Anatomical variations of the vertebral artery and its relation to the atlas vertebra - Radiological and dry bone study

Vertebral artery (VA) variations are important for diagnostic angiographic procedures. This study aimed to describe the anatomical variations of VA using multidetector computed tomography angiography (MDCTA), and to provide a quantitative and qualitative anatomy of the VA groove in dry atlas vertebrae. The study was carried out on 100 MDCTA images from adult Egyptian individuals (69 males; 31 females) and 50 dry atlas fully ossified and of unknown age and sex. MDCTA films were evaluated for VA origin, level of entrance into foramen transversarium, caliber, and distance from the midline. VA grooves in dry bones were examined for the presence of ponticulus posticus (PP). Inner and outer distances from the midline, width and thickness were measured using sliding Vernier caliper. The results revealed that the left VA arose directly from the aortic arch in 7% of cases and was absent in 2% of cases. Atypical entry of VA into foramen transversarium was through C5 (4.5%), followed by C7 (1.5%), then C4 (1%). The left vertebral arteries with direct aortic origin were more medially located than the left arteries with subclavian origin (p=0.005). The mean diameter was significantly greater on the left (3.67±1.07 mm), as compared to the right side (3.36±0.93 mm) (p=0.038). PP was detected in 47% of cases in radiological images and 96% of dry bones. It could be concluded that the most important variations of VA were the aortic origin of the left VA and abnormal entry through transverse foramina. PP was a common variation in atlas vertebrae. These variations should be taken into consideration during radiological and orthopedic procedures

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Combined percutaneous radiofrequency ablation and cementoplasty for the treatment of extraspinal painful bone metastases: A prospective study.

INTRODUCTION: About 50% of patients with cancer develop bone metastasis mainly presenting with distressing, drug-resistant pain. AIM OF THE WORK: The study evaluated efficacy and safety of combined cementoplasty and bony radiofrequency ablation in palliation of intractable pain and disability in cancer patients with bony metastases. PATIENTS AND METHODS: The study included 30 adult patients suffering from localized bony metastases causing refractory moderate to severe pain. Radiofrequency bony ablation performed followed by cementoplasty were done under computed tomography (CT) guidance with conscious sedation and local anesthesia. Final CT check was done to ensure adequate lesion filling and to exclude any cement leakage. Pain, hemodynamic variables, and neurological status were checked for a minimum of 2 h before discharge. The patients were followed up weekly in the pain clinic. The primary outcome measures pain severity and daily opioid consumption. The secondary outcome measures were quality of life and the degree of disability, and procedure-related adverse outcomes. RESULTS: Pain score, daily morphine consumption, and Oswestry Disability Index score decreased significantly after 1 day, and 1, 4 and 12  weeks. None of the patients had serious complications during the postoperative follow up visits. Only 4 patients (13.3%) experienced discomfort during, and few days after the procedure, 3 patients (10%) suffered from local infection, and 2 patients (6.7%) reported cement leakage. CONCLUSION: Combined radiofrequency ablation and cementoplasty is a safe and effective pain relief modality in patients suffering from extraspinal painful bone metastases with improvement of the quality of life.