Study of the Transverse Foramen in the Subaxial Cervical Spine in Korean Patients With Degenerative Changes: An Anatomical Note

Abstract

Background/AimsThe purpose of this study was to provide anatomical data on the dimensions and location of the subaxial transverse foramen (TF) in relation to surgical landmarks routinely used during anterior cervical procedures. MethodsA total of 116 patients who underwent preoperative computed tomography (CT) evaluations for degenerative cervical disease were enrolled. Axial and coronal CT images of the cervical vertebrae from C3 to C6 were analyzed to measure interforaminal distance, the TF distance from the anterior and posterior vertebral body margin, TF dimensions, and the TF medial margin from the tip and medial margin of the uncus. Comparative and correlative analyses were also performed according to age, body mass index (BMI), and sex. ResultsAll measurement values in male patients were larger than those in their female counterparts. The interforaminal distance gradually increased from C3 to C6. The distance of the TF medial margin from the tip of the uncus was found be above approximately 3 mm in all vertebrae except C6. Correlation analysis revealed that age had a significant negative relationship with the transverse diameter of TF. In contrast, BMI had a significant positive correlation with interforaminal distance. Moreover, the distances of the TF medial margin from the tip and medial margin of the uncus showed strong negative correlations with age. ConclusionUseful morphometric data were obtained that may help the operating surgeon to avoid vertebral artery injury. The safe distance from the tip of the uncus to the TF medial margin was found to be approximately 3 mm, and this distance should not be violated during lateral decompression. In addition, this value may decrease with age.

Exploring the relationship between soft and hard tissues: The example of vertebral arteries and transverse foramina

“…Our study provides preliminary data on the spatial relationship between the transverse foramina and the size of the arteries within extant human cervical vertebrae. As in the study by Cagnie et al ( 2005 ), we did find that the size of the foramina increased from C3 to C6, which is also confirmed, to a lesser extent, by Malla et al ( 2018 ). However, contrary to previous studies (Sanelli et al, 2002 ; Cagnie et al, 2005 ; Kim et al, 2012 ; Kotil & Kilincer, 2014 ; Abd El Gawad et al, 2019 ; but see Sangari et al, 2015 about the size of the foramina), our analysis did not show any significant asymmetries between right and left transverse foramina or arteries.…”

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.…”

“…In contrast, the 13 types have been observed in South African populations, with type 1 being the most common found at C3-C6 (Taitz et al 1978). Anatomical variations on the subaxial vertebral pedicles and morphometry of the FT in the upper cervical spine have recently been documented in the Thai population (Mahiphot et al, 2019;Chaiyamoon et al, 2021). However, no morphometric study of variation in the lower cervical FTs (C3-C7) has not been conducted.…”

Anatomical Variation and Morphometric Study on Foramen Transversarium of the Upper Cervical Vertebrae in the Thai Population

“…Additionally, these variations are important for surgeons and radiologists to consider prior to surgery on the posterior upper cervical spine [13]. The morphometric alterations of FT diameters have been documented in many populations including Chilean [6], Kenyan [8], Greek [4], Indian [7,14], American [15], Turkish [16], Japanese [17], Chinese [17], and Korean [18].…”