Differences in Cross-Sectional Intervertebral Foraminal Area From C3 to C7

Abstract

Study Design:Anatomical comparative study.Objectives:Few studies have evaluated foraminal areas in the cervical spine without degenerative changes. The purpose of this study was to determine and compare the mean cross-sectional foraminal areas between the C3/4, C4/5, C5/6, and C6/7 levels while also analyzing specimens for differences between sexes and races.Methods:We performed an anatomic study of the intervertebral foramen at 4 levels (C3/4, C4/5, C5/6, C6/7) in 100 skeletally mature osseous specimens. Specimens were selected to obtain equal number of African American and Caucasian males and females (n = 25/group) aged 20 to 40 years at time of death. Foramina were photographed bilaterally with and without a silicone rubber disc. The maximal vertical height and mid-sagittal width of each foramen were digitally measured and the areas were calculated using an ellipse as a model.Results:The average age at death for all specimens was 30 ± 6 years. The mean cross-sectional area of the C4/5 foramen was significantly smaller compared with the C5/6 (P < .001). C5/6 was significantly narrower than C6/7 (P < .001) foramen with and without disc augmentation. C3/4 was not significantly different from more caudal levels. There was no difference between male and female specimens, while African Americans had smaller foraminal sizes than Caucasians.Conclusions:This study provides the largest anatomical reference of the cervical intervertebral foramen. In a mature spine without facet joint hypertrophy or osteophytic changes, the C4/5 foramen was narrower than C5/6, which was narrower than C6/7. Understanding the relative foraminal areas in the nonpathological cervical spine is crucial to understanding degenerative changes as well as the anatomical changes in pathologies that affect the intervertebral foramen.

Traumatic cervical vertebral artery aneurysm associated with suicidal stabs

“…Furthermore, to perform such surgery, in-depth knowledge of the variability of the occipital artery and PICA, as well as that of the intervertebral foramina and relevant neurovascular and muscular structures of the affected level is necessary. [ 3 , 6 ] Treatment paradigm of penetrating VA injury has significantly evolved with endovascular therapy being remarkably increasing. Piper et al .…”

“…The cross-sectional areas of the intervertebral foramina are documented to be narrow at the C4/5. [ 3 ] This means that an open microsurgery at the level is, compared to other spinal levels, more difficult to perform, while an endovascular therapy is amenable with acceptable difficulty.…”

“…The cross-sectional areas of the intervertebral foramina have been documented to be narrower at C4/5 than at C5/6 and C6/7. [ 3 ]…”

Brachial Plexus Injuries in Sport Medicine: Clinical Evaluation, Diagnostic Approaches, Treatment Options, and Rehabilitative Interventions

“…As described, superior cervical roots (C5 and C6) and upper trunk are the most affected structures of the brachial plexus. This could be related to several factors such as (i) vulnerability of upper trunk at Erb’s point (supraclavicular region); (ii) direct trauma on nerve structures; (iii) anatomical variability in intervertebral foramina (with smallest at C4-C5 level); (iv) mechanism of injury further reducing the diameter of foramina, like hyperextension with ipsilateral side bending and contralateral cervical spine rotation [ 99 , 102 , 103 ].…”

Spinal Nerve Position and Morphometric Analysis with Silicon Molds in the Cadaveric Lumbar Intervertebral Foramen

“…The author presents a method to measure the areas, heights, widths, and perimeters of the IVFs in the lumbar region, from L1 to L5, using silicon molds. As silicon can be molded as shape of the structure until it is solidified, this advantage could be used to mimic the same morphology of a complex bony structure to reveal three dimensional properties [9]. After being removed from the bone, the silicon can be cut to show its cross section that might explain real three dimensional structures.…”