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Anatomical variants of the cervical vertebrae and the first thoracic vertebra in man

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Anatomical variants of the cervical vertebrae and the first thoracic vertebra in man

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Anatomical variants of the cervical part of the human spine were investigated. Morphological variants were studied on 100 cervical vertebrae (37 female and 63 male). The greatest variability was demonstrated by the first cervical vertebra or atlas. The presence of some accessory bony arches embracing the vertebral artery was observed, namely the posterior bridge restraining the arcuate foramen (13.8%) and the lateral bridge restraining the transversovertical foramen (2%). Split posterior (3%) or anterior (1%) arches of the atlas were also encountered in this material. The superior articular face of the atlas divided into two parts was found in 47.8%. Variants of the remaining cervical vertebrae were limited only to the presence of a division of the transverse process foramina or their incomplete closure. Some of these anatomical variants may be a cause of certain clinical symptoms which have previously been described in the literature.

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... Finally, Kimura et al. [13] studied a Japanese specimen of 100 skeletons and found double foramina in 11.10 % of the vertebrae and Sangari et al. found 17 vertebrae (24 %) with unilateral duplication and 1 vertebra (1.04 %) with bilateral duplication of the foramen [9]. Wysocki et al. [14] observed duplication of the foramen too. Our results seem to comply with the literature and confirm the incidence to Indo-European population. ...
... In addition, Rathnakar et al. [16] found one vertebra with a triple foramen on the right side (0.71 %) and Murlimanju et al. [15] found one vertebra with triplication (0.27 %), all in an Indian population specimen. Wysocki et al. [14] also observed a triple transverse foramen in a C 7 vertebra (1 %) in a population specimen of the Kielce region in Poland (XII, XIII century). We found a triple foramen among 102 vertebrae (0.98 %). ...
... The absence of the foramen transversarium is also really unusual. Taitz et al. [4] reported 4 vertebrae without foramen transversarium, Kimura et al. [13] reported 18 cases, and Wysocki et al. [14] reported a single case. In addition, in the Tlatelolco collection studied by Jaen [12], 18 cases were reported. ...
Article
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Purpose: To describe certain anatomical variations of the foramen transversarium, in spine cervical vertebrae in a contemporary specimen of an Indo-European population and approach their clinical importance during cervical spine surgery. Methods: 102 cervical vertebrae (C2-C7) from 17 different skeletons, intact without any degenerative or traumatic disorders, which belonged to the collection of the Department of Anatomy, were examined. The age of specimens at the time of their death was between 25 and 65 years. All foramina were measured with a digital caliper. Results: The average size of the normal foramina was: 6.49 mm × 5.74 mm on the right side and 6.65 mm × 5.76 mm on the left side. Regarding the variations, we found two cervical vertebrae (1.96 %), one C3 and one C6, in which the right foramen transversarium is clearly smaller than the left. The exact dimensions of these foramina are: 2.3 mm × 2.5 mm on the right side and 6.54 mm × 8 mm on the left side in the first vertebra and 2.8 mm × 3.74 mm on the right side and 6 mm × 7.5 mm on the left side, in the second one. We also observed double foramina in 14 vertebrae (13.72 %). In seven vertebrae, the duplication was bilateral (6.86 %). We finally found one vertebra (0.98 %) with triplication of the foramen transversarium on the left side. Conclusions: Summarizing, 10 out of our 17 skeletons were presented with variations (extremely narrow or multiple foramina). This finding of hypoplastic, duplicated and triplicated foramina transversaria in unexpectedly high rates raises questions about the integrity of the contained structures, the possibility of a different path for them. These variations may induce an extra-osseous position of the vertebra artery, and the ignorance of such an event may have catastrophic consequences during a surgery in the cervical spine.
... Knowledge of the anatomy of the FT and its variations is therefore important to clinicians when they diagnose a patient who presents with a history of frequent migraine, headaches and fainting, and also to radiologists for the interpretation of X-rays and computed tomograms, and orthopaedic surgeons during interventions of the cervical spine. Although the frequency of anatomical variation of the FT in the cervical vertebrae is generally studied in the modern clinical settings (e.g., Zhao et al. 2008;Senthilnathan & Rajitha 2011;Kim et al. 2012;Kotil & Kilincer 2014;Quiles-Guiñau et al. 2016;Kültür et al. 2018;Metin Tellioglu et al. 2018; Moreira Moreira & Herrero 2020), a few cases have been reported in the palaeopathological literature (e.g., Jaén 1975;Nagar et al. 1999;Wysocki et al. 2003;Kaya et al. 2011;Lacy & Trinkaus 2013;Kwiatkowska et al. 2014;Travan et al. 2015;Quiles-Guiñau et al. 2017). ...
... Specifically, these vertebrae from Herculaneum had a unilateral absence of the FT for one C1 vertebra. Absence of the FT from the C3 to C6 vertebrae has been reported in the literature (Jaén 1975;Taitz et al. 1978;Kimura et al. 1985;Wysocki et al. 2003 ), but absence of the FT for C1 is very rare and might be related to developmental anomalies of the vertebral arteries that normally traverse it. Vasudeva & Kumar (1995) and Nayak (2007) described C1 vertebrae with the absence of the FT, while Vasudeva & Kumar (1995) described a C1 vertebra with unilateral absence of the FT, and Nayak (2007) described a bilateral absence of the FT. ...
... Also, most studies have reported the prevalence of double FT as an individual observation, without providing the data for each cervical level, rather than for cervical segments or for the whole cervical spine (Kimura et al. 1985;Aydınlıoğlu et al. 2001;Murlimanju et al. 2011;Chaudhari et al. 2013;Rathnakar et al. 2013;Katikireddi & Setty 2014;Mehta et al. 2014;Mishra et al. 2014;Murugan & Verma 2014;Shah et al. 2014;Yadav et al. 2014;Akhtar et al. 2015;Gujar et al. 2015;Kumari et al. 2015;Patra et al. 2015;Esakkiammal & Chauhan 2016;Saxena et al. 2016;Vikani et al. 2016;Ambali & Jadhav 2017;Molinet Guerra et al. 2017;Sheik-Abdul et al. 2018;Sumalatha & Manasa 2018;Zibis et al. 2018;Singh et al. 2019;Ulusoy et al. 2020), and relatively few studies have report differences between complete and incomplete double FT (Jaén 1975;Nagar et al. 1999;Aydınlıoğlu et al. 2001;Sanchis-Gimeno et al. 2005;Kaya et al. 2011;Rathnakar et al. 2013;Mishra et al. 2014;Shah et al. 2014;Yadav et al. 2014;Kumari et al. 2015;Esakkiammal & Chauhan 2016;Vikani et al. 2016;Metin Tellioglu et al. 2018;Sheik-Abdul et al. 2018;Sumalatha & Manasa 2018;Singh et al. 2019). Similarly, when Wysocki et al. (2003) and Kwiatkowska et al. (2014) analysed the prevalence of double FT, they referred to the total number of FT instead of the number of vertebrae examined for each cervical level. ...
Article
Variations in the number, size and shape of the foramina transversaria of cervical vertebrae can affect the anatomical course of vital blood vessels and nerves, with the risk for pathological conditions, like vertebrobasilar insufficiency. This can result in compression of the vertebral artery during neck movements, which is characterised by headache, migraine, difficulties in swallowing, problems with speech and sight, balance disturbances and hearing disorders, among others. The aim of this study was to analyse the prevalence of the diverse anatomical variants of the foramen transversarium in 446 cervical vertebrae from the skeletal remains of 83 victims who died on the ancient beach of Herculaneum (Italy) during the eruption of Vesuvius Volcano in 79 CE. There were complete and incomplete double foramina transversaria in 20.6% of the vertebrae, and absence of foramen transversarium in an atlas (0.2%), a very rare condition in the literature. As the foramen transversarium is a key determinant for correct development of the vertebral artery, evaluations of variations in its number, size and shape provide useful information on the prevalence of these variations in the life and health conditions in the ancient population of Herculaneum.
... In more detail, from a collation of data from several studies that considered complete cervical spines ( Taitz et al., 1978;De Boeck et al., 1984;Sanchis-Gimeno et al., 2005;Sharma et al., 2010;Murlimanju et al., 2011;Chandravadiya et al., 2013;Patil et al., 2014;Rios et al., 2014) and, from the pre- sent study, a clear and consistent pattern of frequency in human samples emerges: C3 < C4 < C5 < C6 > C7. In line with our results, previous studies also observed the absence of DTF in C2 and its occasional presence in C1 (De Boeck et al., 1984;Wysocki et al., 2003), and although we did not find it in C3, other studies did, although at very low frequency (De Boeck et al., 1984;Wysocki et al., 2003;Sanchis-Gimeno et al., 2005;Sharma et al., 2010;Rios et al., 2014). ...
... In more detail, from a collation of data from several studies that considered complete cervical spines ( Taitz et al., 1978;De Boeck et al., 1984;Sanchis-Gimeno et al., 2005;Sharma et al., 2010;Murlimanju et al., 2011;Chandravadiya et al., 2013;Patil et al., 2014;Rios et al., 2014) and, from the pre- sent study, a clear and consistent pattern of frequency in human samples emerges: C3 < C4 < C5 < C6 > C7. In line with our results, previous studies also observed the absence of DTF in C2 and its occasional presence in C1 (De Boeck et al., 1984;Wysocki et al., 2003), and although we did not find it in C3, other studies did, although at very low frequency (De Boeck et al., 1984;Wysocki et al., 2003;Sanchis-Gimeno et al., 2005;Sharma et al., 2010;Rios et al., 2014). ...
