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You can also search for this author in PubMed Google Scholar. Correspondence to Apostolos Karantanas. Approval of the local ethics committee was obtained, but no inform consents were collected due to the retrospective nature of the study.
Reprints and Permissions. Zibis, A. Variations of transverse foramina in cervical vertebrae: what happens to the vertebral artery?. Eur Spine J 27, — Download citation. Received : 25 June Revised : 06 February Accepted : 11 February Published : 17 February Issue Date : June Anyone you share the following link with will be able to read this content:.
The left transverse foramen had a mean transverse diameter of 5. The mean diameter of transverse foramen showed wide variation in individual typical cervical vertebrae. The right transverse foramen varied from 2. The vertebrae characterized by significant narrowing of the transverse foramen were cataloged by grouping the vertebrae for which the dimensions were smaller than one standard deviation away from the mean dimension. The mean diameter of transverse foramen was smaller than 3.
The mean distance of the transverse foramen from the medial margin of the uncinate process was 5. The transverse process of one vertebra showed an accessory transverse foramen on both sides, behind the main transverse foramen Figure 4. The accessory transverse foramina were considerably narrow and therefore were not measured Figure 4.
While performing the measurements on the transverse foramen, it was qualitatively recorded if the specimen had an osteophyte and whether or not the osteophytes were impinging on the transverse foramen. The fifteen vertebrae out of 71 studied The two vertebral arteries are solely responsible for posterior circulation of the brain. The tortuous course of vertebral artery and rarely medial position of transverse foramen in relation to the joint of Luschka may result in life-threatening iatrogenic injury following cervical decompression [ 8 , 9 ].
In the present study, the mean diameter of the right transverse foramen varied from 2. Although there was no statistically significant difference between the dimensions of right and left side, there remains a considerable variation in the diameter of the transverse foramen on left and right side in the same vertebra in C3—C6 vertebrae.
According to the literature, the width of the transverse foramen increased from C3 to C5 vertebra 5. Extreme narrowing of transverse foramen has not been reported in the literature. In the present study, the transverse foramen was less than 3. It is a common finding on angiography that head rotation produces stenosis or occlusion of a contralateral vertebral artery. The narrowing of the transverse foramen may predispose patients to vertebrobasilar insufficiency and thrombus formation especially with head rotation.
The demonstration of accessory transverse foramen Figure 4 reported in this study represents further the clinical importance of abnormal transverse foramen morphology. Duplication of extracranial vertebral artery has been reported in the literature [ 13 — 16 ]. Vertebral artery develops from a fusion of longitudinal anastomosis that links second to sixth cervical intersegmental arteries.
Most of the intersegmental arteries regress except the seventh which forms the origin of vertebral artery. A duplicate vertebral artery may potentially serve to protect patients against ischemic attacks to the brain and provide collateral blood flow to the basilar artery. However, fenestrated vertebral arteries have been demonstrated histologically to be weak with irregular elastic fibers in the vessel wall [ 16 ]. To avoid vertebral artery injury during anterior cervical disc surgery, the medial margin of the uncovertebral joint may be the safe landmark [ 7 ].
In the present study, the mean distance of the transverse foramen from the medial margin of the uncinate process was 5. There may be higher risk of vertebral artery laceration particularly during lateral decompression to resect osteophytes from the uncinate process.
It is suggested that the lateral decompression be completed under direct visualization with opening of the anterior walls of the transverse foramen and the lateral retraction of the vertebral artery [ 5 ].
The osteophytes covering the transverse foramina may force the vertebral artery to meander around these obstructions causing narrowing through external compression and are potential sites of trauma to the vertebral artery [ 17 ]. Injury to the vertebral artery during anterior operative intervention in the subaxial cervical spine may give rise to the catastrophic iatrogenic complications.
The study reports variations in the dimensions of the transverse foramina in a random sample of the typical cervical vertebrae C3—C6 , which allow the passage of the vertebral artery. The transverse foramen was narrow in a significant number of specimens.
Additionally, the osteophytes seen in a large population of specimens which especially were seen impinging on the transverse foramen may be responsible for vertebral artery compression and trauma. Useful morphometric data is provided to assist the surgeon to prevent the vertebral artery damage.
The medial margin of the uncovertebral joint is a safe landmark to avoid vertebral artery injury during anterior surgical approaches to the cervical spine. The accessory transverse foramina seen in the study suggest fenestrations or duplications in the vertebral artery.
The authors declare that there is no conflict of interests regarding the publication of this paper. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Article of the Year Award: Outstanding research contributions of , as selected by our Chief Editors.
Read the winning articles. Special Issues. Academic Editor: Udo Schumacher. Received 30 May Accepted 17 Aug Published 10 Sep The vertebral arteries arise from the first part of the subclavian artery.
The vertebral and internal carotid arteries provide the arterial supply to the brain, forming the Circle of Willis at the base of the brain. After the vertebral artery is given off from the subclavian artery, it passes through the transverse foramina of cervical vertebrae C1 to C6.
It then enters the skull via the foramen magnum. Learn more about the anatomy of the vertebrae in this tutorial. Start typing and press enter to search Search …. We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. Manage consent.
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