Correlation research and clinical significance between youth cervical hook and transverse foramen / 局解手术学杂志

Objective The correlation analysis was proceeded between youth cervical hook and transverse foramen by using imaging scanning and three-dimensional reconstruction method,which can provide theoretical basis for early diagnosis,treatment and prevention of ju-venile cervical spondylosis.Methods A total of 66 teenagers who had no trauma,neurological symptoms or signs were selected with aged from 6 to 20 years old,who were scanned by multi slice spiral CT,ranged from C1 to T1 .The original data in DICOMformat to import 3D re-construction software was related index measurement and subsequent statistical analysis.Results There was a correlation between hook height,base width,base length of luschca joint and transverse diameter,longitudinal diameter.Conclusion Hook vertebral meridian of lus-chca joint and transverse foramen has a close contact.Factors such as fracture and hyperplasia of luschca joint,vertebral artery of transverseforamen can be oppressed that cause corresponding vertebral artery type of cervical spondylosis.

Evaluation of the vertebral artery by 3D digital subtraction angiography / Evaluación de la arteria vertebral mediante angiografía por sustracción digital 3D

The objective of the present study is to determine origin, entry level to the transverse foramen and diameter according to sex and side through 3D angiographic images of seventy-nine vertebral arteries obtained using DSA imaging method. During radiological evaluation, axial, coronal and sagittal images of the artery were used. Data of our study was uploaded to SPSS 14.0 program and significance test and Mann Whitney-U test of the difference between two means were used to evaluate the data. While 76 of the vertebral arteries (96.2%) were originating from the subclavian artery, 3 of them (3.8%) were directly originating from aortic arch. In 67 of 76 the vertebral arteries originating from the subclavian artery were entering through C6, 6 through C7, 2 through C5 and one through C4 transverse foramen. It was seen that one of 3 the vertebral artery originating from aortic arch was entering through C6, one through C7 and the other through C4 transverse foramen. While the mean diameter of the vertebral artery was 3.88±0.71 mm at the right side (3.99 mm in men, 3.66 mm in women), the mean diameter at the left side was 4.15±1.05 mm (4.23 mm in men, 4.06 mm in women).

El objetivo fue determinar el origen, nivel de entrada y diámetro del foramen transverso, en función del sexo y lado sobre 79 arterias vertebrales a través de imágenes angiográficas 3D utilizando el método de formación de imágenes DSA. Durante la evaluación radiológica, se utilizaron imágenes axiales, coronales y sagitales de la arteria. Los datos se procesaron en el programa SPSS 14.0 con las pruebas U de Mann Whitney y de significancia para evaluar la diferencia entre los datos. Mientras que 76 de las arterias vertebrales (96,2%) se originaron de la arteria subclavia, 3 de ellas (3,8%) lo hicieron directamente desde el arco aórtico. En 67 de 76 arterias vertebrales, se observó el origin en la arteria subclavia a través de C6; 6 a través de C7, 2 a través de C5 y una a través del foramen transverso en C4. El diámetro medio de la arteria vertebral fue 3,88±0,71 mm en el lado derecho (3,99 mm en hombres y 3,66 mm en mujeres) y en el lado izquierdo fue 4,15±1,05 mm (4,23 mm en hombres y 4,06 mm en hombres).

Cervicogenic Vertigo Treated by C1 Transverse Foramen Decompression : A Case Report

Cervicogenic vertigo was known as Bow hunter's syndrome. Occlusion of vertebral artery causes vertebrobasilar insufficiency and we reported cervicogenic vertigo case which was treated by simple decompression of transverse foramen of C1. The patient was 48 years old female who had left side dominant vertebral artery and vertigo was provoked when she rotated her head to right side. Angiography showed complete obliteration of blood flow of left vertebral artery when her head was rotated to right side. The operation was decompression of left vertebral artery at C1 level. Posterior wall of transverse foramen was resected and vertebral artery was exposed and decompressed. After surgery, vertigo of the patient was disappeared, and angiography showed patent left vertebral artery when her head was rotated to right side. Vertigo caused by compression of cervical vertebral artery could be treated by decompression without fusion or instrumentation, especially in C1 transverse foramen.

A Quantitative Comparison of the Vertebral Artery and Transverse Foramen Using CT Angiography

BACKGROUND AND PURPOSE: The vertebral artery (VA) is important for the development of the transverse foramen (TF). Most studies of these structures have focused on anatomical anomalies. Therefore, we investigated quantitatively the association between the relative sizes of the TF and VA. METHODS: We recruited a consecutive series of subjects who underwent CT angiography to estimate the relative sizes of the VA and TF in axial source images. Two neurologists independently reviewed the axial CT images of 208 patients who had no history of transient ischemic attack or stroke. Averaged areas of the VA and TF were defined by the sum of the areas at each level from C3 to C6, divided by 4. Correlation analyses were adjusted for age, sex, and vascular risk factors. RESULTS: The mean age of the subjects was 53 years. The interobserver and intraobserver reliabilities of TF size were good. There was a linear relationship between the sizes of the VA and TF on each side (right side: r2=0.58, p<0.001; left side: r2=0.62, p<0.001). The area of the VA was significantly associated with that of the TF after adjusting for vascular risk factors. CONCLUSIONS: The size of the VA is strongly and linearly correlated with the size of the TF. These findings suggest that measurement of the TF and VA with CT angiography is a reliable method for evaluating VA diseases, and may provide new insight into the differentiation between VA hypoplasia and atherosclerosis of the VA.

Application of C1-C3 Halifax Interlaminar Clamps in Addition to C1-C2 Cable Fixation

C1-C2 transarticular screw fixation has been a preferred method for the fixation of atlantoaxial subluxation caused by the rheumatoid arthritis or recurrent subluxation caused by postoperative non-union. However, it has required extensive occipitocervical fusion or rigid external orthoses such as halo brace after cable fixation especially when the patient has the prominent transverse foramen precluding the safe placement of the C1-C2 transarticular screw. The author applied a pair of Halifax interlaminar clamps from C1 to C3 following the C1-C2 cable fixation in one patient with rheumatoid atlantoaxial subluxation and the other with recurrent subluxation after postoperative non-union. The prominent transverse foramen in both patients precluded the safe passage of the C1-C2 transarticular screw. Both patients were maintained in semirigid external orthoses by using philadelphia collar for 3 months after surgery. One has been doing well for 1 year and the other for 5 months following surgery. In conclusion, the application of the Halifax interlaminar clamps from C1 to C3 in addition to the C1-C2 cable fixation can be a useful alternative procedure circumventing extensive occipitocervical fusion for patients with the prominent transverse foramen precluding the safe placement of the C1-C2 transarticular screw, thereby not sacrificing the motion between occiput and atlas.