Article
Introduction: Currently there is no information about the possibility of developing clinical symptoms after whiplash in double transverse foramen subjects. Our aim was to test whether subjects with double transverse foramen have an increased risk of presenting with acute headache, dizziness, vertebral artery dissection, and vomiting after whiplash. Methods: We recorded the absence/presence of double transverse foramen, and the absence/presence of neck pain, acute headache, dizziness, vertebral artery dissection, and vomiting in 85 patients who had suffered whiplash injuries in car rear-end impacts in road traffic accidents. We used the odds ratio test to determine whether double transverse foramen subjects are at a higher risk of developing acute headache, dizziness, and vomiting than non-double transverse foramen subjects. Results: Although double transverse foramen subjects presented with more clinical symptoms after whiplash, the odds ratio test revealed that their risks of developing acute headache (p=0.30), dizziness (p = 0.09), or vomiting (p=0.18) were not significantly greater than in the control group. Conclusions: Double transverse foramen subjects are not at a higher risk of presenting acute headache, dizziness, vertebral artery dissection, and vomiting after whiplash. This article is protected by copyright. All rights reserved.
... From a functional perspective, the cervical spine has been divided into three zones: the suboccipital zone centered on the C1 vertebra; a transitional zone formed by the C2 vertebra; and the typical zone, encompassing the C3-C7 vertebrae (Bogduk & Mercer 2000). The cervical skeleton is also a bony framework for the vertebral arteries in their course from the aortic arch to the cranial fossa (Wysocki et al. 2003). ...
... The latter includes the bilateral superior concave articulating facets of C1 and the convex condyles of the occipital bone. The atlas differs in structure from all other cervical vertebrae and is also the most variable vertebra in man (Wysocki et al. 2003). In contrast to the other vertebrae, the atlas has no body and no spinous process. ...
Article
This review about extraoral anatomy depicted in cone beam computed tomography describes the pharyngocervical region. Large (≥ 8 × 8 cm) field of views of the maxilla and/or mandible will inevita-bly depict the pharyngocervical region that com-prises the posterior upper airway, the pharyngeal part of the digestive tract, as well as the cervical segment of the spine. The latter consists of seven cervical vertebrae (C1-C7) with corresponding distinctive features, i.e., the atlas (C1) and the axis (C2). In addition, cervical vertebrae serve as ref-erences for the vertical position of anatomical structures. For instance, C4 is a typical landmark since it generally denotes the level of the chin, of the body of the hyoid bone, of the base of the epiglottis, and of the bifurcation of the common carotid artery, respectively. The pharynx, which is functionally involved in respiration, deglutition, and vocalization, extends from the lower aspect of the skull base to the esophagus. Anatomically, the pharynx is divided into three segments, i.e. the nasopharynx, the oropharynx, and the laryn-gopharynx. All communicate anteriorly with cor-responding cavities, i.e. the nasal cavities, the oral cavity, and the larynx. Although not directly located within the pharyngocervical region, the hyoid bone and the styloid process are also dis-cussed in this review, since both structures are commonly visible on CBCT images of this region.
... Kwon and coworkers cited the study of Geipel, who reported clefts of the posterior arch in 4% of 1613 autopsy specimens studied, 97% being median clefts [10]. Wysocki observed median split posterior arch in 3 female atlas out of 100 vertebrae studied [11]. Thereby, suggesting a higher incidence in females as compared to the males. ...
... Several disorders including Arnold-Chiari malformations, gonadal dysgenesis and the Klippel-Feil, Down and Turner syndromes have been associated with the congenital absence and hyperplasia of the posterior arch of the atlas [1,2]. Wysocki quoted the work of Li, who reported different variants and developmental defects of the atlas to occur together, especially in families by hereditary transmission [11]. In most reports, deficits in the posterior arch have been discovered incidentally in asymptomatic subjects following x-ray examination of cervical spine due to mild injury [2,5,6]. ...
Article
Isolated cases of partial agenesis of atlas were initially considered benign variations, without any clinical or pathological significance. However, there is increasing evidence that neurological symptoms may occur even after minor cervical trauma in subjects with defects in the posterior arch of the atlas. The present case study describes a rare case of median deficiency in the posterior arch of atlas vertebra. The knowledge of this benign variation is crucial as it may aid clinicians in correct management of subjects presenting with resolution of symptoms and avoid excessive investigations.
... Due to its complicated embryonic development, this area is easily susceptible to skeletal and neural developmental variants and anomalies, producing a wide spectrum of symptom. 1 The first cervical vertebra, the atlas, is the most variable human vertebra. 2 The ponticulus posticus (PP), foramen arcuale or "Kimmerle's anomaly" is a poorly understood anomaly of the atlas vertebrae. 3,4 The PP, which seems to be the consequence of the complete or incomplete ossification of the posterior atlantooccipital membrane over the vertebral artery groove, has become a significant abnor-7tepeklinik mality of the atlas in the management of atlantoaxial instability, which has gained popularity. ...
... of FT in such cases the vertebral artery bypasses the vertebra [6]. [2] has reported duplicated foramen transversarium in two cases out of 132 cases he examined. ...
Article
Background: Cervical vertebrae have a typical feature that is presence of foramen bilaterally in their transverse process which is named as foramen transversarium through it passes vertebral artery, vertebral vein and sympathetic plexus of nerves. Among these cervical vertebrae typical cervical vertebrae have a typical bifid spine along with foramen transversarium. Deformation and variations of this foramen may affect the anatomical course of vascular and neural structures, and consequently may cause pathological conditions. Objectives: To observe the anatomical variations in the foramen transversarium of typical cervical vertebrae. Materials and Methods: Present work was carried on 163 dry typical (C3-C6) cervical vertebrae of unknown sex and age. Each vertebra was observed for shape, symmetry and number of foramen transversarium present in both transverse processes of cervical vertebra. Also we observed presence of any bony spicules in foramen transversarium. Results: We found accessary foramen transversarium in 24 (14.72%) vertebrae. Among these 16 (9.81%) vertebrae were having bilateral and 8 (4.90%) vertebrae had unilateral accessary foramen transversarium. We classified foramen transversarium according to the shape and direction of the main diameter of foramen into seven types. Conclusions: Anatomical knowledge of these variations is helpful for spine surgeons in preoperative planning and for preventing injury of vertebral vessel along with sympathetic nerves during cervical surgical approaches. KEY WORDS: Foramen Transversarium, Typical Cervical Vertebrae, Accessory Foramen, Vertebral Artery, Vertebral Vein.
... Las vértebras cervicales muestran una gran variabilidad, siendo el atlas la que difiere en estructura de las demás vértebras y es también la que presenta la más alta tasa de variabilidad de toda la columna cervical en la especie humana (Wysocki et al., 2003). ...
Conference Paper
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La definición de variante anatómica no está exenta de controversia y ha sufrido variaciones en su denominación a lo largo de su estudio. Actualmente los caracteres no métricos se definen como variantes morfológicas de la anatomía, características, rasgos o marcas anatómicas que pueden estar localizadas en cualquier tejido. Para el antropólogo físico las de mayor interés se localizan en dientes y huesos. Se ha realizado una revisión de aquellas variantes en las vértebras cervicales, de individuos de necrópolis depositadas en el Laboratorio de Antropología Física de la Universidad de León. Entre las variantes halladas están las de las carillas articulares superiores del atlas, la fusión del axis con el atlas y la asimilación del bloque atlantoaxial con la base del cráneo, la dehiscencia del arco vertebral posterior del atlas, el puente posterior del atlas, el puente lateral del atlas, el doble foramen transverso en varias vértebras cervicales, la fusión del atlas con el axis (posible síndrome de Klippel-Feil) y la fusión de la quinta y sexta vértebras cervicales. Durante el siglo veinte, se ha reconocido la base genética de los caracteres no métricos craneales, infracraneales y dentales. Aunque es cierto que no todas las variantes implican necesariamente significación clínica, pueden resultar de gran utilidad en el estudio de poblaciones históricas para detectar diferentes grados de consanguinidad entre los individuos, a través de las variaciones en las frecuencias de los caracteres epigenéticos observados. Además de la aplicabilidad en el campo de la Antropología forense, para la identificación del individuo.
... They found that the greatest variability was demonstrated by the first cervical vertebra that is the Atlas vertebra.They performed study on 100 first cervical vertebrae (37 females and 63 males) that shows an pleuroapophyseal malformation that is anteriorly split foramen of the transverse process in 3 male vertebrae (2.7%) and 5 female vertebrae (6.7%). This phenomenon was invariably an effect of reduction of the anterior lamina of the transverse process and never of the posterior lamina.The occurrence of incomplete FT that is Pleuroapophyseal malformation can be confused with fracture and other anomalies and hence should be known to Radiologists for accurate interpretation of radiographs and hence CT scans [10,11,12]. Due to incomplete formation of FT the vertebral artery may be dislodged and prone to get damaged easily during post cervical injuries. ...
... Given the extensive articular mobility the cervical spine presents, particularly the atlas, any anomaly where the vertebral vessels run through the TF of the atlas could impair the blood flow. Added to this critical situation is the high anatomical variability of the atlas (Wysocki et al., 2003). One of the morphological variants that could affect the vertebral vessels is the presence of an abnormal accessory foramen on the posterior root of the transverse process, called retrotransverse foramen (RF), which is smaller and located behind the TF of the atlas and is formed by a bony bridge extending from the posterior root of the transverse process to the root of the posterior arch of the atlas. ...
Article
Anatomical variations of the atlas vertebra are of particular importance because of their possible repercussions on the vertebral vessels. In view of the extensive articular mobility of the atlas, any anomaly where the vertebral artery and veins run through the transverse foramen could impair blood flow. However, in spite of the possible effect of this anomaly on the vertebral artery and veins, there are few data on the presence of an abnormal accessory transverse foramen, termed retrotransverse foramen, which is smaller and located behind the transverse foramen of the atlas. The aim of this research was to analyse the prevalence of retrotransverse foramen in a sample of 88 dry C1 vertebrae from a Spanish rural population of the late 17th and the early 18th centuries, as well as to study the possible repercussions of the presence of this anatomical variant on the size of the transverse foramen. The anteroposterior diameter and the lateral diameter of the transverse foramen of all the atlas vertebrae and retrotransverse foramina were measured using digital calibres. Two atlases with retrotransverse foramina (2.27%) were found in which the presence of the anatomical variant caused a larger anteroposterior diameter and a smaller lateral diameter than those of the transverse foramina of the normal 86 C1 vertebrae that were analysed. Our results show that a thorough study should be performed on the prevalence of this anatomical variant in the current population, as well as its possible clinical repercussion on the vertebral artery.
