA, Tubbs RS, Tomaszewski KA. Systematic review and meta-analysis of the prevalence of the retrotransverse foramen of the atlas. J Anat 2023; 243:570-578. [PMID: 37278337 PMCID: PMC10485574 DOI: 10.1111/joa.13894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 06/07/2023] Open
Abstract
The retrotransverse foramen (RTF) is a nonmetric variant of the atlas vertebra that can accommodate an anastomotic vertebral vein and occipital nerve. An understanding of this variation and its occurrence is crucial, as it could aid in explanation of the unidentified cause of the high prevalence of variability in this region. The aim of this meta-analysis was to obtain data on the prevalence of the RTF and its variations according to anatomy, sex, and ethnicity. A large-scale search was conducted through the major online databases to establish and determine the pool of studies reporting data relevant to the RTF. No date or language restrictions were applied. The data collection was categorized by prevalence, type (incomplete/complete), side, sex, ethnicity, laterality, and diameter. A total of 17 studies (n = 1979 subjects) were incorporated into our analysis. The overall pooled prevalence for a complete RTF was 11.4% and the overall pooled prevalence of an incomplete (partial) RTF was 9.6%. A complete RTF was most prevalent in Africa (Sub-Saharan population) (12.1%), followed by Europe (11.8%) and Asia (9.7%). As this variant occurs in a significant number of patients in all of the aforementioned populations, recognition, and awareness, especially with thorough investigation with computer tomography angiography (CTA) should be implemented, as it is the only possible way to visualize the possible contents of RTF.
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Affiliation(s)
- Jakub R Pękala
- International Evidence-Based Anatomy Working Group, Krakow, Poland
- The Brain and Spine Lab, Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Jonasz Tempski
- International Evidence-Based Anatomy Working Group, Krakow, Poland
- The Brain and Spine Lab, Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Eirik Krager
- International Evidence-Based Anatomy Working Group, Krakow, Poland
- The Brain and Spine Lab, Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Jacob Johansen
- International Evidence-Based Anatomy Working Group, Krakow, Poland
- The Brain and Spine Lab, Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Dominik P Łazarz
- International Evidence-Based Anatomy Working Group, Krakow, Poland
- The Brain and Spine Lab, Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Jerzy A Walocha
- International Evidence-Based Anatomy Working Group, Krakow, Poland
- The Brain and Spine Lab, Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada
- Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA
- University of Queensland, Brisbane, Australia
| | - Krzysztof A Tomaszewski
- International Evidence-Based Anatomy Working Group, Krakow, Poland
- The Brain and Spine Lab, Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
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Macrì M, Rendina F, Feragalli B, Pegreffi F, Festa F. Prevalence of Ponticulus Posticus and Migraine in 220 Orthodontic Patients: A Cross-Sectional Study. BIOLOGY 2023; 12:biology12030471. [PMID: 36979162 PMCID: PMC10045064 DOI: 10.3390/biology12030471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/26/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Ponticulus posticus (PP) is a medical term that describes an anomaly of the atlas (C1), which has a complete or partial bone bridge over the vertebral artery (VA) groove. The purpose of the study is to estimate the prevalence of PP in patients with a diagnosis of migraine. METHODS Cone beam CT (CBCT) scans (n = 220) were reviewed for the detection of PP in the University "G. D'Annunzio" of Chieti in the Department of Medical, Oral and Biotechnological Sciences. The sample included 220 Italian patients between 18 and 87 years. Pearson chi-square analysis (p < 0.05 and 95% CI) was used to establish an association between migraine and PP. RESULTS The present study found a prevalence of PP of 20.9% and a prevalence of migraine of 12.272%. The association between migraine and PP was confirmed by the chi-square statistic, since the p-value was 0.008065 (significant at p < 0.05). PP was more frequent in the migraine without aura group, without a statistical difference relative to the migraine with aura group. CONCLUSIONS The study concluded that PP is positively associated with migraine.
