The Prevalence of Skeletotopy Variation of the Atlas and Vertebral Arteries Among Lithuanians and Its Significance for Physical Medicine Procedures and Rehabilitation

Research background. Vertebral artery relation with atlas anatomical variations can lead to sensomotor disorders of head and neck, and vertebrobasilar insuffciency. Kimmerle’s anomaly, a bony ring around vertebral artery, is also known as a risk factor for physical medicine procedures. To the best of our knowledge, this is the frst study of Ponticulus posticus prevalence in Lithuania. Aim. The research aim was to investigate the prevalence of skeletotopy variations of the posterior arch and vertebral artery among Lithuanian orthodontic patients of various ages and both genders. Research methods. We randomly selected 870 digital lateral cephalograms of Lithuanian orthodontic patients of various ages and both genders. 706 images with good visualization of VA bony socket shadow on the superior surface of the atlas posterior arch were chosen for the investigation. According to the degree of depth of the bony socket we categorized them into three variations: sulcus, groove and bony ring. If contours around VA of bony arch were equal or greater than 180°, we included those cases into the group of bony groove. Research results. We estimated predominance of sulcus (67.6%) of bony socket variations. A bony groove of various depths was found in 24.0% and a bony ring was found in 7.5% of the subjects studied. Vertebral artery groove was found to be more prevalent in females than in males and bony ring was more common in males than in females, but there was no signifcant difference (p > 0.05). Statistically signifcant predominace of bony ring in the age group of 17–20 years (13.2%) was observed and it was higher than in the age group of 8–16 years (5.1%) (p < 0.05). Conclusions. 1. Variations of bony socket including sulcus, groove, and bony ring (Kimmerle’s anomaly) develop in adolescence when ossifcation is most active. 2. The bony ring and semi open groove, which limit mobility of distal part of the vertebral artery, can be a risk factor of physical medicine procedures, especially in the elderly, whose artery walls are less elastic.Keywords: Ponticulus posticus, Kimmerle’s anomaly, atlas, vertebral artery, manual therapy of neck.

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The vertebral artery convergence to the cervical spine in elders

Folia Medica ◽

10.3897/folmed.61.e39418 ◽

2019 ◽

Vol 61 (3) ◽

pp. 377-383

Author(s):

Banu Alicioglu ◽

Nadir Gulekon

Keyword(s):

Cervical Spine ◽

Vertebral Artery ◽

Anatomical Variations ◽

The Elderly ◽

Uncinate Process ◽

Older Age ◽

Age Group ◽

Transverse Foramen ◽

Cross Sectional ◽

Cervical Spine Surgery

Background: In the older population, tortuosity of the vertebral artery (VA), uncovertebral joint (UVJ) osteoarthritis, and abnormal vertebral alignment may alter the normal anatomy. Aim: We aimed to determine the anatomical variations and relationships between the cervical segment of the VA and the cervical spine with regard to ageing. Materials and methods: In this retrospective cross-sectional study, the computed tomography angiography scans of 110 subjects were reviewed. Any variations in the VA, UVJ degeneration were identified. The distance between the VA and uncinate process (UP) was measured electronically. The distance between the VA and UP were compared according to the age group (group A > 45, group B = 45-65, and group C > 65 years-old). Results: With regard to the transverse foramen, 7.2% of the cases had entering abnormalities of the VA, while in one case (0.83%), the right VA had an exiting abnormality (exiting from the C2 instead of the C1). UVJ degeneration was found to be significantly higher in the older age group (p > 0.05). Furthermore, at the C4-C7 levels, the distances between the VA and UP were significantly smaller in the older age group (p > 0.01). Conclusions: The VA-UP distance has been shown to decrease due to increasing UVJ osteoarthritis in the elderly. The convergence of the VA toward the spine occurs at the most mobile segment of the cervical spine, and this anatomical alteration may predispose temporary and/or permanent vertebral artery occlusion clinically, and be dangerous during cervical spine surgery.