... Taitz et al. 3 (1978) reported 34 vertebrae, which were having accessory foramen transversarium. Jarostow et al. 4 (2003) reported accessory FT most frequent at the level of C-6 (45.6%) and rarest at C-3 (2.8). ...
Article
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BACKGROUND Foramen transversarium is located on the transverse process of cervical vertebrae. These foramina are known to exhibit variations with regard to number, size, shape etc. Vertebral artery and vein passes through the FT of upper six cervical vertebrae. AIMS The aim of this study to observe the variations in number of foramen transversarium in typical cervical vertebrae. METHOD The study was done on 240 dry typical cervical vertebrae (C3-C6). Broken or damaged typical cervical vertebrae were excluded from the study. RESULTS In this study 20 cervical vertebrae (8.4%) are having double foramen transversarium. Unilaterally and bilaterally the incidence of double foramen transversarium is 6.66% and 1.66% respectively. DISCUSSION AND CONCLUSION The variations of the foramen transversarium appears to more on lower cervical vertebrae. The knowledge of these variations are helpful for spinal surgeons and radiologist for evaluation of the patients.
... The ponticulus posticus (arcuate foramen), or "little posterior bridge, " is an ossification of the oblique atlanto-occipital ligament superior to the VA groove of the atlas. An arcuate foramen has been reported with an incidence of from 1.14% to 37% 20,22,24,35,36,38) . In this study, one hundred and eight vertebrae (108/1029, 10.5%) showed the presence of a bony exostosis from the posterior margin of the superior articular facet. ...
Article
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Objective: We sought to examine anatomic variations of the atlas and the clinical significance of these variations. Methods: We retrospectively reviewed 1029 cervical 3-dimensional (3D) CT images. Cervical 3D CT was performed between November 2011 and August 2014. Arcuate foramina were classified as partial or complete and left and/or right. Occipitalization of the atlas was classified in accordance with criteria specified by Mudaliar et al. Posterior arch defects of the atlas were classified in accordance with criteria specified by Currarino et al. Results: One hundred and eight vertebrae (108/1029, 10.5%) showed an arcuate foramen. Bilateral arcuate foramina were present in 41 of these vertebrae and the remaining 67 arcuate foramina were unilateral (right 31, left 36). Right-side arcuate foramina were partial on 18 sides and complete on 54 sides. Left-side arcuate foramina were partial on 24 sides and complete on 53 sides. One case of atlas assimilation was found. Twelve patients (12/1029, 1.17%) had a defect of the atlantal posterior arch. Nine of these patients (9/1029, 0.87%) had a type A posterior arch defect. We also identified one type B, one type D, and one type E defect. Conclusion: Preoperative diagnosis of occipitalization of the atlas and arcuate foramina using 3D CT is of paramount importance in avoiding neurovascular injury during surgery. It is important to be aware of posterior arch defects of the atlas because they may be misdiagnosed as a fracture.
... Previously authors have studied about this foramen and mentioned its occurrence in 9.8-25.9% of the general population [9][10][11][12][13]. Taitz and Nathan (1986) in his study showed the presence of partial posterior bridging of atlas in 25.9% and complete bridging in 7.9% of the population [14]. ...
Article
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The arcuate foramen is a bony arch which connects the posterior end of the superior articular fossa with the posterior arch of atlas. In the case of presence of arcuate foramen, the vertebral artery follows the normal course but it has to traverse through the osseofibrous ring (arcuate foramen). Objectives: To determine the height, width, and area of the arcuate foramen and to determine the morphometric difference between the transverse foramen and the canal formed by bony bridges over the vertebral artery of the atlas vertebra. Methods: A total of 75 dry human atlas vertebrae were taken for the study. These vertebrae were examined carefully for the presence of arcuate foramen. Measurements of the maximum dimensions of the arcuate foramen and foramen transversarium were taken. Area of the arcuate foramen was calculated. Differences in the dimension of arcuate foramen and foramen transversarium were compared. Side differences of arcuate foramen were compared using the unpaired Student's t-test. Results: The dimension of the arcuate foramen of both sides as compared with a dimension of foramen transversarium was found to be more, so the chance of compression of vertebral artery on both sides was less. The percentage of the occurrence of arcuate foramen was 2.25% (bilateral), and ponticles was (1.5%) unilateral. Conclusion: The dimension of arcuate foramen was more when compared to foramen Transversarium dimensions so the chances of compression of vertebral artery would be less. The knowledge of these foramina may be important for orthopedic surgeons, radiologists, neurosurgeons, and anthropologists.
... [2,3] Ponticulus posticus is seen commonly in the lower primates. Its history dates back to the 12 th century, [4] when it was reported that these anatomical structures were found in the human skeletons. The earliest description of the structure was given by Cleland in 1861, [5,6] and the first writings on ponticulus posticus was by Louis Bolk, a Dutch anatomist, in 1906. ...
Article
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Introduction: Ponticulus posticus is an anomaly located on the first cervical vertebra which can be appreciated on the lateral cephalogram that is mostly neglected by the dentists. Aims and Objectives: To assess the prevalence of ponticulus posticus and its relationship with gender and age. Materials and Methods: A sample of 580 patients' lateral cephalograms were retrieved from the archives of the department (Sirona Orthophos XG 5). Seventy-nine lateral cephalograms were excluded, and only 501 lateral cephalograms were taken with the age range of 8 to 60 years. Each digital radiograph was inspected for the presence and absence of ponticulus posticus and further evaluated for both the partial and complete form using Sidexes software and the results were statistically analyzed. Results: Ponticulus posticus was observed in 14.4% of the patients, among which 2.8% had complete and 11.6% had partial type; 59.7% were females and 40.3% were males. Conclusion: Ponticulus posticus is not an uncommon anomaly; therefore, lateral cephalogram should be carefully examined to check for the presence of this anomaly.
... The atlas assimilation to the occipital bone (the atlanto-occipital fusion) was recorded in a female teenager aged 17-18 years (M XVI), with an incidence of 1.09% (Figure 4). The atlas has the highest variability among the cervical vertebrae (Wysocki et al. 2003) and it can partially or totally fuse with the occipital bone (Nayak et al. 2005). The fusion of the atlas vertebra with the occipital bone might produce clinical problems such as cerebellar infarction and Bow Hunter's stroke (Sakai and Tsutsui 1999). ...
Article
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This paper presents the prevalence and study of abnormalities in a skeletal series exhumed from the necropolis of the former Princely Court of Iaşi City (Iaşi County, Romania). The necropolis, discovered in 2008 and dated in the 17th century, consists of 111 human skeletons (adolescents, adults, mature and senile) found in 60 inhumation tombs (individual and collective). The distribution on age and sex categories reveals a high prevalence of adult males. The frequency of abnormalities was estimated both separately on sexes and for the entire osteological series. In the cranial segment, wormian bones have a rate of 27.47%, metopic suture has 7.69%, whereas hypodontia is present in only 2.22% of the cases. As regards the postcranial segment, the lumbarization has the highest incidence (15.38%), followed by sacralization (13.18%) and spina bifida occulta (6.59%). Other abnormalities have sporadic occurrences.
... In the present study retroarticular canal were seen in 5.7% of specimens while Sarita Sylvia et al., Taitz C and Nathan H, Wysocki J et al., Bilodi AK and Gupta SC, Manjunath KY found it in 1 specimen bilaterally out of 50 cases, with figures of 7.9%, 13.8%, 14.7% and 11.7% of cases respectively (SYLVIA, KULKARNI and HATTI, 2007;TAITZ and NATHAN, 1986;WYSOCKI, BUBROWSKI, REYMOND et al., 2003;BILODI and GUPTA, 2005;MANJUNATH, 2001) . ...
Article
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Introduction: The anatomy of the atlas vertebra reveals complex, three-dimensional structures, showing extensive variability in morphology. Features of the atlas vertebra must be familiar before any spinal surgeries such as transpedicular screw fixation, transarticular screw fixation, interspinous wiring, and interlaminar clamp. So, this study was undertaken to assess the various dimensions of the first cervical vertebra and evaluate their relationship with the vertebral artery foramen, and also to decide the safe locations for different surgical methods. Materials and Methods: In this study, thirty five dried specimens of atlas vertebrae were examined. Various dimensions of the vertebrae were measured, using vernier calliper and any abnormalities present in it were noted down and photographed. Statistical analyses of the measurements were done. Results: Abnormal foramina and retroarticular canal were seen in 5.7% of specimens. Incomplete foramen transversarium were seen in 8.57% of specimens. Mean of all parameters of atlas were tabulated. Commonest shape of superior articular facet was oval in 42.8% of specimens. Conclusion: The knowledge of these measurements and the variations present may be of importance to orthopaedic surgeons, neurosurgeons. This information may also be helpful in avoiding and reducing complications such as vertebral artery injury, spinal cord injury during spine surgeries.
... [34] Condylar Hypoplasia: In condylar hypoplasia the occipital condyles are underdeveloped and have flattened appearance leading to basilar invagination and widening of atlanto occipital joint axis angle. [35] Basiocciput hypoplasia: It results in shortening of clivus and violation of chamberlain line and is virtually always associated with basilar invagination. The clivus canal angle is typically decreased and there is bowstring deformity of the cervicomedullary junction. ...
