IJAR.2021.194

Type of Article:  Original Research

Volume 10; Issue 1 (March 2022)

Page No.: 8238-8243

DOI: https://dx.doi.org/10.16965/ijar.2021.194

Morphometric Analysis of Vertebral Artery Groove in Human Atlas Vertebra in South Indian Population

Suganya Saminathan.

Assistant Professor of Anatomy, PSGIMS & R, Coimbatore, Tamilnadu, India. https://orcid.org/0000-0002-8991-7805

Corresponding Author: Dr. Suganya Saminathan, Assistant Professor of Anatomy, PSGIMS & R, Coimbatore, Tamilnadu, India – 641004. E-Mail: suganss02@gmail.com   

ABSTRACT

Introduction: Recent trends like pedicle screws and other instrumentation of cervical vertebra are on the rise. However, proximity of vertebral artery coursing in vertebral artery groove (VAG) on the superior surface of the posterior arch of atlas poses a unique challenge to surgeons performing these procedures. Such vascular injuries though rare, are not uncommon and may pose immediate to delayed complications. Radiological studies of atlas vertebra & VAG are being extensively done with CT and MR Angiography, but morphometric studies of VAG in atlas vertebra in South Indian population is lacking.

Aims: To understand the morphology and dimensions of the vertebral artery groove and its variations if any, in dry atlas vertebra of South Indian population.

Settings and Design: Descriptive observational study

Methods and Material:  50 dried adult human atlas vertebra of unknown age & sex from the Anatomy Department, PSGIMS & R, Coimbatorewere studied. Intact cervical vertebrae without any degenerative or traumatic disorders were included.  The morphometry of VAG and its distance from midline were evaluated through six linear measurements.The parameters were  inner and outer lengths of the groove, width & thickness of the groove and the distance of its medial most and lateral most edges from the midline on both sides.

Statistical analysis used: SPSS software

Results: There is no statistically significant difference between mean values on right and left side for inner length, outer length, width and thickness of vertebral artery groove. The mean inner  and outer distance of the vertebral artery groove from the midline on the right is higher than the left.

Conclusions: The present study provides morphometric data of VAG & recommends a safe zone of 11.82 mm from midline for instrumentation in posterior spinal surgeries to minimize vertebral artery injuries.

Key words: Atlas, Morphometry, Screw Fixation, Vascular Injury, Vertebral Artery.

REFERENCES

[1]. Standring S, Churchill Livingstone; Gray’s Anatomy: The Anatomical basis of Clinical Practice 41st edition, Elsevier 2016. p. 458.
[2]. C.W. Peng et al. Vertebral artery injury in cervical spine surgery: anatomical considerations, management, and preventive measures .The Spine Journal 2009;9:70–76.
[3]. Daentzer D, Deinsberger W, Boker D et al. Vertebral artery complications in anterior approaches to the cervical spine: report of two cases and review of literature. Surg Neurol 2003;59:300–9.
[4]. Smith M, Emery S, Dudley A et al. Vertebral artery injury during anterior decompression of the cervical spine: a retrospective review of ten patients. J Bone Joint Surg 1993;75(B): 410–5.
[5]. Gluf W, Schmidt M, Apfelbaum R. Atlantoaxial transarticular screwfixation: a review of surgical indications, fusion rate, complications, and lessons learned in 191 adult patients. J Neurosurg Spine 2005;2:155–63.
[6]. Mendez J, Gonzales-Llanos F. Endovascular treatment of a vertebral artery pseudoaneurysm following posterior C1-C2 transarticular screw fixation. Cardiovasc Intervent Radiol 2005;28:107–9.
[7]. Prabhu V, France J, Voelker J et al. Vertebral artery pseudoaneurysm complicating posterior C1-2 transarticular screw fixation: case report. Surg Neurol 2001;55:29–34.
[8]. Cosgrove Gr, Theron J. Vertebral arteriovenous fistula following anterior cervical spine surgery: report of two cases. J Neurosurg 1987;66:297–9.
[9]. Shintani A, Zervas N. Consequence of ligation of the vertebral artery. J Neurosurg 1972;36:447–50.
[10]. Wright Nm, Lauryssen C. Vertebral artery injury in C1-2 transarticular screw fixation: results of a survey of the AANS/CNS section on disorders of the spine and peripheral nerves. J Neurosurg 1998;88:634–40.
[11]. Madawi Aa, Case Ath, Solanki GA, et al. Radiological and anatomical evaluation of the atlantoaxial transarticular screw fixation technique. J Neurosurg 1997;86:961–8.
[12]. Neo M, Sakamoto T, Fujibayashi S, et al. A safe trajectory for atlantoaxial transarticular screw fixation achieved using an aiming device. Spine 2005;30:E236–42.
[13]. D.J. Lunardini et al. Vertebral artery injuries in cervical spine surgery. The Spine Journal 2014;14:1520–1525.
[14]. Eskander Ms, Drew Jm, Aubin ME, et al. Vertebral artery anatomy: a review of two hundred fifty magnetic resonance imaging scans. Spine 2010;35:2035–40.
[15]. Max Franco De Carvalho, Roberta Teixeira Rocha et al. Vertebral artery groove anatomy. Acta Ortopedica Brasileira 2009;17(1):50-54.
[16]. Ravichandran D, Vertebral Artery Groove in the Atlas and Its Clinical Significance. Journal of Clinical and Diagnostic Research. 2011 June;5(3):542-545.
[17]. Gupta T, Quantitative anatomy of vertebral artery groove on the posterior arch of atlas in relation to spinal surgical procedures. Surg Radiol Anat – May2008;30(3);239-42.
[18]. Akram M Awadhalla, Morphometric analysis of the vertebral artery groove of the first cervical vertebra (atlas); PanArab Journal of Neurosurgery ;April 2009;13;67-71.
[19]. Mukesh S, Distance between Midline and Vertebral Artery Groove of Atlas – A Real Aid to the Neurosurgeon. Journal of Surgical Academia 2014;4(1):26-29.
[20]. Simpson Jm, Ebraheim Na, Jackson WT et al. Internal fixation of the thoracic and lumbar spine by using Roy-Camille plates. Orthopedics 1993;16:663-72.
[21]. Stauffer ES. Posterior atlanto-axial arhtrodesis: the Gallie and Brooks techniques and their modifications. Tech Orthop. 1994;9:43-8.
[22]. Ebraheim Na, Xu R, Ahmad M. The quantitative anatomy of the vertebral artery groove of the atlas and its relationship to the posterior atlantoaxial approach. Spine. 1998;23:320-3.
[23]. Maxim R. Leventhal. Campbell’s Operative Orthopaedics In: Spinal Anatomy and Surgical Approach. 9th edn; Vol. 3. Mosby, St. Louis; 1998;2681-270.
[24]. Pandey, Suniti & Singh, Rahul. Surgical anatomy of vertebral artery groove. Journal of the Anatomical Society of India. 2018;67:S49.

Cite this article: Suganya Saminathan. Morphometric Analysis of Vertebral Artery Groove in Human Atlas Vertebra in South Indian Population. Int J Anat Res 2022;10(1):8238-8243. DOI: 10.16965/ijar.2021.194