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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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2
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Li G, Wang Q, Wang G. Torticollis, Facial Asymmetry, Local Pain, and
Barré‐Liéou
Syndrome in Connection with
One‐Sided
Ponticulus Posticus: A Case Report and Review of the Literature. Orthop Surg 2022; 14:1235-1240. [PMID: 35466518 PMCID: PMC9163971 DOI: 10.1111/os.13267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 03/16/2022] [Accepted: 03/21/2022] [Indexed: 11/27/2022] Open
Affiliation(s)
- Guangzhou Li
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University Luzhou China
| | - Qing Wang
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University Luzhou China
| | - Gaoju Wang
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University Luzhou China
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3
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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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Sanchis-Gimeno JA, Palancar CA, García-Martínez D, Radovčić D, Bastir M. Response to Letter to the Editor by Dr Rios and Dr Cardoso. J Anat 2020; 237:1189-1191. [PMID: 32794174 DOI: 10.1111/joa.13267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/05/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Juan Alberto Sanchis-Gimeno
- Giaval Research Group, Department of Anatomy and Human Embryology, Faculty of Medicine, The University of Valencia, Valencia, Spain
| | - Carlos A Palancar
- Department of Paleobiology, Paleoanthropology Group, Museo Nacional de Ciencias Naturales (CSIC), Madrid, Spain.,Department of Palaeontology, Faculty of Geology, Universidad Complutense de Madrid, Madrid, Spain.,Department of Biology, Faculty of Sciences, Universidad Autónoma de Madrid, Madrid, Spain
| | - Daniel García-Martínez
- Department of Paleobiology, Paleoanthropology Group, Museo Nacional de Ciencias Naturales (CSIC), Madrid, Spain.,Centro Nacional de Investigación sobre la Evolución Humana, Burgos, Spain
| | - Davorka Radovčić
- Department of Geology and Paleontology, Croatian Natural History Museum, Zagreb, Croatia
| | - Markus Bastir
- Department of Paleobiology, Paleoanthropology Group, Museo Nacional de Ciencias Naturales (CSIC), Madrid, Spain
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Palancar CA, García-Martínez D, Radovčić D, Llidó S, Mata-Escolano F, Bastir M, Sanchis-Gimeno JA. Krapina atlases suggest a high prevalence of anatomical variations in the first cervical vertebra of Neanderthals. J Anat 2020; 237:579-586. [PMID: 32436615 DOI: 10.1111/joa.13215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/26/2020] [Accepted: 04/20/2020] [Indexed: 01/22/2023] Open
Abstract
The first cervical vertebra, atlas, and its anatomical variants have been widely studied in Homo sapiens. However, in Neanderthals, the presence of anatomical variants of the atlas has been very little studied until very recently. Only the Neanderthal group from the El Sidrón site (Spain) has been analysed with regard to the anatomical variants of the atlas. A high prevalence of anatomical variants has been described in this sample, which points to low genetic diversity in this Neanderthal group. Even so, the high prevalence of anatomical variations detected in El Sidrón Neanderthal atlases needs to be confirmed by analysing more Neanderthal remains. In this context, we analysed the possible presence of anatomical variants in the three Neanderthal atlases recovered from the Krapina site (Croatia) within the Neanderthal lineage. Two of the three Krapina atlases presented anatomical variations. One atlas (Krapina 98) had an unclosed transverse foramen and the other (Krapina 99) presented a non-fused anterior atlas arch. Moreover, an extended review of the bibliography also showed these anatomical variations in other Middle and Upper Pleistocene hominins, leading us to hypothesise that anatomical variations of the atlas had a higher prevalence in extinct hominins than in modern humans.