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Affiliation(s)
- Monica Macrì
- Department of Innovative Technologies in Medicine & Dentistry, University "G. D'Annunzio" of Chieti-Pescara, 66100 Chieti, Italy
| | - Fabiola Rendina
- Department of Innovative Technologies in Medicine & Dentistry, University "G. D'Annunzio" of Chieti-Pescara, 66100 Chieti, Italy
| | - Beatrice Feragalli
- Department of Innovative Technologies in Medicine & Dentistry, University "G. D'Annunzio" of Chieti-Pescara, 66100 Chieti, Italy
| | - Francesco Pegreffi
- Department for Life Quality Studies, University of Bologna, 40126 Bologna, Italy
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy
| | - Felice Festa
- Department of Innovative Technologies in Medicine & Dentistry, University "G. D'Annunzio" of Chieti-Pescara, 66100 Chieti, Italy
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The morphological classification and clinical significance of atlas vertebral artery sulcus based on computed tomography three-dimensional reconstruction. Surg Radiol Anat 2023; 45:241-246. [PMID: 36715709 PMCID: PMC9981493 DOI: 10.1007/s00276-023-03079-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 01/06/2023] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The purpose of this study was to research the morphological classification and clinical significance of vertebral artery sulcus on atlas based on CT three-dimensional reconstruction. METHODS Three-dimensional reconstruction images of 300 adult atlases were collected. A total of 600 atlas vertebral artery sulci were selected in this study. The parameters required for placement of C1 pedicle screw, including depth of grinding drilling (ao), width (cd), length ab), height (H), lateral wall thickness (L1), inner wall thickness (L2), medial angle (∠α), and the cephalad angle to the transverse plane of atlas pedicle (∠β), were measured. RESULTS CT three-dimensional reconstruction images showed that there were five types of atlas vertebral artery sulci: no process type (n = 494 cases, 82.33%), upper process type (n = 29, 4.83%), lower process type (n = 25, 4.17%), double process type (n = 19, 3.17%), and posterior ring type (33, 5.50%). One-way ANOVA tests showed that the five groups differed significantly in the parameter of ao, L2, H, ∠α and ∠β. One-way ANOVA with the LSD post hoc tests showed that the parameter ao of the group of no process type was less than that of the group of upper or lower process type (P < 0.05), and ao of the group of lower process or posterior ring type was less than that of the group of the upper type (P < 0.05). The parameter of ao of the male group was larger than that of the female group. CONCLUSION No process type of the atlas vertebral artery sulcus was the most common, and the medial angle and cephalad angle of the atlas pedicle in this type were the smallest. When pedicle screws are inserted, the above two angles should not be too large. Male's ao was larger than that of female's. All these findings should be considered to avoid the deviation of the nail track.
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Güvercin Y, Yaylacı M, Dizdar A, Kanat A, Uzun Yaylacı E, Ay S, Abdioğlu AA, Şen A. Biomechanical analysis of odontoid and transverse atlantal ligament in humans with ponticulus posticus variation under different loading conditions: Finite element study. Injury 2022; 53:3879-3886. [PMID: 36229242 DOI: 10.1016/j.injury.2022.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 09/22/2022] [Accepted: 10/05/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE Ponticulus posticus (PP) is a variation of the bone bridge that appears in the first cervical vertebra and through which the vertebral artery passes. Odontoid fractures are common spinal bone fractures in older people. This study aims to investigate the effect of neck movements on the odontoid and transverse atlantal ligament (TAL) of people with PP variation from a biomechanical view. METHOD C1, C2, and C3 vertebrae of the occipital bone were analyzed using the finite element method (FEM). In this study, solid models were created with the help of normal (N), incomplete (IC), and asymmetric complete (AC) PP tomography images. The necessary elements for the models were assigned, and the material properties were defined for the elements. As boundary conditions, models were fixed from the C3 vertebra, and 74 N loading was applied from the occipital bone. Stress and deformation values in the odontoid and transverse atlantal ligament were obtained by applying 1.8 Nm moment in flexion, extension, bending, and axial rotation directions. RESULTS The stress and deformation values of all three models in odontoid and TAL were obtained, and numerical results were evaluated. In all models, stress and deformation values were obtained in decreasing order in rotation, bending, extension, and flexion movements. The highest stress and strain values were obtained in AC and the lowest values were obtained in N. In all movements of the three models, the stress and deformation values obtained in the TAL were lower than in the odontoid. CONCLUSION The greatest stresses and deformations obtained in spines (AC) with PP were found in the odontoid. This may help explain the pathogenesis of odontoid fractures in older people. First, this study explains the mechanism of the formation of neck trauma in people with PP and the need for a more careful evaluation of the direction of impact. Secondly, the study reveals that the rotational motion of the neck independent of PP has more negative effects on the odontoid.
