Sizes of the transverse foramina correlate with blood flow and dominance of vertebral arteries

• Published in: The spine journal 2014-06, Vol.14 (6), p.933-937
• Main Authors: Kotil, Kadir, MD, Kilincer, Cumhur, MD, PhD
• Format: Article
• Language: English
• Subjects: Adult; Blood Flow Velocity; Cervical vertebrae; Cervical Vertebrae - diagnostic imaging; Color Doppler ultrasonography; Diagnostic imaging; Female; Humans; Male; Middle Aged; Orthopedics; Prospective Studies; Sensitivity and Specificity; Spondylosis - diagnostic imaging; Spondylosis - physiopathology; Tomography, X-Ray Computed - methods; Ultrasonography, Doppler - methods; Vertebral artery; Vertebral Artery - diagnostic imaging; Vertebral Artery - physiology
• ISSN: 1529-9430; 1878-1632
• DOI: 10.1016/j.spinee.2013.07.447

Abstract Background context Knowing the side of the dominant vertebral artery (VA) may be of utmost importance if the VAs are at risk during spine surgery. Determination of the size of VAs is obtained by using Doppler ultrasonography or angiography. Because VA is the main anatomic structure occupying the transverse foramina (TF), it may be assumed that size of TF and blood flow of VAs should be proportional. Purpose To investigate if there is a correlation between the sizes of TF and the flow of VAs and determine the diagnostic accuracy of measuring TF to predict dominant side of VA. The specific hypothesis was that the larger side of TF corresponds to the side of the dominant VA. Study design This is a morphologically based, prospectively designed, single-center study. Thirty patients (14 male, 16 female) who were treated for degenerative spinal pathologies were included. Patients with cervical fractures, occluded VA, prominent degenerative changes affecting TF, deformity, or previous cervical instrumentation were excluded from the study. Outcome measures In all patients, computed tomography of the cervical spine and Doppler ultrasonography of VAs were obtained for morphometric analysis. Methods Axial computed tomography cuts at the C6 vertebral level were taken. Two measurements were performed for each foramen: its right to left width and its anteroposterior depth. Blood flow volumes of bilateral VAs were measured using color Doppler. Results Diameters of TF ranged between 2.2 and 7 mm, and its width was generally slightly larger than the depth. Transverse foramina were always asymmetric, with no right or left side preference. There was a strong correlation between TF diameters and blood flow of VAs. Between TF width and VA blood flow, the Pearson correlation coefficient was 0.59 (p=.001) for right side and 0.72 for left side (p