DOUBLE TRANSVERSE FORAMEN IN INFANTILE CERVICAL VERTEBRAE OF THE LATE 17TH AND EARLY 18TH CENTURIES. Doble foramen transverso en las vértebras infantiles cervicales de finales del siglo XVII y principios del XVIII

Abstract

La presencia de doble foramen transverso es una variante anatómica que se observa con frecuencia en el raquis cervical inferior y que presenta implicaciones clínicas en relación con la arteria vertebral. Aunque en la actualidad existe cierta controversia acerca de si el origen de esta variante cervical es congénito o adquirido, y a pesar de que la presencia de doble foramen transverso en población infantil descartaría un origen degenerativo-artrósico, se encuentra una falta de información acerca de su presencia en vértebras cervicales infantiles. En este sentido, nuestro objetivo ha sido analizar la presencia de doble foramen transverso en vértebras cervicales infantiles procedentes de restos óseos, datados entre finales del siglo XVII y principios del XVIII, y exhumados de una fosa común en la Iglesia de Nuestra Señora de los Ángeles en Castielfabib (Ademuz, España). Se encontraron 10 vértebras infantiles con doble foramen transverso, 4 de ellas pertenecientes a niños de menos de 4 años y 6 a niños de más de 4 años. Este hallazgo apoya un origen congénito de esta variante anatómica, frente a la hipótesis degenerativo-artrósica, y apunta a la necesidad de un estudio en profundidad acerca de la prevalencia actual de esta variante anatómica en población pediátrica, dadas sus posibles consecuencias clínicas. Double transverse foramen is an anatomical variant often observed in the inferior cervical spine and which may present clinical considerations with regard to the vertebral artery. There is some current controversy as to whether the origin of this cervical variant is congenital or acquired. Despite the fact that its presence in children would discard a degenerative osteo-arthritic origin, there is a lack of information on the origin and physiological meaning of this anatomical feature. In this respect, our objective was to analyse the presence of double transverse foramen in infantile cervical vertebrae in skeletal samples dating from the end of the 17th and early 18th centuries and exhumed from a common grave in the "Nuestra Señora de los Ángeles" church, in Castielfabib (Ademuz, Valencia, Spain). Ten infantile vertebrae with double transverse foramen were discovered: 4 from children under 4 years old and 6 from children over 4 years old. This finding supports more a congenital origin than a degenerative osteoarthritis process. Therefore, it is fundamental to further study its prevalence in a current paediatric population and its clinical significance.

Morphometric Study and Anatomical Variation with its Incidence of Foramina Transversaria on the Lower Cervical Vertebrae

“…In addition, the recent study showed significantly higher AP diameters of C6-7 and T diameter of only C7 in male, indicating that such parameters could be used to be very helpful in forensic identification of complete cervical vertebral FT remains. These findings were similar to those of previous reports in Korean (Malla et al, 2018) and Spanish populations (Quiles-Guiñau et al, 2017) but differed in that the C5 T diameter in females in our study was significantly longer than in the males. Consideration of lateral size differences may help prevent left vertebral neurovascular damage during spinal surgery.…”

“…FT variation is clinically significant to radiologists and surgeons planning posterior operations at the lower cervical spine (C3-C7). The morphometry (such as type and diameter) and rates of variance of FT have been found to differ by population, with previous studies being conducted in Israel, Japan, China, India, Italy, Turkey, the US, Greece, Spain, Chile, South Africa, and Korea (Taitz et al 1978;Kimura et al, 1985;Sangari et al, 2015;Zibis et al, 2016;Quiles-Guiñau et al, 2017;Guerra et al, 2017;Abdul et al, 2018;Malla et al, 2018;Gupta & Agarwal, 2019). Ours was the first study to report the incidence of variance and morphometric features of the lower cervical spine FT in a Thai population.…”

Systematic review and meta‐analysis of the prevalence of the retrotransverse foramen of the atlas

“…This was later confirmed by Bodon et al (2016) who also described anastomotic veins connecting the venous sinuses superiorly (suboccipital cavernous sinus) and inferiorly (vertebral artery venous plexus) on the posterior arch of the atlas (Arnautović et al, 1997). In addition to describing the anastomotic vein, both Paraskevas et al (2005) and Karau et al (2010) detected a supplementary occipital nerve in the RTF (Kaushal, 2011; Quiles‐Guiñau et al, 2016). Other researchers, including Dubreuil‐Chambardel (1921) noticed an additional slender artery (Gupta et al, 1979) and Sylla (1976) hypothesized that a dorsal branch of the first cervical spinal nerve runs through the RTF.…”

“…An RTF should not be considered as a mere anatomical idiosyncrasy, but as an anatomical variant of the atlas with significant clinical correlations and implications. Paraskevas et al (2005) found a high incidence of a coexisting canal for the vertebral artery (CVA) and a complete RTF (72.22%) (Quiles‐Guiñau et al, 2016). This can potentially lead to compression of the vertebral veins, ultimately causing vertebrobasilar insufficiency.…”

“…The earliest descriptions were canalicus venosus (Karau & Odula, 2013) and posterior lateral foramen (Chinnappan & Manjunath, 2008). Later descriptions using a variety of new synonyms were published by Quiles‐Guiñau et al (2016) and included “secondary hole” (Sylla, 1976), “retrotransverse canal” (De Boeck et al, 1984; Henry et al, 2017; Veleanu et al, 1977), “retrotransverse foramen” (Goel & Laheri, 1994; Kaushal, 2011; Le Minor & Trost, 2004; Quiles‐Guiñau et al, 2016), “retroarticular canal” (Loth‐Niemirycz, 1916), “abnormal foramen on the posterior arch of atlas” (Agrawal et al, 2012; Loth‐Niemirycz, 1916; Paraskevas et al, 2005), “accessory costotransverse foramen” (Dubreuil‐Chambardel, 1921), “accessory foramen transversarium” (Karau et al, 2010; Mead et al, 2016; Recha & Neginhal, 2014), “double foramina” (Bharathi et al, 2016; Bilodi & Gupta, 2005), and “double transverse foramina” (Bharathi et al, 2016). Among this collection of denominations for the RTF, “retroarticular canal” (Loth‐Niemirycz, 1916) seems particularly confusing as it can be misinterpreted for another variant of the atlas called the arcuate foramen (Kaushal, 2011).…”