Kotil Kadir, Kilincer Cumhur
Akademik Hospital, T.C. Istanbul Arel University, Nuh Kuyusu Cad. No: 94 Baglarbasi 34664 Uskudar, Istanbul, Turkey.
Neurosurgery Department, Trakya University Faculty of Medicine, 22030 Edirne, Turkey.
Spine J. 2014 Jun 1;14(6):933-7. doi: 10.1016/j.spinee.2013.07.447. Epub 2013 Sep 27.
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.
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.
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.
In all patients, computed tomography of the cervical spine and Doppler ultrasonography of VAs were obtained for morphometric analysis.
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.
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).
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.
如果在脊柱手术中椎动脉（VA）存在风险，了解优势椎动脉的侧别可能至关重要。通过使用多普勒超声或血管造影来确定椎动脉的大小。由于椎动脉是占据横突孔（TF）的主要解剖结构，可以推测横突孔的大小与椎动脉的血流应该是成比例的。
研究横突孔大小与椎动脉血流之间是否存在相关性，并确定测量横突孔以预测优势椎动脉侧别的诊断准确性。具体假设是横突孔较大的一侧对应于优势椎动脉的一侧。
这是一项基于形态学的前瞻性单中心研究。纳入了30例因退行性脊柱疾病接受治疗的患者（14例男性，16例女性）。颈椎骨折、椎动脉闭塞、影响横突孔的明显退行性改变、畸形或既往颈椎内固定的患者被排除在研究之外。
对所有患者进行颈椎计算机断层扫描和椎动脉多普勒超声检查以进行形态学分析。
在C6椎体水平进行轴向计算机断层扫描。对每个椎间孔进行两次测量：其左右宽度和前后深度。使用彩色多普勒测量双侧椎动脉的血流量。
横突孔直径在2.2至7毫米之间，其宽度通常略大于深度。横突孔总是不对称的，没有右侧或左侧偏好。横突孔直径与椎动脉血流之间存在很强的相关性。在横突孔宽度与椎动脉血流之间，右侧的Pearson相关系数为0.59（p = 0.001），左侧为0.72（p < 0.0001）。在30例中的28例（93.3%）中，横突孔较大的一侧与优势椎动脉的一侧相匹配（p < 0.0001）。优势椎动脉与横突孔较大一侧之间的一致性几乎完美（Kappa = 0.087，p < 0.0001）。
横突孔直径与椎动脉血容量之间存在很强的相关性。我们的结果表明，C6水平的横突孔直径可用于可靠地预测优势椎动脉的侧别。