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Affiliation(s)
- Yılmaz Güvercin
- Trabzon Kanuni Training and Research Hospital, Department of Orthopaed & Traumatol, 61000 Trabzon, Turkey.
| | - Murat Yaylacı
- Recep Tayyip Erdogan University, Biomedical Engineering MSc Program, 53100 Rize, Turkey; Recep Tayyip Erdogan University, Department of Civil Engineering, 53100 Rize, Turkey.
| | - Ayberk Dizdar
- Kocaeli University, Department of Biomedical Engineering, 41380 Kocaeli, Turkey.
| | - Ayhan Kanat
- Recep Tayyip Erdogan University, Department of Neurosurgery, 53100 Rize, Turkey.
| | - Ecren Uzun Yaylacı
- Karadeniz Technical University, Surmene Faculty of Marine Science, 61530 Trabzon, Turkey.
| | - Sevil Ay
- Department of Civil Engineering, Artvin Coruh University, 08100 Artvin, Turkey.
| | | | - Ahmet Şen
- University of Health Sciences, Trabzon Kanuni Training and Research Hospital, Anesthesiaa and Reanimation Department, 61100 Trabzon, Turkey.
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Najmuddin M. Prevalence of ponticulus posticus on the posterior arch of the atlas in symptomatic and asymptomatic patients. Oral Radiol 2022; 38:527-533. [PMID: 35088221 DOI: 10.1007/s11282-021-00583-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 12/16/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To calculate the prevalence of ponticulus posticus and its association with headache. METHODS The presence and types of ponticulus posticus were investigated on 640 digital lateral cephalograms. Patients with complete or partial ponticulus posticus were further evaluated and questioned for a history of cervicogenic headache. Dissemination of attain values was analyzed using a Chi-Square test, and p values < 0.05 were considered statistically significant. RESULTS The prevalence of ponticulus posticus in our study was 9.8%, with complete form in 45 (7%) patients of which 29 (64.5%) were male and 16 (35.5%) were female. Partial ponticulus posticus was found in 18 (2.8%) of patients, of which 12 (66.6%) patients were male and six (33.33%) were female. In patients with the complete form of ponticulus posticus, 37 (82.22%) were symptomatic. Among these 37 patients, 22 (59.45%) were male and 15 (40.54%) were female. In complete ponticulus posticus patients, symptoms were slightly worse in males than females. Whereas in partial ponticulus posticus, 13 (72.22%) patients were found to be symptomatic. Of these 13 patients, seven (53.84%) were male and six (46.15%) were female. Of the 72 patients with a history of cervical pain, 50 (69.44%) showed ponticulus posticus on a lateral cephalogram. Of the 568 patients with no history of cervical pain, only 13 (2.2%) showed ponticulus posticus on the lateral cephalogram. CONCLUSION This study examination showed that ponticulus posticus is a common anatomic variation often associated with tension-type headaches.
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Affiliation(s)
- Mohammed Najmuddin
- Department of Maxillofacial Dental Sciences, College of Dentistry, Jazan University, Jazan, Kingdom of Saudi Arabia.
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Xu X, Zhu Y, Ding X, Yin M, Mo W, Ma J. Research Progress of Ponticulus Posticus: A Narrative Literature Review. Front Surg 2022; 9:834551. [PMID: 35392059 PMCID: PMC8980277 DOI: 10.3389/fsurg.2022.834551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/17/2022] [Indexed: 11/13/2022] Open
Abstract
Study DesignNarrative review.ObjectiveThe purpose of this review was to consolidate the current literature related to ponticulus posticus (PP) and to improve the systematic understanding of this anatomical variant of atlas among spine surgeons.MethodsArticles reviewed were searched in PubMed, Ovid MEDLINE, and Embase. All articles of any study design discussing on PP were considered for inclusion. Two independent authors read article titles and abstracts and included appropriate articles. The relevant articles were studied in full text.ResultsA total of 113 literatures were reviewed and consolidated in this narrative review. These articles are roughly divided into the following five subcategories: (1) epidemiology, (2) pathology and anatomy, (3) clinical presentation, (4) surgical significance, and (5) radiographic examination.ConclusionThe PP is non-negligible with a high prevalence. The PP compresses the V3 segment of the artery, the suboccipital nerve, and the venous plexus, consequently contributing to the incidence of neurological pathologies. When a PP is observed or suspected on a lateral radiograph, we recommend that a computed tomography (CT) scan of a patient who is about to receive a C1 lateral mass screw (C1LMS) should be performed, which could determine a safe entry point and the right trajectory of screw insertion.