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Affiliation(s)
- Carlos A Palancar
- Department of Paleobiology, Paleoanthropology Group, Museo Nacional de Ciencias Naturales (CSIC), Madrid, Spain.,Department of Palaeontology, Faculty of Geology, Universidad Complutense de Madrid, Madrid, Spain.,Department of Biology, Faculty of Sciences, Universidad Autónoma de Madrid, Madrid, Spain
| | - Daniel García-Martínez
- Department of Paleobiology, Paleoanthropology Group, Museo Nacional de Ciencias Naturales (CSIC), Madrid, Spain.,Centro Nacional de Investigación sobre la Evolución Humana, Burgos, Spain
| | - Davorka Radovčić
- Department of Geology and Paleontology, Croatian Natural History Museum, Zagreb, Croatia
| | - Susanna Llidó
- Department of Anatomy and Human Embryology, Giaval Research Group, Faculty of Medicine, University of Valencia, Valencia, Spain
| | - Federico Mata-Escolano
- Department of Anatomy and Human Embryology, Giaval Research Group, Faculty of Medicine, University of Valencia, Valencia, Spain
| | - Markus Bastir
- Department of Paleobiology, Paleoanthropology Group, Museo Nacional de Ciencias Naturales (CSIC), Madrid, Spain.,Department of Anatomy and Human Embryology, Giaval Research Group, Faculty of Medicine, University of Valencia, Valencia, Spain
| | - Juan Alberto Sanchis-Gimeno
- Department of Anatomy and Human Embryology, Giaval Research Group, Faculty of Medicine, University of Valencia, Valencia, Spain
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Sanchis-Gimeno JA, Llido S, Perez-Bermejo M, Nalla S. Prevalence of anatomic variations of the atlas vertebra. Spine J 2018; 18:2102-2111. [PMID: 29960109 DOI: 10.1016/j.spinee.2018.06.352] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 06/19/2018] [Accepted: 06/19/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The retrotransverse foramen (RTF), arcuate foramen (AF), unclosed transverse foramen (UTF) and posterior atlas arch defects (PAAD) are anatomic variations of the atlas vertebra that surgeons must be aware of before spine surgery is performed. PURPOSE To analyze the prevalence of the AF, RTF, UTF, and PAAD. STUDY DESIGN Ex-vivo anatomical study. PATIENT SAMPLE Two hundred eighteen atlas vertebrae obtained from 100 Caucasian subjects and 118 sub-Saharan African subjects (48 Sotho subjects, 35 Xhosa subjects and 35 Zulu subjects). METHODS We studied 218 atlas vertebrae from skeletons of the Raymond A. Dart Collection in order to analyze the prevalence of AF, RTF, UTF, and PAAD in both Caucasian and sub-Saharan African subjects. OUTCOME MEASURES Not applicable. RESULTS Sixty-nine (31.2%) atlases presented anatomical variants: 64 (29.3%) presented one anatomical variant, 4 (1.8%) presented two, and 1 (0.5%) presented three. AF, RTF, UTF, Type A and Type E defects were present in 35 (16.1%), 17 (7.8%), 17 (7.8%), 5 (2.3%), and 1 (0.5%) vertebrae, respectively. The vertebrae with two anatomical variants presented a bilateral UTF and a Type A defect, a bilateral AF and a Type A defect, a right UTF and a left AF, and a right UTF and a Type E defect. The vertebra with three anatomical variants presented a bilateral RTF, a left UTF, and a left AF. No sex differences in prevalence of the RTF (p=.775), AF (p=.605), UTF (p=.408) and Type A defects (p=1.000) were found in the sub-Saharan African and Caucasian groups (RTF, p=.306; AF, p=.346; UTF, p=.121; Type A defects, p=.561). Comparison between the sub-Saharan African (all subjects) and the Caucasian group revealed no differences in the UTF (p=.105), AF (p=.144), RTF (p=.542) and Type A defects (p=.521) prevalence. Also, no differences in the prevalence of the UTF (p=.515), AF (p=.278), and RTF (p=.857) between Zulu, Xhosa and Sotho subjects were found. Neither were found sex differences in the prevalence of UTF, RTF and AF in Zulu (p=.805, p=.234, p=.129), Xhosa (p=.269, p=.181, p=.309), and Sotho subjects (p=.062, p=.590, p=.106). CONCLUSIONS The present study has revealed no sex differences in the prevalence of AF, UTF, RTF or PAAD in both Caucasian and sub-Saharan African subjects. This research has also indicated no differences in the prevalence of the UTF, AF and RTF between Zulu, Xhosa and Sotho subjects. In addition, this study has revealed no differences in the Type A, UTF, AF, and RTF prevalence between the sub-Saharan African (all subjects) and the Caucasian subjects. These variations may be known by surgeons before spine surgery for better planning.
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Affiliation(s)
- Juan A Sanchis-Gimeno
- Department of Anatomy and Human Embryology, Faculty of Medicine, University of Valencia, Avda Blasco Ibanez 15, E46010 Valencia, Spain.