... The atlas vertebra can partially or totally fuse (assimilation) with the occipital bone [ 1 ]. A recent study [ 2 ], has shown that the atlas is the most variability among the cervical vertebrae. Absence of foramen transversarium in atlas is a very rare variation. ...
Article
Atlas is the first cervical vertebra. It does not have a body like other cervical vertebrae. It has two transverse processes, each one of which bears a foramen transversarium. The vertebral artery passes through this foramen. It has two lateral masses which articulate with the occipital condyles to form atlanto-occipital joints. Rarely, the atlas vertebra fuses with the occipital bone. We observed a potentially dangerous incomplete occipitalization of the atlas vertebra during osteology demonstration classes. The fusion resulted in reducing the diameter of foramen magnum approximately by 25%. The knowledge of this variation may be of importance to orthopedic surgeons, neurosurgeons, radiologists and anthropologists.
... The relationship between PP and vertebral artery has been reported in the several studies [6,[23][24][25]. During rotational and bending movements of the neck, the physiological stretching and compression of the vertebral artery by the bony posterior bridge of the atlas can lead to impaired arterial flow, therefore causing vertebrobasilar insufficiency syndrome or vertebral artery tethering and dissection [5,13,23,26]. ...
Article
Ponticulus posticus (PP) is the bony bridge that can completely or partially embrace the vertebral artery and the suboccipital nerve root at the atlas posterior arch. The PP can be a possible cause of vertigo, vertebrobasilar insufficiency, neck pain, shoulder pain, and cervicogenic headache. Moreover, the vertebral artery injury may happen during atlas lateral mass screw insertion in the presence of PP. To determine the prevalence of PP in a population of patients undergoing dental cone-beam computed tomography (CBCT), and the association between PP and atlas superior articular facet (SAF). A retrospective study. Five hundred consecutive patients who had undergone dental CBCT scans. Age, sex, and radiologic measures. The maximum anteroposterior and transverse dimensions of atlas SAF were measured on the axial image, and then the area was calculated by using the formula for an elliptical area. The left-right differential ratios of the SAF in patients with unilateral PP were compared with those in age- and gender-matched patients without PP. The relationships among imaging findings, age, and sex were assessed with the two-tailed paired t test, χ2 test, and logistic regression model, as appropriate. The overall prevalence of PP was 7% (35 of 500 patients). There were no significant differences in the prevalence of PP with gender and age. The anteroposterior dimension, transverse dimension, and area of atlas SAF on the PP side were significantly larger than those on the non-PP side in the 18 unilateral complete PP patients (p<.001, p<.001, p<.001, respectively), and in the 11 unilateral partial PP patients (p=.001, p=.007, p<.001, respectively). The SAF area differential ratios in patients with unilateral PP were greater than those in the patients without PP (29.8% vs. 2.9%, p=.002 for 18 complete lesions, and 23.5% vs. 1.8%, p<.001 for 11 partial lesions). The prevalence of PP and the measurement of SAF can be assessed by CBCT. The imaging findings show the larger SAF on the PP side, and greater left-right difference of SAF area in the patients with unilateral PP. Copyright © 2015 Elsevier Inc. All rights reserved.
... ing. There occur extensive variations in the craniocervical junctions [1]. For these reasons they must be studied with care to ensure adequate differentiation from disease processes. ...
... RF neurotomy of C7 medial branch was also included in this study as the pathway of this nerve is along the superior articular process, which has a similar width as the typical cervical spine. 15,16 The technique used in this study is a modification of the posterior technique described by . The original technique consisted of 2 skin entries: 1 through the posterior parasagittal approach and another entry at a 30° angle to the sagittal plane. ...
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Background: Cervical facet joint pain is an important cause of chronic neck pain. The recommended treatment for this condition is radiofrequency (RF) neurotomy of the medial branch of dorsal rami. There have been attempts to find safe and effective ways to perform this procedure. The objective of this study is to describe the single entry posterior parasagittal approach and to evaluate the efficacy and safety of this approach compared to the conventional posterolateral approach of RF neurotomy of cervical medial branch. Methods: The record of all patients with cervical facet pain who were treated with RF neurotomy medial branch of dorsal rami between January 2016 and December 2019 were reviewed retrospectively. Comparisons were made between patients who underwent RF neurotomy with multiple skin entry posterolateral approach and those who underwent RF neurotomy with single entry posterior parasagittal approach. The primary outcome was measured as the mean changes in numerical rating scale (NRS), and the secondary outcomes were duration and complications related to both approaches. Results: Thirty-one patients who underwent RF neurotomy via posterolateral approach were compared with 40 patients who underwent the procedure via posterior parasagittal approach. Both approaches showed a significant decrease in the NRS from baseline values. However, the differences in the NRS lowering effect at 3 and 12 months between these 2 approaches were not statistically significant. The duration of the procedure was significantly shorter with posterior parasagittal approach (44.13 ± 4.72 minutes vs 54.68 ± 7.39 minutes; P < 0.001). There were no serious complications encountered in both approaches. Conclusions: With comparable efficacy and safety profile between the posterior parasagittal and the conventional posterolateral approaches, the former single skin entry approach offers the added advantage of being less time-consuming. Further randomized prospective studies are necessary to validate these findings.
... Maintaining the vertebral artery intact constitutes an important concern during cervical spinal procedures. Incomplete transverse foramen was formed due to partially developed anterior bar of transverse foramen and never of posterior bar [9]. Along with embryological factors, other factors like anatomical variations in the Vertebral artery and functional conditions may play important role in the formation of incomplete transverse foramen. ...
... 14 The embryological development is often suggested to be the aetiology of the variations. 15,16 Especially the vertebral arteries fi lling more than half of the diameter of the foramen transversarium are postulated, because it is told that the tortuosity of the artery and bone erosion may change this diameter but this evidence is not enough for certain conclusion. 2,4,5,[17][18][19][20] The anatomical location of atlas and the structures in relation to it especially the vertebral Arteries enrich the symptoms due to pathologies of this region. ...
... The AFTs were always smaller in size than the main FT. Wysocki et al. also mentioned one C7 vertebra with triple foramina(28). ...
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AIM: To examine the variations in number, size, and shape of foramina transversaria (FTs) of cervical vertebrae, and to discuss their clinical importance. MATERIAL and METHODS: The FTs of 200 dry cervical vertebrae (C3–C7) from 40 spines were studied for the presence of variations in their number (single, double, or triple), size, and shape. The foramina were classified according to their shape depending upon the direction of their main diameter. RESULTS: Accessory foramina were found in 40 cervical vertebrae. Bilateral accessory foramina were slightly more common than a unilateral accessory foramen. Accessory foramina occurred in a particular pattern, with incidence increasing with descending order of cervical vertebrae, and were most commonly found in C7. The mean values of the anteroposterior and transverse FT diameters on the right side were 4.96 ± 1.08 and 5.68 ± 1.20 mm, respectively, and on the left side were 5.07 ± 1.12 and 5.76 ± 1.29 mm, respectively. The difference was not statistically significant. FTs with very small diameter (<3.5 mm) were found mostly in C7 followed by C5 and C6. Five types of shape were noted. Type 1 was predominant on the right side, whereas type 4 was predominant on the left side. CONCLUSION: Differences in number (duplication), size, and shape of the FTs are not uncommon phenomena. Anatomical knowledge of FT variations is surgically pertinent, as in such conditions the vertebral artery may become twisted or deformed and result in vertebrobasilar insufficiency. Morphometric measurements from this study may be useful in interpreting radiographic images of the cervical spine obtained using computed tomography or cervical angiograms. KEYWORDS: Anatomical variation, Cervical vertebra, Foramen transversarium, Transverse process, Vertebral artery
... This is supported by other studies as well. 11,13 However, a few researchers reported higher prevalence of complete posterior ponticle than incomplete ponticles. 14,15 The difference could be ethnic as the study population of each researcher was different. ...
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Background: Among the cervical vertebrae, atlas is known to have many variations, posterior ponticle being the commonest. It may completely or incompletely covers the groove of vertebral artery leading to ischemia of posterior circulation. Therefore, vertebral artery is at greater risk of injury during neurological and spinal surgeries. Prevalence of posterior ponticles varies widely among different populations, for instance in Turkish population it was 10.8%, in American 22.1%, Kenyan 14.7%, Brazilian and Indian 16.7%. The prevalence of lateral ponticle in Kenyan population was reported to be 3.9% and in Indians it was 2%. However, the data regarding the prevalence of these ponticles is largely lacking in Pakistan. Therefore, this research was designed to determine the prevalence of posterior and lateral ponticle in atlas vertebrae of Pakistani population. Materials and methods: A total of 47 human atlas vertebrae of unknown age and gender from bone bank of Department of Anatomy Fatima Jinnah Medical University, Lahore were studied for the presence of complete and incomplete posterior and lateral ponticles. The bones studied were completely intact and did not have any pathology. Results: Total incidence of ponticles was 38 % in this study, of which 36% were posterior ponticles and 2% were lateral ponticles. Bilateral incomplete posterior ponticles/were found in 8 (17%) atlas vertebrae whereas bilateral complete posterior ponticles/foramen arcuale were found in only 1 (2%) atlas vertebrae. Unilateral incomplete posterior ponticle was identified on right side in 5 (11%) and left side in 2 (4%) atlas vertebrae. Unilateral complete posterior ponticle was found in only 1 (2%) atlas on the left side whereas no such finding was identified on right side in any vertebra. Unilateral complete lateral ponticle was found in only 1 (2%) atlas on the right side but not on left side. No bilateral complete lateral ponticle and incomplete unilateral or bilateral lateral ponticles were identified in this study. Conclusion: Presence of posterior and lateral ponticles pose a risk of vertebrobasilar vascular insufficiency and may cause variety of symptoms. Vertebral artery may be at risk during neurosurgical procedures when having a foramen arculae and may give a false impression of much wider posterior arch of atlas. Knowing the prevalence of this can help neurosurgeons, general surgeons, radiologists, and chiropractors in management of the patients.