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Morphometric study of the posterior arch of atlas vertebra in the Serbian population

Medicinski pregled ◽

10.2298/mpns1808250p ◽

2018 ◽

Vol 71 (7-8) ◽

pp. 250-255

Author(s):

Radmila Peric ◽

Bojana Krstonosic ◽

Ivana Starcevic

Keyword(s):

Vertebral Artery ◽

Cervical Vertebra ◽

Anatomical Variations ◽

Morphometric Study ◽

Posterior Arch ◽

Class Iii ◽

Maximum Width ◽

Morphological Variations ◽

Significant Difference ◽

Superior Surface

Introduction. Groove for the vertebral artery and the suboccipital nerve, is located on the superior surface of the posterior arch of the first cervical vertebra (the atlas). Presence of bony variations may transform the groove into incomplete/complete canal, causing compression of its structures and consequently symptoms of vertebro-basilar insufficiency. The aim of the present study was to determine the incidence and extent of morphological variations of the posterior arch of the atlas vertebra. Material and Methods. The investigation was conducted on 41 atlas vertebrae, part of the Osteological Collection of the Department of Anatomy of the Faculty of Medicine in Novi Sad and the Faculty of Medicine in Nis. According to the shape of the posterior arch, the atlas vertebrae were classified into three classes. The measurements of maximum width and height diameters of the incomplete/complete canal for the vertebral artery were performed. All the measurements were done using open source software for image analysis, Image J. Results. The results of the study showed that in our sample of atlases the most common class was class I (78.05%), and class III the least frequent (7.32%). There was no statistically significant difference in the observed measurements of the atlas anatomical variations between the right and left side. Conclusion. Morphometric analysis of the superior surface of the posterior arch of the atlas vertebra has shown the existence of variations and their importance has been discussed.

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Study of mortality and morbidity patterns and various emerging non communicable diseases in the elderly

Medpusle International Journal of Medicine ◽

10.26611/102119314 ◽

2021 ◽

Vol 19 (3) ◽

pp. 150-154

Author(s):

Sanjay B Jagtap ◽

Keyword(s):

Health Care ◽

Risk Factor ◽

Heart Disease ◽

Ischemic Heart Disease ◽

The Elderly ◽

Communicable Diseases ◽

Ischemic Heart ◽

Age Group ◽

Geriatric Population ◽

Non Communicable Diseases

Background: The geriatric population is defined as population aged 60 years and above. The mixed profile of communicable and non-communicable diseases among the elderly population in developing countries places a huge burden on the existing health care delivery system. Present hospital based cross-sectional study was focused on the morbidity profile of the elderly and improve the health care services so as to enable them to lead a productive life. Material and Methods: Present study was single centre, descriptive observational study, conducted in subjects above 60 years and both gender, visiting to OPD and IPD, willing to participate in study after written consent. Results: We included total 200 geriatric population in our study. Majority of them were from 60-70 years age group (50 %) followed by 71-80 years (37%) and 81-90 years age group (13%). Mean age was 70.75±7.25 years. Males were 56.5% and females were 43.5%. Males were predominant in our study with male to female ratio 1.29:1. Most common addiction seen among the patients are tobacco chewing (49.5%) followed by smoking (27%), followed by pan (24.5%), nut (21.5%) and alcohol (10.5%). Family history of diabetes and hypertension was present in 63.5% and 72% cases respectively. Prevalence of cataract as commonest observed morbidity in our study was 60%, DM 37%, hypertension 34%, IHD 33.5%, anemia 21%, hearing loss 11.5% and cancer was 4%. Out of 45 deaths, 44.4% deaths occurred in patients with IHD as risk factor, 26.6% deaths occurred in patients with COPD as risk factor, 22.2% deaths occurred in patients with CVA/stroke as risk factor and 17.8% deaths occurred in patients with AKI as risk factor. So IHD, COPD, CVA and AKI were significantly associated with mortality. Conclusion: Commonly observed morbidities were cataract (60%), diabetes mellitus (37%), hypertension (34%), ischemic heart disease (33.5%) Significant association of mortality was seen with ischemic heart disease, chronic obstructive pulmonary disease, cerebrovascular accident and acute kidney injury.

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Posterolateral protrusion of the vertebral artery over the posterior arch of the atlas: quantitative anatomical study using three-dimensional computed tomography angiography

Journal of Neurosurgery Spine ◽

10.3171/spi/2008/9/8/167 ◽

2008 ◽

Vol 9 (2) ◽

pp. 167-174 ◽

Cited By ~ 22

Author(s):

Satoshi Yamaguchi ◽

Kuniki Eguchi ◽

Yoshihiro Kiura ◽

Masaaki Takeda ◽

Kaoru Kurisu

Keyword(s):