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Affiliation(s)
- Xiaoyan Xu
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yuefeng Zhu
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Department of Orthopaedics, Huadong Hospital, Fudan University, Shanghai, China
| | - Xing Ding
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Department of Orthopaedics, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Mengchen Yin
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Department of Orthopaedics, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: Mengchen Yin
| | - Wen Mo
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Department of Orthopaedics, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Wen Mo
| | - Junming Ma
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Department of Orthopaedics, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Junming Ma
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Accuracy of patient-specific drill guide template for bilateral C1-C2 laminar screw placement: a cadaveric study. World Neurosurg 2022; 162:e225-e234. [PMID: 35259502 DOI: 10.1016/j.wneu.2022.02.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/27/2022] [Accepted: 02/28/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the accuracy of using patient-specific drill guides to place bilateral laminar screws in C1 and C2. METHODS Nine cervical specimens (8 male; mean age: 66.6 (56-73)) with the occiput attached (C0-C3) were used in this study. Pre-operative CT scans were used to create digital anatomic models for templating and guide creation. A total of 36 screws were placed with the aid of 3D printed patient-specific guides (2 screws at C1 and C2). Post-operative CT scans were performed following screw insertion. The planned and actual trajectories were compared using pre- and post-operative imaging based on the angular and entry point deviation. After screw placement and post-operative imaging, each specimen was dissected and performed a visual inspection for breaches. RESULTS No breaches or violations were observed on post-procedure CT and visual inspection. The average variation of the entry point in the X, Y, and Z-axis was 0.3±0.28, 0.41±0.38, and 0.29±0.24, respectively. No statistically significant difference (p>0.05) was observed between the planned and obtained entry points. There was no significant difference (p>0.05) in the deviation analysis between the planned and obtained angles in the axial and coronal planes. CONCLUSION The study demonstrates that patient-specific drill guides allow for accurate C1 and C2 bilateral laminar screw placement, with a low risk of cortical breach.
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Aksoy S, Yalcin B. Morphometric Anatomy of the Posterior Aspect of the Atlas and the Vertebral Artery Groove in Relation to Lateral Mass Screw Placement. J Neurol Surg A Cent Eur Neurosurg 2021; 84:227-233. [PMID: 34929748 DOI: 10.1055/s-0041-1739214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Atlantoaxial instability is an important disorder that causes serious symptoms such as difficulties in walking, limited neck mobility, sensory deficits, etc. Atlantal lateral mass screw fixation is a surgical technique that has gained important recognition and popularity. Because accurate drilling area for screw placement is of utmost importance for a successful surgery, we aimed to investigate morphometry of especially the posterior part of C1. METHODS One hundred and fifty-eight human adult C1 dried vertebrae were obtained. Measurements were performed directly on dry atlas vertebrae, and all parameters were measured by using a digital caliper accurate to 0.01 mm for linear measurements. RESULTS The mean distance between the tip of the posterior arch and the medial inner edge of the groove was found to be 10.59 ± 2.26 and 10.49 ± 2.20 mm on the right and left, respectively. The mean distance between the tip of the posterior arch and the anterolateral outer edge of the groove was 21.27 ± 2.28 mm (right: 20.96 ± 2.22 mm; left: 21.32 ± 2.27 mm). The mean height of the screw entry zone on the right and left sides, respectively, were 3.86 ± 0.81 and 3.84 ± 0.77 mm. The mean width of the screw entry zone on both sides was 13.15 ± 1.17 and 13.25 ± 1.3 mm. CONCLUSION Our result provided the literature with a detailed database for the morphometry of C1, especially in relation to the vertebral artery groove. We believe that the data in the present study can help surgeons to adopt a more accurate approach in terms of accurate lateral mass screw placement in atlantoaxial instability.