... However, this finding was different from that of the study conducted by Giudice et al. [14]. This difference was probably caused by racial and hereditary transmission differences in the data obtained from the previous studies in a similar society [7,12,19,21,35]. According to Geist et al., since cervical vertebral anomalies/variations can be affected by genetic background, they differ according to the ethnies or geographic origin and not according to demographic or site variables [12]. ...
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Purpose: To compare cervical vertebral anomalies and sella turcica bridging (STB) in different growth stages in orthodontic patients with different vertical skeletal growth patterns. Methods: Lateral cephalometric radiographs (LCR) of 270 patients in the preadolescent, adolescent, or postadolescent periods and having low angle [LA], normal angle [NA], or high-angle [HA] vertical skeletal growth patterns were evaluated retrospectively. STB was visualized using LCRs while evaluating the deficiency of ponticulus posticus (PP) and atlas posterior arch (PAA) associated with the atlas bone. The Pearson chi-square and Fisher's exact tests were used for categorical data and one-way ANOVA for numerical data. Results: The prevalence of fully calcified PP and STB increased from the preadolescent (PP, 10.0%; STB, 11.1%) to the postadolescent period (PP, 24.4; STB, 21.1%); they did not differ from vertical skeletal growth patterns (p > 0.05). The prevalence of PAA deficiency is significantly higher in individuals with LA (46.7%) than with other angles (NA, 27.8%; HA, 26.7%). The vertical skeletal growth pattern was significantly related to STB in the preadolescent period and PAA in the postadolescent period. Conclusions: Different anomalies during different growth periods correlate with the vertical skeletal growth pattern. It will be useful to evaluate a different anomaly according to the relevant growth period.
... They pointed out that the presence of extra foramina in the transverse processes may indicate multiplication of the number of structures running through them.Kaya et al (2011) reported that the shape and size of the FT varies from different vertebrae and individuals.9 The studies on the 12th /13th c. material from the environs of Kielce(Wysocki et al. 2003b) confirmed the most frequent occurrence of double foramina in C6, and the least frequent in C3.10 Jaffar's (2004) results were similar: double foramina were the most frequent at the level of C6 (70%), while C2 had no extra foramina. The greatest variation in the number of foramina appeared in vertebrae at lower levels (C7-C6), which may be associated with the nerves running there. ...
... As características anatômicas macroscópicas da vértebra atlas têm sido bem descritas por gerações de anatomistas ( Monu et al., 1987). As vértebras da parte cervical e da porção torácica proximal da coluna vertebral humana são as áreas que sofrem a transformação mais intensa durante a filogenia, levando a muitas variantes anatômicas ( Wysocki et al., 2003 (Crowe, 1986), processo glenóideo posterior, Posticus ponticularis ( Prescher et al., 1996); no entanto, o nome mais aceito é Ponticulus posticus. ...
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Os cães são animais tidos como de companhia e é a espécie mais atendida por veterinários, seja exames de rotina, seja emergência. É comum, na clínica, a admissão de pacientes com traumas resultantes de acidentes. Com base nisso há uma enorme necessidade em se ter amplo conhecimento da anatomia desses animais para possibilitar uma intervenção médica eficaz. Para o trabalho foram utilizadas 22 costelas, 11 de cada antímero, com as quais foi realizada a biometria e logo após os ensaios mecânicos destrutivos para determinar sua resistência. Com os resultados obtidos é possível desenvolver materiais substitutivos que possam ser implantados por conta de fraturas
... As características anatômicas macroscópicas da vértebra atlas têm sido bem descritas por gerações de anatomistas ( Monu et al., 1987). As vértebras da parte cervical e da porção torácica proximal da coluna vertebral humana são as áreas que sofrem a transformação mais intensa durante a filogenia, levando a muitas variantes anatômicas ( Wysocki et al., 2003 (Crowe, 1986), processo glenóideo posterior, Posticus ponticularis ( Prescher et al., 1996); no entanto, o nome mais aceito é Ponticulus posticus. ...
... As características anatômicas macroscópicas da vértebra atlas têm sido bem descritas por gerações de anatomistas ( Monu et al., 1987). As vértebras da parte cervical e da porção torácica proximal da coluna vertebral humana são as áreas que sofrem a transformação mais intensa durante a filogenia, levando a muitas variantes anatômicas ( Wysocki et al., 2003 (Crowe, 1986), processo glenóideo posterior, Posticus ponticularis ( Prescher et al., 1996); no entanto, o nome mais aceito é Ponticulus posticus. ...
... As características anatômicas macroscópicas da vértebra atlas têm sido bem descritas por gerações de anatomistas ( Monu et al., 1987). As vértebras da parte cervical e da porção torácica proximal da coluna vertebral humana são as áreas que sofrem a transformação mais intensa durante a filogenia, levando a muitas variantes anatômicas ( Wysocki et al., 2003 (Crowe, 1986), processo glenóideo posterior, Posticus ponticularis ( Prescher et al., 1996); no entanto, o nome mais aceito é Ponticulus posticus. ...
... It may completely or partially encircle the suboccipital nerve, the vertebral venous plexus, and the vertebral artery existing from the transverse foramen and turning anteriorly to become intradural (atlantic portion or V3). Its morphology is thus highly variable and it may be uni or bilateral [19,43]. Only a small percentage of patients' variable from 4% [32,34] to 17% [4,9,13,16,19] has been reported as having a true canal for the vertebral arteries in the posterior arch of the atlas and this finding is generally not related with sex [7,16,19,27,36]. ...
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Purpose The groove of the vertebral artery on the posterior arch of the atlas (sulcus arteriae vertebralis) may become a complete or partial osseous foramen: the arcuate foramen. The presence of a complete or partial arcuate foramen is a rare anatomical variant described in a minority of patients and it seems to be associated with vertigo, vertebro-basilar insufficiency, posterior circulation strokes, and musculoskeletal pain. As the number and morphology of cervical vertebrae is highly preserved, we questioned about its significance from an evolutionary point of view. We thus investigated through an extensive literature review if the arcuate foramen is a pure anatomical variation shape or if it might represent an adaptation legacy. Methods We observed five atlas of an extinct species, the Late Pleistocene Mammoths (M. primigenius), and we compared them with five atlas of a closely related existent species, the African elephant (L. africana). Results All the mammoths’ atlas had an arcuate foramen through which the vertebral artery passed before turning anteriorly and becoming intradural. This foramen was not present in elephants’ atlas, where only a groove was observed, such as in the majority of patients. Conclusion We would like to raise the hypothesis that this peculiar morphology of mammoths’ atlas might have contributed, in association with other factors, to their precocious extinction and that the arcuate foramen might represent a disadvantage in the evolutionary process, with a low prevalence in humans being the result of a natural selection.
Article
Background: The double transverse foramen (DBLTF) is a cervical spine anatomic variant. Current literature has presented prevalence values of DBLTF in Caucasian Mediterranean subjects that seem to be higher than those observed in other samples of subjects. Therefore we aimed to test if Caucasian Mediterranean subjects present a higher prevalence of the DBLTF than sub-Saharan African subjects. Methods: We analyzed the presence of DBLTF in cervical spines of 100 skeletons from Caucasian Mediterranean subjects and 91 skeletons from sub-Saharan African subjects, resulting in a total of 1337 cervical vertebrae having been studied. Results: No DBLTF was found in vertebrae C1, C2, and C3. The pattern of prevalence observed in all samples analyzed indicated the prevalence ranged from exhibiting the most to the least prevalence as C6 > C5 > C7 > C4. The sub-Saharan African subjects presented a significant reduced DBLTF prevalence of 2.2%, 14.3%, 19.8%, and 3.3% in C4 (P = 0.043), C5 (P = 0.004), C6 (P < 0.001), and C7 (P = 0.041), respectively, than that presented by Caucasian Mediterranean subjects (9.0%, 32.0%, 45.0%, 11.0% in C4, C5, C6, and C7, respectively). Conclusions: Our study has revealed that this anatomic variation is more frequently found in Caucasian Mediterranean subjects than in sub-Saharan African subjects.
Article
The bony components of the craniovertebral junction (CVJ) have been investigated in 172 skeletons, dug up from several archaeological sites, to define the frequency of developmental dysmorphisms, and to acquire qualitative and quantitative data about their morphology. A review of the pertinent literature is also presented. Twenty-five individuals (14.5%) exhibited at least one dysmorphism, which ranged from a condition of simple variant to a true malformation. Four individuals presented two or more anomalies at the same time (2.3% of the whole sample, 16% of the affected individuals). The most frequently observed abnormalities were: (i) the presence of a complete bony bridge in the atlas, forming a canal surrounding the vertebral artery (arcuate foramen, supertransverse foramen, and the simultaneous occurrence of arcuate foramen and supertransverse foramen); (ii) the presence of basilar processes. Basilar processes displayed a great variety in shape and dimension. They also differed with respect to their relationship with atlas and axis. The less frequently detected anomalies were: (i) complete absence of the posterior arch of C1, (ii) fusion of C2 and C3, and (iii) irregular segmentation of C2. A broad array of structural defects has been described at the CVJ. They may occur either isolated or as part of complex multisystem syndromes. Although harmless in many cases, they can notwithstanding cause severe, even life-threatening complications. When unrecognized, they may generate trouble during surgery. Hence, accurate knowledge of CVJ arrangement, including its multifarious variations, is a critical issue for radiologists, clinicians, surgeons, and chiropractors.
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Introduction. Conventional complete dentures are still the first choice in the treatment of completely edentulous patients. Dissatisfaction among complete denture wearers is not uncommon. The goal of this study was to determine the causes of patients? dissatisfaction with complete dentures. Material and Methods. A total of sixty patients participated in this study, 36 f?males (60%) and 24 males (40%). Twenty-five patients received their first complete dentures, and fourteen of them had previously worn complete dentures. In patients receiving complete dentures, there are many factors contributing to their adaptation, acceptance and feeling discomfort while wearing them. Conclusion. Our study showed that patients? satisfaction was not directly related with the quality of complete dentures.