Vertebral Artery ◽

Ct Angiography ◽

Preoperative Evaluation ◽

Posterior Inferior Cerebellar Artery ◽

Three Dimensional ◽

Anatomical Variations ◽

Posterior Arch ◽

Outer Cortex ◽

The Right ◽

Dominant Side

Object The vertebral artery (VA) often takes a protrusive course posterolaterally over the posterior arch of the atlas. In this study, the authors attempted to quantify this posterolateral protrusion of the VA. Methods Three-dimensional CT angiography images obtained for various cranial or cervical diseases in 140 patients were reviewed and evaluated. Seven patients were excluded for various reasons. To quantify the protrusive course of the VA, the diameter of the VA and 4 parameters were measured in images of the C1–VA complex obtained in the remaining 133 patients. The authors also checked for anomalies and anatomical variations. Results When there was no dominant side, mean distances from the most protrusive part of the VA to the posterior arch of the atlas were 6.73 ± 2.35 mm (right) and 6.8 ± 2.15 mm (left). When the left side of the VA was dominant, the distance on the left side (8.46 ± 2.00 mm) was significantly larger than that of the right side (6.64 ± 2.0 mm). When compared by age group (≤ 30 years, 31–60 years, and ≥ 61 years), there were no significant differences in the extent of the protrusion. When there was no dominant side, the mean distances from the most protrusive part of the VA to the midline were 30.73 ± 2.51 mm (right side) and 30.79 ± 2.47 mm (left side). When the left side of the VA was dominant, the distance on the left side (32.68 ± 2.03 mm) was significantly larger than that on the right side (29.87 ± 2.53 mm). The distance from the midline to the intersection of the VA and inner cortex of the posterior arch of the atlas was ~ 12 mm, irrespective of the side of VA dominance. The distance from the midline to the intersection of the VA and outer cortex of the posterior arch was ~ 20 mm on both sides. Anatomical variations and anomalies were found as follows: bony bridge formation over the groove for the VA on the posterior arch of C-1 (9.3%), an extracranial origin of the posterior inferior cerebellar artery (8.2%), and a VA passing beneath the posterior arch of the atlas (1.8%). Conclusions There may be significant variation in the location and branches of the VA that may place the vessel at risk during surgical intervention. If concern is noted about the vulnerability of the VA or its branches during surgery, preoperative evaluation by CT angiography should be considered.

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Posterior inferior cerebellar artery with an extradural origin from the V3 segment: higher incidence on the nondominant vertebral artery

Journal of Neurosurgery Spine ◽

10.3171/2017.5.spine161286 ◽

2018 ◽

Vol 28 (2) ◽

pp. 154-159 ◽

Cited By ~ 3

Author(s):

Taiki Isaji ◽

Muneyoshi Yasuda ◽

Reo Kawaguchi ◽

Masahiro Aoyama ◽

Aichi Niwa ◽

...

Keyword(s):

Vertebral Artery ◽

Posterior Inferior Cerebellar Artery ◽

Three Dimensional ◽

Ct Scanning ◽

Anatomical Variations ◽

Craniovertebral Junction ◽

Ponticulus Posticus ◽

Cerebellar Artery ◽

3D Ct Angiography ◽

Relationship Of

OBJECTIVEThe posterior inferior cerebellar artery (PICA) and the vertebral artery (VA) often exhibit anatomical variations at the craniovertebral junction (CVJ). An example of this is the PICA originating extradurally from the V3 segment of the VA. To date, some cadaveric investigations have been reported, but the incidence and relationship of this variation to the VA and the atlas as observed on clinical imaging have not been discussed. This study evaluated the prevalence of PICAs originating from the V3 on CT scanning. Other variations of the atlas and VA were also analyzed.METHODSCT images from a series of 153 patients who underwent 3D CT angiography (CTA) were analyzed, and variations of the PICA, VA, and atlas were investigated.RESULTSA total of 142 patients (284 sides) were analyzed; 11 patients (7.2%) were excluded due to poor image quality. The most common VA variation was the PICA originating from V3 (9.5% of 284 sides), which was more frequently observed on the nondominant VA than the dominant VA (22.5% vs 6.25%, p = 0.0005). A VA with a PICA end was identified in 4 sides (1.4%), which is the same incidence as observed in the persistent first intersegmental VA (1.4%). VA fenestration was only found in 1 side (0.35%). Regarding the atlas, ponticulus posticus was observed in 24 sides (8.5%). There was no relationship between the incidence of ponticulus posticus and the variations of the VA.CONCLUSIONSA PICA originating from V3 was the most common VA variation at the CVJ and was more common on the nondominant VA. Three-dimensional CTA is useful for the evaluation of this variance. Surgeons should be mindful of this variation during operations.

