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


OBJECTIVE
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.


METHODS
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.


METHODS
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<.0001). The side of the larger TF matched with the side of dominant VA in 28 of 30 cases (93.3%) (p<.0001). The agreement between the dominant VA and the larger side of TF was almost perfect (Kappa=0.087, p<.0001).


CONCLUSIONS
There was strong correlation between TF diameters and VA blood volume. Our results suggest that TF diameter of C6 level can be used to predict the side of the dominant VA reliably.
Akademik Hospital, T.C. Istanbul Arel University, Nuh Kuyusu Cad. No: 94 Baglarbasi 34664 Uskudar, Istanbul, Turkey.
Kadir
K
Kotil
Neurosurgery Department, Trakya University Faculty of Medicine, 22030 Edirne, Turkey. Electronic address: ckilincer@yahoo.com.
Cumhur
C
Kilincer
D000328:Adult; D001783:Blood Flow Velocity; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D055009:Spondylosis / Q000000981:diagnostic imaging / Q000503:physiopathology*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D018608:Ultrasonography, Doppler / Q000379:methods*; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000502:physiology*
Cervical vertebrae; Color Doppler ultrasonography; Diagnostic imaging; Sensitivity and specificity; Vertebral artery