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50 sets of typical dried cervical vertebrae of human were studied for no. of foramen transversarium present on each transverse process of vertebra. So double foramen transversarium were detected unilaterally or bilaterally in 16 vertebrae out of 200 typical (C3-C6) cervical vertebrae. The variation of foramina appears to follow a pattern at various vertebral level.The course of vertebral artery may be distorted under such conditions. The normal factor responsible for such anomalies of foramen transversarium is developmental or related to the variation of course of vertebral artery.
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In forensic anthropology, identification begins by determining the sex, age, ancestry and stature of the individuals. Asymptomatic variations present on the skeleton, known as discrete traits, can be useful to identify individuals, or at least contribute to complete their biological profile. We decided to focus our work on the upper part of the skeleton, from the first vertebra to the pelvic girdle, and we chose to present 8 discrete traits (spina bifida occulta, butterfly vertebra, supraclavicular nerve foramen, coracoclavicular joint, os acromiale, suprascapular foramen, manubrium foramen and pubic spine), because they show a frequency lower than 10%. We examined 502 anonymous CT scans from polytraumatized individuals, aged 15 to 65 years, in order to detect the selected discrete traits. Age and sex were known for each subject. Thin sections in the axial, coronal and sagittal planes and 3D volume rendering images were created and examined for the visualization of the selected discrete traits. Supraclavicular foramina were found only in males and only on the left clavicle. Coracoclavicular joints were observed only in males. The majority of individuals with a suprascapular foramen were older than 50 years of age. Pubic spines were observed mostly in females. Other traits did not present significant association with sex, age and laterality. No association between traits was highlighted. Better knowledge of human skeletal variations will help anthropologists come closer to a positive identification, especially if these variations are rare, therefore making them more discriminant. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
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: Foramen transversarium are located on the transverse process of cervical vertebrae and are the cardinal features of cervical vertebrae. These foramina are known to exhibit variations in size, shape and may be absent or duplicated. Keeping this in mind, a study was done to record these variations. A hundred and twenty dry typical cervical vertebrae procured from department of anatomy were used for this study. Unilateral double foramen transversarium were seen in 2.5% cases while 4.16% cases showed bilateral double foramen transversarium. 0.83% cases showed symmetrical foramen transversarium and another 1.66% cases showed incomplete foramen transversarium. The normal factor responsible for such anomalies is developmental or related to variation in course of vertebral artery. The recognition of this variation provides safety and efficiency for the posterior approaches of the cervical spine.
Article
OBJECTIVE: The foramen arcuale (FA) is a bony bridge located over the vertebral artery on the posterior arch of the atlas. The presence of an FA can pose a risk during neurosurgery by providing a false impression of a broader posterior arch. The aim of this study was to provide the most comprehensive investigation on the prevalence of the FA and its clinically important anatomical features. METHODS: Major electronic databases were searched to identify all studies that reported relevant data on the FA and the data were pooled into a meta-analysis. RESULTS: A total of 127 studies (involving 55,985 subjects) were included. The overall pooled prevalence of a complete FA was 9.1% (95% CI 8.2%–10.1%) versus an incomplete FA, which was 13.6% (95% CI 11.2%–16.2%). The complete FA was found to be most prevalent in North Americans (11.3%) and Europeans (11.2%), and least prevalent among Asians (7.5%). In males (10.4%) the complete FA was more common than in females (7.3%) but an incomplete FA was more commonly seen in females (18.5%) than in males (16.7%). In the presence of a complete FA, a contralateral FA (complete or incomplete) was found in 53.1% of cases. CONCLUSIONS: Surgeons should consider the risk for the presence of an FA prior to procedures on the atlas in each patient according to sex and ethnic group. We suggest preoperative screening with computerized tomography as the gold standard for detecting the presence of an FA.
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Objective: This study evaluated the prevalence and morphologic characteristics of ponticulus posticus (PP) by using cervical 3-dimensional (3-D) cone-beam computed tomography (CBCT) scan images. Methods: This was a retrospective study conducted by selecting cervical 3-D CBCT images of 698 patients, which were examined for the presence and types of PP. Results: In 257 patients, 438 PPs, complete or partial, bilateral or unilateral, were identified on the 698 cervical 3-D CBCT scans; therefore, the prevalence was 36.8%. Bilateral complete PP and partial PP were observed in 6.3% and 16.2% of subjects, respectively. There was a significant difference in the prevalence between males and females (P = .001) and between the right and left sides between males and females, but not between age groups. Conclusion: Ponticulus posticus is a relatively common anomaly in this Turkish sample, which may have implications for those who perform clinical procedures on the upper cervical spine.
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A very rare case of anomalies of the craniovertebral junction (CVJ) is reported owing to its clinical significance and rarity. MRI and CT scan studies of the CVJ of a 52-year-old female patient revealed a hypoplastic clivus, an occipital vertebra, partial occipitalization of the atlas and atlas posterior rachischisis. The presence of an occipital vertebra and occipitalization of the atlas in the same case has not been reported previously. The signs and symptoms of CVJ abnormalities are varied, typically begin insidiously, and arise fairly late, progress slowly, remain stationary and rarely relapse. Congenital and developmental osseous abnormalities and anomalies affecting the craniovertebral junction complex can result in neural compression and vascular compromise and may manifest with abnormal cerebrospinal fluid dynamics. An understanding of the development of the craniovertebral junction is essential for the recognition of pathological abnormalities.
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Inferior accessory ossicle of anterior arch of atlas is a rare, albeit normal variant in relation to cervical spine, invariably detected incidentally while investigated for other unrelated condition. Its existence should always be kept in mind while evaluating any bony fragment in relation to atlas axis vertebrae so as to avoid unnecessary investigation in suspicion of other sinister aetiology. Presence of well-cortical margins, constant size and shape over a course of time, constant position in close relation to anterior atlas arch, normal appearing pre-paravertebral soft tissue are indicators of its presence. We present a case of this anatomical variant detected incidentally in an old man investigated for oral malignancy.
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Background and aims: Foramen transversarium of cervical vertebra is a bony enclosure for the vertebral artery. These foramina are known to exhibit variations in size, shape and may be multiple in number or absent. The aim of this study is to record these variations of foramen transversarium of cervical vertebrae. Material and methods: This study was carried out on 150 cervical vertebrae available in the department of anatomy at Pondicherry Institute of Medical Sciences. Results: Among 150 cervical vertebrae, 19 vertebrae were found to possess double foramina transversaria. Among these 15 were typical and four were atypical vertebrae. Among 15 typical cervical vertebra 12 (80%) had double foramina on right side, one (6.6%) on left side and two (13.3%) bilaterally. Among four atypical vertebra three (75%) possessed double foramina on right side and one (25%) bilaterally. In one typical vertebra there was an enmeshed foramen. Conclusions: The knowledge of these variations is important for radiologists in interpreting computed tomographs and magnetic resonance images.
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During a routine osteology class for undergraduate students in Government Medical College, Kozhikode, Kerala, a median defect of posterior arch was found in the atlas of a cadaver. It was not a fracture as the edges were regular, round and smooth.There was no associated anomalies. These midline defects of posterior arch of atlas are sub divided both morphologically (types A-E) and clinically (sub groups 1-5) depending on the extent of absence of posterior arch and presence or absence of the posterior tubercle.The author presents a rare anomaly of a posterior arch partial aplasia which could be congenital. Since major neurologic deficits can be produced by a minor trauma, it is crucial to recognize this anomaly.
Article
Objectives: The aim of this study was to calculate the prevalence of ponticulus posticus: a small bony bridge on the dorsal aspect of the Atlas on lateral digital cephalometric radiographs and classify it into a complete ring or an incomplete ring. The study also investigated its association with the presence or absence of cervicogenic headache in the examined population if any and presents a literature review on Ponticulus posticus. Methods: The presence and types of ponticuli posticus were investigated on 500 digital lateral cephalograms and the same patients were questioned for a history of cervicogenic headache. Results: In 500 patients, 79 Ponticulus Posticus: 34 complete and 45 incomplete, were identified on the Lateral Cephalograms; therefore, the prevalence was 15.8%. The distribution of the type of PP in males was 13.1% and females was 17.9% in the studied sample. The overall prevalence of Cervicogenic headache was 6% in the studied sample with significant association between Cervicogenic headache and type of PP. Conclusion: The study shows that ponticulus posticus it is a not a rare finding and its association with unexplainable headache, neck pain and other symptoms as well as its importance and implications during management of cervical spine surgical procedures, especially those requiring lateral mass screw placements in the atlas, implies that, radiologists and dentists in general should closely inspect the vertebral region on a lateral cephalogram.
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Objective: To investigate the incidence of foramen arcuale in dry atlas vertebrae which may cause clinical problems. Materials and methods: Eighty-one dry human cervical vertebrae were examined. The evaluated parameters of two atlas vertebrae including foramen arcuale were as follows: maximum antero-posterior, transverse diameters and areas of the right and left superior articular facets and transverse foramina; maximum antero-posterior diameters, heights, areas and central sagittal thickness of bony arch forming roof of foramen arcuale, respectively. All parameters were measured with caliper in milimeters. Results: Thirteen of eighty-one cervical vertebrae specimens (13/81, 16.05%) were atlas and the two of thirteen atlas vertebrae (2/13, 15.38%) had macroscopically complete foramen arcuale. Each of the two atlas vertebrae was including one foramen arcuale (one on the left and one on the right side). There was a statistically significant difference (p = 0.04) between the mean antero-posterior diameter of superior articular facet located on each side of atlas vertebrae, whereas not (p = 0.51) between mean antero-posterior diameter of transverse foramina. There was not any significant difference between the mean transverse diameters and areas of superior articular facets and transverse foramina located on each side of atlas vertebrae, respectively. Each of the areas of transverse foramina located on the same sides with foramen arcuale in two atlas vertebrae was less than the mean areas of transverse foramina located ipsilateral side with each foramen arcuale in thirteen atlas vertebrae. Conclusion: The present study provides additional information about the incidence and topography of the atlas vertebrae including foramen arcuale.