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Affiliation(s)
- Selda Aksoy
- Department of Anatomy, University of Health Sciences Gulhane Health Sciences Institute, Gulhane Medical Faculty, Ankara, Turkey
| | - Bulent Yalcin
- Department of Anatomy, University of Health Sciences Gulhane Health Sciences Institute, Gulhane Medical Faculty, Ankara, Turkey
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Xing XH, Zhang AM, Adu IK, Huang MH, Cui G. Arterial Vascular Structures Running Through Retrotransverse Foramen and Retrotransverse Groove of the Atlas Vertebrae. World Neurosurg 2021; 154:e416-e420. [PMID: 34293524 DOI: 10.1016/j.wneu.2021.07.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 07/12/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Retrotransverse foramen (RTF) and retrotransverse groove (RTG) are anatomic variations of the atlas (C1) vertebrae. RTF contains an anastomotic vein connecting atlanto-occipital and atlanto-axodian venous sinuses. The purpose of this study was to analyze the arterial vascular structures running though the RTF and RTG. METHODS Three-dimensional volume rendered computed tomography angiography (3D VR CTA) images of 427 patients (264 men, 163 women; age 17-87 years) were reviewed and evaluated using the RadiAnt DICOM Viewer (version 5.0.2; Medixant, Poznan, Poland). The incidence of RTF or RTG, the incidence of the V3 segment of vertebral artery variants, and the artery vascular structures inside the RTF and RTG anatomic variation of C1 were analyzed. RESULTS Fifty (11.7%) atlases presented RTF anatomical variant; 113 (26.5%) atlases presented RTG anatomical variants. The incidence of the V3 segment of vertebral artery variants was 0.94% (4 of 427). Three (0.7%) were persistent first intersegmental artery and 1 (0.2%) was the fenestration of the vertebral artery on left side. In 4 cases of C1 vertebral artery V3 segmental variants, there were no RTF and RTG. No artery vascular structure was found in RTF or RTG. CONCLUSIONS The RTF or RTG of C1 was a common anatomical variant. No arterial vascular structure runs though the RTF or RTG. The presence of C1 RTF and RTG variants had no effect on the V3 segmental course of the vertebral artery. Preoperative understanding of these variations using 3D CTA are helpful for the safe execution of the upper cervical posterior approach surgeries.
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Affiliation(s)
- Xi-Hong Xing
- Department of Neurosurgery, First Affiliated Hospital of Soochow University, Suzhou, China; Department of Neurosurgery, Second Hospital of Jingzhou, Affiliated Hospital of Hubei College of Chinese Medicine, Jingzhou, China
| | - Ai-Ming Zhang
- Department of Neurosurgery, Second Hospital of Jingzhou, Affiliated Hospital of Hubei College of Chinese Medicine, Jingzhou, China
| | - Isaac Kumi Adu
- Department of Neurosurgery, Second Hospital of Jingzhou, Affiliated Hospital of Hubei College of Chinese Medicine, Jingzhou, China; Health Science Center, Yangtze University, Jingzhou, China
| | - Man-Hua Huang
- Department of Radiology, First People's Hospital of Jingzhou City, Affiliated Hospital of Yangtze University, Jingzhou, China
| | - Gang Cui
- Department of Neurosurgery, First Affiliated Hospital of Soochow University, Suzhou, China.
