The commonly used examination procedures of the upper cervical spine depend upon the symmetry for comparison and interpretation of joint functions. If symmetry is not normal, then these assessments may mislead the examiners, allowing them implementation of incorrect treatment plans. Objectives of this study are to explore the possibility that asymmetry is more common than symmetry and, if it is true, to find out the effects of asymmetry on the biomechanics of these joints. The study was carried out on 30 atlas vertebrae of cadavers of Indian origin. The different intra-atlas distances were measured on both sides by digital vernier calliper. All the parameters studied showed statistically significant differences between the right and left side i.e. a p value of < 0.05. The anteroposterior diameter of the foramen transversarium, the transverse diameter of the foramen transversarium, the distance from the midline to medial edge of the vertebral artery groove (inner as well as outer cortex) and the length of the superior articular facets were more on the right side as compared to the left side. The breadth as well as the length of the inferior articular facet, the breadth of the superior articular facet and the difference of posterior arch thickness at the site of vertebral artery groove were more on the left side as compared to the right side. These differences may be explained by the handedness of an individual, which influences the intra-osteal asymmetry in a characteristically distinct manner, which needs to be confirmed or refuted in a further study.

Background: There are few studies that compared CTCA in patients presenting with chest pain, probably ischaemic (i.e., atypical) with negative or inconclusive TMT in outpatient department. Objective: To assess 64-slice CTCA findings in patients with suspected ischaemic chest pain and negative or inconclusive TMT. Methodology: Enrolled patients underwent TMT and classified as TMT negative or inconclusive patients. These patients underwent CTCA and findings were analysed. Results: 50 patients completed the study protocol. Of these, 31 (62%) were TMT negative and 19 (38%) were TMT inconclusive. CTCA showed obstructive CAD in 19 (38%) patients; 7 (36%) with negative TMT and 12 (63%) with inconclusive TMT. Overall, CTCA was more predictive of diagnosing obstructive lesion in TMT inconclusive group as compared to TMT negative group. Conclusion: In patients with atypical chest pain with negative or non-diagnostic TMT, CTCA provides an important diagnostic tool for rapid triaging of such patients.