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Assessment of Skeletal Discrepancies by Determining R Angle in Lateral Cephalograms in Navi Mumbai Population

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i53b33681 ◽

2021 ◽

pp. 65-77

Author(s):

Sushma Sonawane ◽

Vaidehi Save ◽

Vivek Soni ◽

Sameer Narkhede ◽

Karthick Shetty ◽

...

Keyword(s):

Treatment Planning ◽

Vertical Plane ◽

Age Group ◽

Lateral Cephalograms ◽

Orthodontic Patients ◽

School Of Dentistry

There is considerable interest in the area of orthodontics in malocclusions caused by vertical discrepancies because of their causes, diagnosis, treatment planning, and tendency to return after treatment. Hence, this study aimed to assess, evaluate and check reliability for vertical skeletal discrepancy by establishing a parameter ‘R angle’ in Navi Mumbai population. In this study, the lateral cephalometric radiographs of 135 orthodontic patients between the age group of 18-30 years of age were selected from the database of the Department of Orthodontics and Dentofacial Orthopaedics in D Y Patil University School of Dentistry, Navi Mumbai The study found that the R angle is clinically and statistically important when examining vertical skeletal discrepancies. So with the above results it is observed that R angle can be used to assess vertical skeletal discrepancy in Navi Mumbai population. Along with other parameters it can be important and valuable tool for orthodontist to determine skeletal discrepancies in vertical plane.

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Assessments of Prevalence of Ponticulus Posticus, Atlas Posterior Arch Deficiency, Sella Turcica Bridging, Maxillary Canine Impaction, and Associations Among Them in 500 CBCTs of Italian Orthodontic Patients

Frontiers in Dental Medicine ◽

10.3389/fdmed.2021.708169 ◽

2021 ◽

Vol 2 ◽

Author(s):

Monica Macrì ◽

Giada Perrella ◽

Giuseppe Varvara ◽

Giovanna Murmura ◽

Tonino Traini ◽

...

Keyword(s):

Cone Beam Ct ◽

Age Groups ◽

Sella Turcica ◽

Chronological Age ◽

Posterior Arch ◽

Maxillary Canine ◽

Ponticulus Posticus ◽

Chi Squared ◽

Orthodontic Patients ◽

The Right

Background: The ponticulus posticus (PP) is an important anomaly of the atlas (C1 vertebra) with a complete or partial bone bridge that transforms the groove of the vertebral artery (VA) into a canal (arcuate foramen). The aim was to retrospectively determine prevalence of PP evaluating morphological features and the possible association with other dentoskeletal anomalies in the midface and neck area such as maxillary canine impaction (MCI), atlas posterior arch deficiency (APAD), and sella turcica bridging (SB).Methods: This study was conducted in the Department of Medical, Oral and Biotechnological Sciences of the University “G. D'Annunzio” in Chieti. The detection of PP was performed on 500 patients with cone beam CT (CBCT) images (6 to 87 years).Results: Analysis revealed the presence of uni- and bi-lateral PP in 110 patients (22%): 24 (4.8%) patients with bilateral complete PP, 12 (2.4%) patients with complete PP on the left, 6 (1.2%) patients with complete PP on the right, 8 (1.6%) patients with complete PP on the right and partial PP on the left, 6 (1.2%) patients with complete PP on the left and partial PP on the right, 26 (5.2%) patients with partial bilateral PP, 18 (3.6%) patients with partial left PP, and 10 (2%) patients with partial PP on the right. The Chi-squared statistic confirmed that there are significant associations between MCI and PP (p = 0.020) and between SB and MCI (p <0.00001). No correlation between chronological age and presence of the PP (p = 0.982), between chronological age and morphotypes of the PP (p = 0.779), between APAD and the PP (p = 0.0757), between SB and the PP (p = 0.111), and between APAD and MCI (p = 0.222) were found.Conclusion: This observational study showed how bilateral partial variant and bilateral complete variant are the most represented morphotypes in all the age groups. The prevalence of MCI is positively associated with PP and with SB.