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Burtsev AV, Sergeenko OM, Gubin AV. An alternative way of C1 screwing: Supralaminar C1 lateral mass screws. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2021; 12:191-196. [PMID: 34194167 PMCID: PMC8214239 DOI: 10.4103/jcvjs.jcvjs_45_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 04/05/2021] [Indexed: 11/18/2022] Open
Abstract
Study Design: This study involves literature review, technical note, and case series. Objectives: The objectives were to analyze indications and contraindications, advantages, and disadvantages for C1 lateral mass screw (LMS) insertion above or partially above the arch, to descript technical features, and to give examples of the practical application of this technique and investigated its safety. Methods: A literature review was carried out in English and Russian in PubMed, Google Scholar, and eLibrary databases. We selected four patients, treated in our clinic, which was carried out partially supralaminar C1 LMS. Results: Only three descriptions of supralaminar C1 LMS were found in the literature. Four adult patients underwent posterior C1–C2 screw fixation with C1 LMS along the superior edge of the C1 arch at our clinic. Partially supralaminar C1 screws were inserted on one of the sides due to the difficulties of using classical techniques. The main reasons for supralaminar screw fixation were narrow C1 lamina, hypertrophied venous plexus, and intraoperative failures of classic techniques application (broken screw trajectory, profuse venous bleeding from the plexus). The average follow-up time for the patients was 2.7 years, no complications were noted, and all had a satisfactory spinal fusion. Conclusions: The proposed types of C1 LMS above or partially above the C1 arch can be useful alternative method of C1 screwing in selected patients. Indications for the use of the supralaminar C1 LMS method can be narrow C1 posterior arch and pedicle, pronounced C1-C2 venous plexus, some V3 segment anomalies at C1 level, small arthritic inferior part of lateral mass, and intraoperative failures of classic techniques application.
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Affiliation(s)
| | | | - Alexander V Gubin
- National Medical Research Center for Traumatology and Orthopedics named after N.N. Priorov, Moscow, Russia
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Xing XH, Huang MH, Adu IK, Wang JC, Cui G. Retrotransverse Foramen and Retrotransverse Groove Anatomic Variations of the Atlas Vertebra in the Chinese Population. World Neurosurg 2021; 152:e193-e200. [PMID: 34052448 DOI: 10.1016/j.wneu.2021.05.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/15/2021] [Accepted: 05/17/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To analyze the prevalence of retrotransverse foramen (RTF) or retrotransverse groove (RTG) anatomic variations in Chinese atlas vertebra (C1). METHODS Three-dimensional volume-rendered computed tomography angiography images of 427 subjects (264 males, 163 females; 17-87 years old) were reviewed and evaluated using dedicated software. The prevalence of RTF and RTG anatomic variation of C1 was analyzed. RESULTS RTF anatomic variants were present in 50 (11.7%) atlases. Bilateral RTF, unilateral left RTF, and unilateral right RTF were present in 16 (3.8%), 20 (4.9%), and 14 (3.3%) vertebrae. Comparison between males and females revealed differences in bilateral RTF (P = 0.010) and unilateral left RTF (P = 0.008). RTG anatomic variants were present in 113 (26.5%) atlases. Bilateral RTG, unilateral left RTG, and unilateral right RTG were present in 39 (9.1%), 30 (7.0%), and 44 (10.3%) vertebrae. Comparison between males and females revealed differences in RTG (P = 0.000), bilateral RTG (P = 0.006), and unilateral left RTG (P = 0.034). RTF was detected in 36 cases on the left and 30 cases on the right. RTG was detected in 69 cases on the left and 79 cases on the right. There were no side differences in the prevalence of RTF and RTG. CONCLUSIONS The incidence of RTG is higher than the incidence of RTF. Incidence of bilateral RTF, bilateral RTG, unilateral left RTF, unilateral left RTG, and RTG differed between males and females. Preoperative understanding of these variations using three-dimensional computed tomography angiography is helpful for safe execution of upper cervical posterior approach surgery.
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Affiliation(s)
- Xi-Hong Xing
- Department of Neurosurgery, the First Affiliated Hospital of Soochow University, Suzhou, China; Department of Neurosurgery, the Second Hospital of Jingzhou & the Affiliated Hospital of Hubei College of Chinese Medicine, Jingzhou, China
| | - Man-Hua Huang
- Department of Radiology, the First Hospital of Jingzhou, Affiliated Hospital of Yangtze University, Jingzhou, China
| | - Isaac Kumi Adu
- Department of Neurosurgery, the Second Hospital of Jingzhou & the Affiliated Hospital of Hubei College of Chinese Medicine, Jingzhou, China; Health Science Center, Yangtze University, Jingzhou, China
| | - Jian-Cheng Wang
- Department of Radiology, the Second Hospital of Jingzhou & the Affiliated Hospital of Hubei College of Chinese Medicine, Jingzhou, China
| | - Gang Cui
- Department of Neurosurgery, the First Affiliated Hospital of Soochow University, Suzhou, China.
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