| | - Susanna Llido
- Department of Anatomy and Human Embryology, Faculty of Medicine, University of Valencia, Avda Blasco Ibanez 15, E46010 Valencia, Spain
| | - Marcelino Perez-Bermejo
- Department of Nursing, Catholic University San Vicente Martir, C/Espartero 7, E46007 Valencia, Spain
| | - Shahed Nalla
- Department of Human Anatomy and Physiology, Faculty of Health Sciences, University of Johannesburg, 7304e, John Orr Building, Johannesburg, South Africa
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Presence of a foramen arcuale as a possible cause for headaches and migraine: Systematic review and meta-analysis. J Clin Neurosci 2018; 54:113-118. [DOI: 10.1016/j.jocn.2018.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 04/05/2018] [Accepted: 05/17/2018] [Indexed: 11/20/2022]
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8
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Sanchis-Gimeno JA, Llido S, Guede D, Nalla S, Martinez-Soriano F, Blanco-Perez E, Caeiro JR. Atlases with Arcuate Foramen Present Cortical Bone Thickening That May Contribute to Lower Fracture Risk. World Neurosurg 2018; 117:e162-e166. [PMID: 29883825 DOI: 10.1016/j.wneu.2018.05.220] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 05/28/2018] [Accepted: 05/29/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND To date, no information about the cortical bone microstructural properties in atlas vertebrae with arcuate foramen has been reported. As a result, we aimed to test in an experimental model if there is a cortical bone thickening in an atlas vertebra which has an arcuate foramen that may play a protective role against bone fracture. METHODS We analyzed by means of micro-computed tomography the cortical bone thickness, the cortical volume, and the medullary volume (SkyScan 1172 Bruker micro-CT NV, Kontich, Belgium) in cadaveric dry atlas vertebrae with arcuate foramen and without arcuate foramen. We also reviewed a case series of 31 posterior atlas arch fractures to correlate the possible presence in the same atlas of both fracture and arcuate foramen. RESULTS The micro-computed tomography study revealed significant differences in cortical bone thickness (P < 0.001), cortical volume (P < 0.004), and medullary volume (P = 0.013) values between the arcuate foramen vertebrae and the nonarcuate foramen vertebrae. The clinical series found no coexistence in the same vertebra of a posterior atlas arch fractures and the arcuate foramen. CONCLUSIONS An atlas with arcuate foramen presents cortical bone thickening. This advantage in bone microarchitecture seems to contribute to a lower fracture risk compared to subjects without arcuate foramen as no coexistence in the same vertebra of a posterior atlas arch fractures and arcuate foramen was found.
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Affiliation(s)
- Juan A Sanchis-Gimeno
- Department of Anatomy and Human Embryology, Faculty of Medicine, University of Valencia, Valencia, Spain.
| | - Susanna Llido
- Department of Anatomy and Human Embryology, Faculty of Medicine, University of Valencia, Valencia, Spain
| | - David Guede
- Trabeculae Technology Based Firm, Technological Park of Galicia, Ourense, Spain
| | - Shahed Nalla
- Department of Human Anatomy and Physiology, Faculty of Health Sciences, University of Johannesburg, Auckland Park, South Africa
| | - Francisco Martinez-Soriano
- Department of Anatomy and Human Embryology, Faculty of Medicine, University of Valencia, Valencia, Spain
| | - Esther Blanco-Perez
- Department of Radiology, University Hospital de La Ribera, Alzira, Valencia, Spain
| | - Jose R Caeiro
- Orthopedic Surgery Service, USC University Hospital Complex, Santiago de Compostela, Spain
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9
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Sanchis-Gimeno JA, Llido S, Nalla S. Double Retrotransverse Foramen of Atlas (C1). World Neurosurg 2018; 114:e869-e872. [DOI: 10.1016/j.wneu.2018.03.102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/13/2018] [Accepted: 03/14/2018] [Indexed: 11/28/2022]
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10
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Sanchis-Gimeno JA, Llido S, Miquel-Feutch M, Quiles-Guinau L, Rios L, Murillo-Llorente M, Perez-Bermejo M, Nalla S. The Decreasing Prevalence of the Arcuate Foramen. World Neurosurg 2018; 110:521-525. [DOI: 10.1016/j.wneu.2017.10.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 10/03/2017] [Accepted: 10/06/2017] [Indexed: 11/26/2022]
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11
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The Michel Benoist and Robert Mulholland yearly European Spine Journal Review: a survey of the "surgical and research" articles in the European Spine Journal, 2017. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:28-39. [PMID: 29313092 DOI: 10.1007/s00586-017-5435-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 12/16/2017] [Indexed: 10/18/2022]
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12
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Sanchis-Gimeno JA, Blanco-Perez E, Perez-Bermejo M, Llido S, Nalla S. Retrotransverse foramen of the atlas: prevalence and bony variations. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 27:1272-1277. [DOI: 10.1007/s00586-017-5372-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 10/06/2017] [Accepted: 10/29/2017] [Indexed: 10/18/2022]