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The role of vitamin D deficiency in the pathogenesis of falls and fractures

Orvosi Hetilap ◽

10.1556/oh.2013.29607 ◽

2013 ◽

Vol 154 (19) ◽

pp. 731-736 ◽

Cited By ~ 1

Author(s):

Antal Salamon ◽

Csaba Biró ◽

Erzsébet Toldy

Keyword(s):

Vitamin D ◽

Risk Factor ◽

Vitamin D Deficiency ◽

Human Body ◽

Calcium Metabolism ◽

The Elderly ◽

Review Literature ◽

Age Group ◽

Elderly Age

The diverse effects of vitamin D in human body became known during the last years. Vitamin D deficiency causes many problems in medical care. Important roles of vitamin D are the regulation of calcium metabolism and the effect on bone metabolism. The authors review literature data on vitamin D deficiency recognized as an important risk factor in the pathogenesis of falls and fractures and they call attention of Hungarian physicians to the importance of vitamin D substitution. Supplementation of vitamin D deficiency is particularly important in the elderly age-group. Orv. Hetil., 2013, 154, 731–736.

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C1-2 Pedicle Screw Fixation for Ponticulus Posticus and Duplication of Vertebral Artery: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opaa397 ◽

2020 ◽

Author(s):

Yoon Gyo Jung ◽

Byung-Jou Lee ◽

Wonhyoung Park ◽

Jin Hoon Park

Keyword(s):

Computed Tomography ◽

Vertebral Artery ◽

Pedicle Screw ◽

Facet Joint ◽

Pedicle Screw Fixation ◽

Screw Placement ◽

Posterior Arch ◽

Pedicle Screw Placement ◽

Ponticulus Posticus ◽

Patient Consent

Abstract We previously introduced C1 pedicle screw placement to treat C1-2 pathology in a patient with normal vertebral artery anatomy.1 However, we should prepare to meet various anatomic variations. Ponticulus posticus is a bony prominence arising from the posterior arch or the superior articulating process of the atlas that completely or partially encircles the vertebral artery.2 We herein report a 79-yr-old female who presented with myelopathy and was diagnosed with compressive myelopathy at the C1 level in magnetic resonance imaging. A computed tomography showed ponticulus posticus (complete type to the right side) with duplication of vertebral artery. She underwent surgical treatment of C1-2 pedicle screw placement and reduction of C1 vertebra under a microscopic view. After C1 laminectomy, both-side vertebral arteries were dissected with a microscissor. The mobilization of upper divisions of vertebral artery was identified to secure the entry point and pedicle to insert a C1 pedicle screw. After complete protection of the upper and lower divisions of vertebral artery and identification of pedicle, a C1 pedicle screw was inserted by a freehand technique. We inserted autologous bone chips in the distracted C1-2 facet joint for facet joint fusion, and the C1 vertebra was pulled out by a rod reducer. After surgery, the patient's symptoms disappeared, and no vertebral artery injury was identified in postoperative 3-dimensional computed tomography angiography. Patient consent was obtained prior to performing the procedure.

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Cervical vertebral anomalies in patients with obstructive sleep apnea

APOS Trends in Orthodontics ◽

10.4103/2321-1407.169974 ◽

2015 ◽

Vol 5 ◽

pp. 262-266 ◽

Cited By ~ 1

Author(s):

Saugat Ray ◽

Sanjeev Datana ◽

Balakrishnan Jayan ◽

Amit Jain

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Cervical Vertebrae ◽

Control Group ◽

Posterior Arch ◽

Obstructive Sleep ◽

Lateral Cephalograms ◽

Orthodontic Patients ◽

Vertebral Anomalies ◽

One Way Anova

Objective The aim of this study was to find an association between the patients with obstructive sleep apnea (OSA) and with cervical vertebral anomalies and any further correlation between various anomalies with varying severities of OSA. Materials and Methods The sample consisted lateral cephalograms of 70 subjects who were diagnosed with OSA and 70 other orthodontic patients who were selected as a control group. The lateral radiographs of both cases and controls were traced and findings were recorded. Results In total, 21.42% of subjects in the OSA group and 8.57% in the control group were affected with cervical vertebrae anomalies. The statistical analysis reveals that the number of subjects affected with cervical vertebrae anomalies in OSA group is highly significant. A number of cases of fusion were higher than posterior arch deficiency in OSA group and equal in the control group. However, in both the groups, the number of cases with two vertebrae fusion was higher. Further, the higher number of two vertebrae fusion cases in OSA group was found to be statistically significant. The findings of one-way ANOVA for OSA cases reveals the number of cases affected with cervical vertebrae anomalies were statistically highly significant (P < 0.01) in severe cases of OSA. Conclusion Patients of cervical vertebral anomalies may be at higher risk of developing OSA, and the possibility of the presence of cervical vertebral anomalies may increase with the increase in the severity of OSA. The most common vertebral anomaly was found to be two vertebral fusions.

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