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The lateral (LF) and posterolateral (PLF) foramina are anatomical variants of the atlas. Both variants have been implicated in multiple neurological conditions including vertebrobasilar insufficiency, with symptoms such as dizziness, syncope, auditory and visual disturbances and paresis. The aim of this study was to conduct a systematic meta-analysis on the prevalence and anatomical characteristics of the LF and PLF. An extensive search of the major electronic databases was conducted to identify all studies that reported relevant data on the LF and PLF. No date or language restrictions were applied. Data on the prevalence, type (complete and incomplete), side, gender, and laterality of the LF and PLF, when available, were extracted and pooled into a meta-analysis. A total of 33 studies (n = 10,190 subjects) were included in the quantitative analysis. The overall pooled prevalences of complete LF and PLF were 2.6% (95%CI: 2.1–3.1) and 1.2% (95%CI:0.6–2.0), respectively, while the overall pooled prevalence of the incomplete LF was 2.7% (95%CI:1.3–4.4) and the incomplete PLF was 0.7% (95%CI:0.0–1.8). When there was a complete PLF, a contralateral PLF (complete or incomplete) was found in 32.8% of cases. The geographical distribution of both variants was variable. The findings of this study provide an evidence-based foundation of anatomical knowledge of the two variants of the atlas. We recommend that physicians consider the possible role of the LF and PLF during the diagnosis of various neurological disturbances, especially in situations when all other possible explanations for the symptoms have been excluded.
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Summary Introduction. Conventional complete dentures are still the first choice in the treatment of completely edentulous patients. Dissatisfaction among complete denture wearers is not uncommon. The goal of this study was to determine the causes of patients’ dissatisfaction with complete dentures. Material and Methods. A total of sixty patients participated in this study, 36 fеmales (60%) and 24 males (40%). Twenty-five patients received their first complete dentures, and fourteen of them had previously worn complete dentures. In patients receiving complete dentures, there are many factors contributing to their adaptation, acceptance and feeling discomfort while wearing them. Conclusion. Our study showed that patients’ satisfaction was not directly related with the quality of complete dentures. Key words: Denture, Complete; Patient Satisfaction; Jaw, Edentulous; Surveys and Questionnaires; Treatment Outcome; Mastication; Esthetics, Dental; Quality of Health Care
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Introduction: The Foramina Transversaria (FT) are known to exhibit variations in their size, shape and they may be absent or duplicated/triplicated. The deformation of foramina may result in derangement of neurovascular structures passing through these foramina. This necessitates the need of extensive analysis of variation of the foramina. Aim: To present morphometric details of FT of cervical vertebrae as well as incidence of accessory FT in intact cervical spine of Indian population and to make a comparison with previous studies done. Materials and Methods: The study was conducted on 319 FT of 161 dry cervical vertebrae of 23 complete vertebral spines of Indian population (3 FT were absent in 2 C7 vertebrae). For morphometric measurements, transverse and anteroposterior diameters were measured on both sides of all cervical vertebrae using digital vernier calliper. Accessory transverse foramina were also noted and photographed. Mean, range and standard deviation of morphometric measurements of these foramina were analyzed. The comparison was made between their various parameters on right and left side using student’s t-test and p-value. Results: Transverse and anteroposterior diameters were higher on left side than right. Mean value of foramen transversarium of C1 was highest on both sides where as of C7, it was lowest. Forty two cervical vertebrae (26.09%) among 161, showed accessory FT. Here, 25 vertebrae (15.53%) showed unilateral and 17 vertebrae (10.56%) bilateral showed accessory foramen. Accessory foramina were most commonly seen in C6 vertebrae. Two C7 vertebrae showed absence of FT, one bilaterally and one unilaterally. Accessory foramina were always smaller than main foramina transversarium. All accessory foramina were located posterior to main foramina transversarium except in one C4 vertebrae where accessory foramen was present anterior to main foramina transversarium. Conclusion: The present morphometric study done on intact cervical vertebral column demonstrates that different cervical vertebrae (C1-C7) shows considerable variation in terms of their size, shape and number of FT. This detailed report on morphology of cervical vertebrae would be useful for neurosurgeons and will help in better surgical outcome. It would also help radiologisfor better understanding.
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Background: Since scanty literature is available on the absence of costal element forming foramen transversarium of atlas vertebra therefore this study was undertaken. Atlas vertebrae were examined to see the presence of foramen transversarium and their boundaries. Methods: Hundred foramina transversaria of 50 atlas vertebrae were examined grossly. Results: Foramen transversarium was seen to be present in all the transverse processes of the atlas vertebrae examined. Costal element was found to be missing in seven foramina tranversaria out of 100 foramina seen. It was found to be absent on the right side in three vertebrae and in two it was absent bilaterally. Conclusions: In case the costal element of the foramen transversarium is absent, the second part of vertebral artery passing through this foramen is liable to be damaged while operating at the level of atlanto-occipital joint the operating surgeon should be aware of such variations so as to avoid injury of second part of vertebral artery and subsequently preventing any kind of neurological involvement. Radiologists must also know about such variations so as to correctly interpret radiological image of the craniovertebral region. [Int J Res Med Sci 2013; 1(2.000): 66-68]
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Four hundred and eighty foramina transversaria in dry cervical vertebrae of 36 spines and in a number of dissections were studied and classified according to size, shape, and direction of their main diameter. A coefficient of roundness was then elaborated. The variations of foramina appear to follow a pattern at various vertebral levels. The possible factors (in addition to the embryological ones) involved in causing these variations-for example, mechanical stress, size, course, and number of vertebral vessels-were analysed. The importance of the correct interpretation of the variations in the foramina transversaria in radiographic or computerised axial tomography is discussed. The contribution of the present study to the understanding and diagnosis of pathological conditions related to the vertebral artery and its sympathetic plexus is stressed.
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Two patients with vertebrobasilar ischemia are described in whom angiography demonstrated obstruction of one vertebral artery at the C1–2 level on rotation of the head. The possible anatomical explanation and physiological significance of this finding are discussed.In zwei Patienten mit vertebrobasilarer Ischimie wurde angiographisch bei Rotation des Kopfes eine Obstruktion der Vertebralarterie in Hhe von C1–2 nachgewiesen. Es wird die mgliche anatomische Erklrung und physiologische Bedeutung dieses Befundes diskutiert.Deux cas d'ischemie vertbrobasilaire par rotation de la tte ont t dmontres par artriographie. L'ischemie tait produite par une obstruction externe au niveau des deux premires vertbres cervicales. Les raisons anatomiques possibles aussi bien que la signification physiologique de ces troubles sont analyses.
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Two cases of angiographically demonstrated fenestration of the extracranial vertebral artery and a review of 32 cases reported in Japan are presented. The embryological basis of this anomaly and its association with other intracranial abnormalities are discussed.2 Flle von angiographisch nachgewiesener Fensterung des intracraniellen Abschnittes der A. vertebralis werden geschildert, gleichzeitig wird ein Literaturberblick gegeben. Die Ursache dieser Anomalie und ihre Kombination mit anderen intracraniellen Mibildungen wird diskutiert.Deux cas de mise en vidence angiographique de fnstration de l'artre vertbrale extra-crnienne sont prsents, et les auteurs font la revue de 32 cas rapports au Japon. Ils discutent la base embryologique de cette anomalie et son association avec d'autres anomalies intracrniennes.
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Congenital absence of part of the anterior arch of the atlas, a rare disorder, was observed in two patients. The defect in the C1 cervical vertebrae, caused by congenital nonfusion of the arch of C1, may be confused with a cervical spinal fracture on plain radiographs of the cervical spine. The diagnosis is established by characteristic radiological changes, especially in the CT scan and bone scan. Because congenital anomalles of the cervical spine may predispose to instability of the cervical spine and can be confused with traumatic lesions, thorough evaluation is warranted. Treatment should be based on signs of instability, if present.
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The incidence of a foramen retroarticulare atlantis in a group of 380 patients was investigated and put in relation to the frequency of headaches, migraine and Meniere's syndrome. These complaints are found more frequently in patients with a retroarticular foramen. Angiograms of the vertebral artery show vascular constrictions in the region of the foramen retroarticulare in the majority of patients examined. In 5 patients, the clinical symptoms of a mechanical irritation with changes in blood flow through the vertebral artery in the region of a foramen retroarticulare atlantis have been described.
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An anatomical peculiarity of the first cervical vertebra is described: the retrotransverse groove (or canal) containing an anastomotic vein.Copyright © 1977 S. Karger AG, Basel
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The transverse process C2 plays an important role in the stabilization of the vertebral unit C2/C3 and the protection of the vertebral artery and the cervical spinal cord. The anatomical disposition of the transverse processes C2 and especially the lateral processes may be different from one subject to another. Certain anatomical variants of the transverse process can exert a negative effect on the stabilizing and protective function of the same. Our observations suggest that a maldevelopment or a lesion of the transverse process of the axis may induce extra stresses in the vertebral unit C2/C3 with subsequent development of a zygapophyseal arthrosis at this level. Any zygapophyseal arthrosis (uni- or bilaterally) should lead us to think of this possibility too.
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Six hundred foramina transversaria (FT) of the axis vertebrae of 4 population groups were examined for the presence of erosion of the lateral articular mass. Of these, 127 (21%) and 72 (12%) presented with moderate and marked erosion, respectively. Evidence is presented incriminating the tortuosity of the vertebral artery as well as congenital factors in the etiology of the erosion of the FT. Attention is drawn to the possible correlation between angulation of the transverse process of the axis and erosion of the FT.