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13
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Sanchis-Gimeno JA, Perez-Bermejo M, Rios L, Llido S, Bastir M, Blanco-Perez E, Mata-Escolano F. Analysis of the relationship between the double transverse foramen and the possibility of developing clinical symptoms after whiplash. Clin Anat 2017; 30:761-766. [PMID: 28509423 DOI: 10.1002/ca.22897] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 04/25/2017] [Accepted: 05/05/2017] [Indexed: 01/03/2023]
Affiliation(s)
- Juan A. Sanchis-Gimeno
- Department of Anatomy and Human Embryology; University of Valencia. Faculty of Medicine; Avda. Blasco Ibanez 15 Valencia Spain
| | - Marcelino Perez-Bermejo
- Department of Anatomy and Human Embryology; University of Valencia. Faculty of Medicine; Avda. Blasco Ibanez 15 Valencia Spain
- University San Vicente Martir; C/Espartero 7. Valencia Valencia Spain
| | - Luis Rios
- Department of Anatomy and Human Embryology; University of Valencia. Faculty of Medicine; Avda. Blasco Ibanez 15 Valencia Spain
- National Museum of Natural Sciences - Spanish National Research Council; C/Jose Gutierrez Abascal 2 Madrid Spain
| | - Susanna Llido
- Department of Anatomy and Human Embryology; University of Valencia. Faculty of Medicine; Avda. Blasco Ibanez 15 Valencia Spain
| | - Markus Bastir
- National Museum of Natural Sciences - Spanish National Research Council; C/Jose Gutierrez Abascal 2 Madrid Spain
| | - Esther Blanco-Perez
- Department of Anatomy and Human Embryology; University of Valencia. Faculty of Medicine; Avda. Blasco Ibanez 15 Valencia Spain
- Department of Radiology; University Hospital de La Ribera; Carretera Corbera km 1 Alzira, Valencia Spain
| | - Federico Mata-Escolano
- University San Vicente Martir; C/Espartero 7. Valencia Valencia Spain
- Department of Radiology; General University Hospital; Avda. Tres Cruces 2 Valencia Spain
- CT and MRI Unit; ERESA Clinic Research Foundation; Calle Marques de San Juan 6 Valencia Spain
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Lvov I, Lukianchikov V, Grin A, Sytnik A, Polunina N, Krylov V. Minimally invasive surgical treatment for Kimmerle anomaly. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2017; 8:359-363. [PMID: 29403250 PMCID: PMC5763595 DOI: 10.4103/jcvjs.jcvjs_73_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction: Kimmerle anomaly is the bony ridge between the lateral mass of atlas and its posterior arch or transverse process. This bony tunnel may include the V3 segment of the vertebral artery, vertebral vein, posterior branch of the C1 spinal nerve, and the sympathetic nerves, which results in the clinical symptoms of this disease. Reports on the surgical treatment of Kimmerle anomaly are rare. There are no reports on minimally invasive surgical treatment of this pathology. Materials and Methods: Six patients with Kimmerle anomaly were treated from 2015 until 2016. Three patients underwent routine surgery through the posterior midline (posterior midline approach [PMA] group). The other three patients underwent decompression with a paravertebral transmuscular approach (PTMA group). The operation time, intraoperative blood loss, clinical symptoms before and after surgery as well as intra- and post-operative complications were compared between the PTMA and PMA groups. Results: The results of the surgical treatments were assessed at discharge and 1 year later. Blood loss, operation time, and intensity of pain at the postoperative wound area were lower in the PTMA group. There were no postoperative complications. The delayed surgical treatment outcomes did not depend on the method of artery decompression. Conclusions: Surgical treatment of vertebral artery compression in patients with Kimmerle anomaly is preferable in cases where conservative treatment is inefficient. A minimally invasive PTMA is an alternative to the routine midline posterior approach, providing direct visualization of the compressed V3 segment of the vertebral artery and minimizing postoperative pain.
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Affiliation(s)
- Ivan Lvov
- Department of Neurosurgery, Sklifosovsky Research Institute of Emergency Care, Moscow, Russia
| | - Victor Lukianchikov
- Department of Neurosurgery, Sklifosovsky Research Institute of Emergency Care, Moscow, Russia
| | - Andrey Grin
- Department of Neurosurgery, Sklifosovsky Research Institute of Emergency Care, Moscow, Russia.,Department of Neurosurgery, Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - Aleksey Sytnik
- Department of Neurosurgery, Sklifosovsky Research Institute of Emergency Care, Moscow, Russia.,Department of Neurosurgery, Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - Natalya Polunina
- Department of Neurosurgery, Sklifosovsky Research Institute of Emergency Care, Moscow, Russia
| | - Vladimir Krylov
- Department of Neurosurgery, Sklifosovsky Research Institute of Emergency Care, Moscow, Russia.,Department of Neurosurgery, Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
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