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Research ArticleOriginal Article
Open Access

Quantitative assessment of vertebral artery anatomy in relation to cervical pedicles: surgical considerations based on regional differences

Amro Al-Habib, Fahad Albadr, Jehad Ahmed, Abdulrahman Aleissa and Abdullah Al Towim
Neurosciences Journal April 2018, 23 (2) 104-110; DOI: https://doi.org/10.17712/nsj.2018.2.20170448
Amro Al-Habib
From the Division of Neurosurgery (Al-Habib, Ahmed, Al Towim), Department of Surgery, and Department of Radiology (Albadr, Aleissa) College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
MD, MPH
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  • For correspondence: [email protected]
Fahad Albadr
From the Division of Neurosurgery (Al-Habib, Ahmed, Al Towim), Department of Surgery, and Department of Radiology (Albadr, Aleissa) College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
MD
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Jehad Ahmed
From the Division of Neurosurgery (Al-Habib, Ahmed, Al Towim), Department of Surgery, and Department of Radiology (Albadr, Aleissa) College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
MD
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Abdulrahman Aleissa
From the Division of Neurosurgery (Al-Habib, Ahmed, Al Towim), Department of Surgery, and Department of Radiology (Albadr, Aleissa) College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
MD
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Abdullah Al Towim
From the Division of Neurosurgery (Al-Habib, Ahmed, Al Towim), Department of Surgery, and Department of Radiology (Albadr, Aleissa) College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
MD
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    Figure 1

    Radiological measurements of different parameters. TFC - transverse foramen on coronal image; FZ- free zone defined as the distance between the lateral border of the pedicle and medial border of vertebral artery (safe zone for pedicle screw insertion); PD - cervical pedicle diameter at the level of isthmus; SCDC - spinal canal diameter on coronal image; SCDS - spinal canal diameter on sagittal image, LTF - longitudinal diameter of transverse foramen, TTF - transverse diameter of transverse foramen, SCLD - spinal canal longitudinal diameter, SCTD - spinal canal transverse diameter, LDVA - longitudinal diameter of vertebral artery, TDVA - transverse diameter of vertebral artery

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    Figure 2

    Vertebral artery entry to the transverse foramina of the cervical spine at different levels within the same patients. Image A shows VA entry at C6 level on the left side and at C4 level on the right side. Image B shows another patient with VA entry at C5 level on the left side and at C6 level on the right side.

Tables

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    Table 1

    Patients’ bone anatomy parameters at different levels of the cervical spine.

    LevelC3C4C5C6C7
    Overall bilateralRightLeftP-valueOverall bilateralRightLeftP-valueOverall bilateralRightLeftP-valueOverall bilateralRightLeftP-valueOverall bilateralRightLeftP-value
    Mean ± SD
    TTF (mm)6.09±0.686.01±0.816.17±0.770.1605.90±0.745.72±0.986.08±0.840.0215.81±0.765.66±0.975.94±0.970.1085.89±0.775.82±1.15.94±1.10.6103.90±1.483.81±1.63.98±1.80.486
    LTF (mm)5.22±0.525.13±0.725.3±0.630.1745.22±0.585.12±0.835.32±0.670.1505.50±0.755.43±1.05.57±0.890.4245.82±0.775.75±1.15.87±1.10.6184.08±1.143.96±1.44.21±1.60.374
    PD (mm)4.29±0.814.36±0.954.21±0.890.2384.30±0.754.34±0.914.26±0.860.5194.69±0.754.78±0.904.60±0.840.1555.44±3.635.01±7.25.86±7.00.3895.78±1.025.88±1.075.68±1.10.146
    • SD - standard deviation, TTF - transverse diameter of transverse foramen, LTF - longitudinal diameter of transverse foramen, PD - cervical pedicle diameter at the level of isthmus

    • View popup
    Table 2

    Spinal canal diameter variability between males and females at different cervical spine levels.

    LevelSCTDSCLD
    Mean±SD (mm)P-valueMean±SD (mm)P-value
    All patientsMaleFemaleAll patientsMaleFemale
    C323.57±1.9923.75±1.5123.15±2.850.33214.33±1.5514.65±1.4913.60±1.450.027
    C424.27±1.7424.65±1.6923.39±1.560.01713.78±2.2714.34±1.7412.45±2.850.006
    C524.97±1.7225.44±1.5723.87±1.590.00214.0±1.8814.58±1.7912.81±1.470.002
    C625.07±1.5825.49±1.5524.08±1.210.00314.29±2.0414.88±2.0512.93±1.210.001
    C724.46±1.824.78±1.5423.82±2.160.09414.62±1.6714.97±1.5813.88±1.660.035
    • SD - standard deviation, SCTD - spinal canal transverse diameter, SCLD - spinal canal longitudinal diameter

    • View popup
    Table 3

    Patients’ vertebral artery parameters at different levels of the cervical spine.

    LevelC3C4C5C6C7
    Overall bilateralRightLeftP-valueOverall bilateralRightLeftP-valueOverall bilateralRightLeftP-valueOverall bilateralRightLeftP-valueOverall bilateralRightLeftP-value
    TDVA (mm)3.58±0.633.42±0.823.75±0.690.0103.65±0.653.45±0.953.85±0.740.0163.70±0.673.57±0.903.82±0.750.0893.62±0.613.54±0.893.69±0.700.2883.83±0.763.73±1.13.93±0.760.262
    LDVA (mm)3.30±±0.623.15±0.883.46±0.630.0203.38±0.563.22±0.903.54±0.560.0293.59±0.633.51±0.923.68±0.670.2263.66±0.703.57±0.973.74±0.760.2363.75±0.763.59±0.993.89±0.820.039
    FZ (mm)0.98±0.251.01±0.340.95±0.320.3970.95±0.270.93±0.310.96±0.340.6591.16±0.631.04±0.411.27±1.20.2180.99±0.410.94±0.291.05±0.710.313N/AN/AN/AN/A
    TDVA/ TTF (%)58.78±8.3656.84 ±11.5360.72 ±8.540.02161.66±7.9859.99±12.5563.32±8.590.12064.29±11.3563.68±17.0164.89±12.590.67163.09±13.1561.86 ±17.4864.32±19.540.514N/AN/AN/AN/A
    • SD - standard deviation; TDVA - transverse diameter of vertebral artery; LDVA - longitudinal diameter of vertebral artery; FZ - Free zone (see text for definition); N/A - not applicable

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Neurosciences Journal: 23 (2)
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1 Apr 2018
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Quantitative assessment of vertebral artery anatomy in relation to cervical pedicles: surgical considerations based on regional differences
Amro Al-Habib, Fahad Albadr, Jehad Ahmed, Abdulrahman Aleissa, Abdullah Al Towim
Neurosciences Journal Apr 2018, 23 (2) 104-110; DOI: 10.17712/nsj.2018.2.20170448

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Quantitative assessment of vertebral artery anatomy in relation to cervical pedicles: surgical considerations based on regional differences
Amro Al-Habib, Fahad Albadr, Jehad Ahmed, Abdulrahman Aleissa, Abdullah Al Towim
Neurosciences Journal Apr 2018, 23 (2) 104-110; DOI: 10.17712/nsj.2018.2.20170448
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