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Six hundred and seventy-two atlas vertebrae of 6 population groups were examined for the presence of a posterior and/or lateral bridge. Of these, 174 (25.9%) presented with partial posterior bridge formation and 53 (7.9%) with a complete bridge. Twenty-six (3.8%) showed some form of lateral bridging. Although controversy exists as to the origin of atlas bridging, the findings of the present study show that aging could be a factor predisposing to complete bridge formation. The clinical significance of bridge formation is discussed with reference to their possible effect on normal vertebral artery function, particularly in rotation.
Article
The retrocondylar vertebral artery ring of the atlas, which has been described by many authors as an ossification of the oblique ligament bridging the groove of the vertebral artery, has been studied in 60 macerated specimens, 12 dissections of the atlanto occipital region and in 990 x rays of the cervical spine. Dissecting the specimens, the oblique ligament of the atlas was seen to be lower border of the posterior atlanto occipital membrane. The retrocondylar bony ring of the vertebral artery of the atlas was seen in the skeletons of children aged 2 and 4 years respectively and in the cervical spine x ray of a 13 yr old boy. It is a permanent structure in other vertebrates so that the retrocondylar bony ring of the human atlas cannot be a simple ossification, but is a regressive and disappearing morphological phenomenon. In the study of the macerated specimens, a complete ring was found in 15% of the cases and an incomplete ring in 21.66%. This represents more than one third of cases. In nearly the same number of cases, the groove for the vertebral artery was deeper than is usually described, but not sufficiently so as to be described as an incomplete ring. Several morphological variations were present both in the size of the complete rings and in the size and shape of the tubercles of the incomplete rings. The presence of a bony ring is always accompanied by a deeper groove than usual on the other side if the groove on that side is not itself a ring. Of the 990 x rays studied, 7.58% had complete rings and 6.06% had incomplete rings. This is a higher incidence than previously described in the literature. The relatively high incidence of the bony ring suggests that it may be of significance in the etiology of vertebrobasilar insufficiency. This view is supported by the study of 77 case histories of patients in whom the ring was present. Of these, 5 were diagnosed as having symptoms of vertebro basilar insufficiency of unknown origin. A further 8 cases had symptoms which suggest a possible relationship between these and the presence of a bony ring of the atlas.
Article
At the point where the vertebral artery crosses the posterior arch of the atlas it may sometimes be enclosed by a bridge of bone, the so-called foramen arcuale. The foramen limits the normal mobility of the vessel during flexion and extension of the neck and may cause disturbances of arterial flow and of the peri-arterial sympathetic plexus giving rise to symptoms similar to those found in the Barre-Lieou syndrome. The authors describes the angiographic findings in such patients and a technique for the surgical excision of the foramen. The results of the operation in two groups of patients, with and without associated spondylosis of the lower cervical spine, are presented.
Article
The foramen arcuale of vertebral artery of altas is one of the causes of vertigo. Leven cases of the cervical vertigo caused by foramen arcuale were operated on. The patients were followed up for 3-6 years. The results were satisfactory. The mechanism of inducing vertigo by foramen arcuale was discussed. We demonstrated that excision of the foramen arcuale is available for cervical vertigo.
Article
The authors report a symptomatic congenitally anomalous ectatic vertebral artery not passing through the transverse foramen of the atlas (C-1), but instead piercing the dura mater below the posterior arch of the C-1 in the atlantoaxial (C1-2) interlaminar space. This occurrence is exceptionally rare, but in this case it was uniquely associated with occipital neuralgia due to vascular compression of the C-2 root. Microvascular decompression was curative. Neuroradiological and surgical findings are presented and their implications discussed.
Article
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).
Article
The retroarticular canal has been implicated in compression of the vertebral artery, where it passes over the posterior arch of the atlas vertebra, during extreme rotational movements of the head and neck. The incidence of this retroarticular canal is not known in the South African population. The aim of the present study was to record the incidence and the dimensions of the retroarticular canal in South African white and black adults, aged 20-80 years. In a total of 1,354 atlas vertebrae, 9.8% of sides (264 left and/or right sides) were classified as having complete retroarticular canals, of which 11.7% (31 sides) were right-only, 24.6% (65 sides) left-only and 31.8% (84 left plus right sides) bilateral canals. This incidence did not increase with age and was lower in whites than blacks, with white males having the lowest and white and black females alike having the highest incidence of the canal. Measurements of the retroarticular canal showed that there was no difference between left and right sides. However, the superoinferior diameter was significantly less than the anteroposterior diameter, in all but the right canals in the white female subgroup. This difference in the dimensions of the retroarticular canal will decrease the cross-sectional area of the space available for the vertebral artery passing through it and may compromise blood flow in the vessel.
Article
Vertebral artery compression causing brainstem ischemia has been suggested to underlie the sudden infant death syndrome. Vertebral artery distortion from neck movements has been demonstrated by angiography in infants, but direct evidence for arterial compression is lacking. In an attempt to demonstrate vertebral artery compression from head movement, we examined at postmortem the vertebral arteries of infants after neck extension or rotation. The C1-C7 spinal column, together with a 2-cm rim of skull base, was removed from 20 infants dying from sudden infant death syndrome or other causes. In 5 cases the neck was extended, in 9 cases it was rotated 90 degrees to the right, and in 6 cases the neck was held in the neutral position. The neck was maintained in these positions during formalin fixation, and serial sections of selected blocks were examined microscopically. In 3 of 5 extended cases, bilateral vertebral artery compression was seen between the occipital bone and C1. In 3 of 9 rotated cases, the left vertebral artery was compressed adjacent to C1 before the artery entered the transverse foramen. No vertebral artery compression was seen in the necks held in the neutral position. The vertebral arteries of some infants can be compressed by neck movement. This could induce lethal brainstem ischemia in infants with inadequate collateral blood flow or with poor compensatory arterial dilatation, and may underlie some cases of sudden infant death syndrome.
Article
Twelve children with vertebrobasilar artery stroke are reported (seven males, five females; aged 6 months to 15 years). Patient 1 showed an arcuate foramen in the posterior arch of the atlas, an anatomical variant occurring in 3 to 15% of the population. It was hypothesized that the presence of the arcuate foramen might cause tethering of the vertebral artery and lead to its dissection by repetitive trauma. Lateral plain films of the cervical spine in cases of posterior circulation stroke were taken. Eight of 11 patients showed aberrant arcuate foramina. Of the remaining three patients, one had normal cervical spine X-rays, one had an absent right posterior arch of the atlas following previous surgery for a cervical meningocele, and one patient had incomplete ossification of the vertebrae. Seven of the nine patients with arcuate foramina had vertebral angiograms. In all cases this showed the vertebral artery passing through the arcuate foramen before entering the brain and an appearance consistent with arterial dissection and occlusion at the same site below the foramen. Most documented cases of posterior circulation stroke in children follow trauma, which may be minimal or repetitive, with thrombotic occlusion of the artery at C1-C2 level. The association with an arcuate foramen and its possible causative role in the genesis of posterior circulation stroke in children has not been previously recognized. There may be a causal association between the presence of an arcuate foramen, tethering of the vertebral artery in the foramen, and dissection from repetitive trauma with movement of the neck.
Article
The evaluation of anatomic landmarks is an important task of the radiologist because significant changes in these structures may be an index to underlying disease processes. The variations and asymmetrical deviations of such landmarks in size, shape, and contour are often many and confusing. For this reason they must be studied with care to insure adequate differentiation from disease processes. The extensive variations which may occur in the region of the craniocervical junction have been reviewed by McRae (6). Hoare (3) has also pointed out the importance of evaluating the grooves and foramina in the region of the posterior and lateral margins of the atlas and axis in vascular lesions of the posterior fossa and in lesions involving the cerebellum. It appeared desirable to us to evaluate the sulcus formed by the vertebral artery as it crosses the posterolateral laminar margin of the first cervical vertebra. After its exit from the transverse foramen, the vertebral artery passes over the posterior arch of...
Article
Lateral cephalometric radiographs of 353 young caucasoid orthodontic patients from 6 years to 17 years were examined for the presence of ponticulus posticus of the first cervical vertebra. Visualization of the posterior fossa was not obstructed and in each case the squamous occipital and posterior arch of the atlas could be clearly defined. Of the 353 subjects, 56 (15.8%) showed some degree of a ponticulus posticus. Of these, 24 (14.6%) of 164 were males and 32 (16.9%) of 189 were females, with no apparent sex differences in the occurrence of this anomaly. Those showing a ponticulus were divided on the basis of bilateral complete or incomplete and unilateral complete or incomplete. There were numerous variations in the size and location of the ossification centers in the atlanto-occipital membrane. The youngest female with a ponticulus was six years seven months and the oldest 16 years 11 months, while the youngest male was six years four months and the oldest 16 years five months. Two females with a unilateral partial ponticulus were observed over a one to two year period. During this time a complete unilateral radiopaque ponticulus had developed.
The retroarticular vertebral artery ring of the atlas and its significance Operative treatment for cervical vertigo caused by foramen arcuale
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  • S Zivanovic
  • S Li
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  • J Sun
Lamberty BGH, Zivanovic S (1973) The retroarticular vertebral artery ring of the atlas and its significance. Acta Anat, 85: 113–122. 11. Li S, Li W, Sun J (1995) Operative treatment for cervical vertigo caused by foramen arcuale. Zhonghua Wai Ke Za Zhi, 33: 137–139.
Badania nad kręgiem szczytowym Polaków
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O odmianach kręgu szczytowego człowieka
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Bony abnormalities in the region of the foramen magnum: correlation of the anatomic and neurologic findings
  • Mac Rae
Mac Rae DL (1953) Bony abnormalities in the region of the foramen magnum: correlation of the anatomic and neurologic findings. Acta Radiol, 40: 335-354.