Prevalence of anatomic variations of the atlas vertebra

BACKGROUND CONTEXT

The retrotransverse foramen (RTF), arcuate foramen (AF), unclosed transverse foramen (UTF) and posterior atlas arch defects (PAAD) are anatomic variations of the atlas vertebra that surgeons must be aware of before spine surgery is performed.

PURPOSE

To analyze the prevalence of the AF, RTF, UTF, and PAAD.

STUDY DESIGN

Ex-vivo anatomical study.

PATIENT SAMPLE

Two hundred eighteen atlas vertebrae obtained from 100 Caucasian subjects and 118 sub-Saharan African subjects (48 Sotho subjects, 35 Xhosa subjects and 35 Zulu subjects).

METHODS

We studied 218 atlas vertebrae from skeletons of the Raymond A. Dart Collection in order to analyze the prevalence of AF, RTF, UTF, and PAAD in both Caucasian and sub-Saharan African subjects.

OUTCOME MEASURES

Not applicable.

RESULTS

Sixty-nine (31.2%) atlases presented anatomical variants: 64 (29.3%) presented one anatomical variant, 4 (1.8%) presented two, and 1 (0.5%) presented three. AF, RTF, UTF, Type A and Type E defects were present in 35 (16.1%), 17 (7.8%), 17 (7.8%), 5 (2.3%), and 1 (0.5%) vertebrae, respectively. The vertebrae with two anatomical variants presented a bilateral UTF and a Type A defect, a bilateral AF and a Type A defect, a right UTF and a left AF, and a right UTF and a Type E defect. The vertebra with three anatomical variants presented a bilateral RTF, a left UTF, and a left AF. No sex differences in prevalence of the RTF (p=.775), AF (p=.605), UTF (p=.408) and Type A defects (p=1.000) were found in the sub-Saharan African and Caucasian groups (RTF, p=.306; AF, p=.346; UTF, p=.121; Type A defects, p=.561). Comparison between the sub-Saharan African (all subjects) and the Caucasian group revealed no differences in the UTF (p=.105), AF (p=.144), RTF (p=.542) and Type A defects (p=.521) prevalence. Also, no differences in the prevalence of the UTF (p=.515), AF (p=.278), and RTF (p=.857) between Zulu, Xhosa and Sotho subjects were found. Neither were found sex differences in the prevalence of UTF, RTF and AF in Zulu (p=.805, p=.234, p=.129), Xhosa (p=.269, p=.181, p=.309), and Sotho subjects (p=.062, p=.590, p=.106).

CONCLUSIONS

The present study has revealed no sex differences in the prevalence of AF, UTF, RTF or PAAD in both Caucasian and sub-Saharan African subjects. This research has also indicated no differences in the prevalence of the UTF, AF and RTF between Zulu, Xhosa and Sotho subjects. In addition, this study has revealed no differences in the Type A, UTF, AF, and RTF prevalence between the sub-Saharan African (all subjects) and the Caucasian subjects. These variations may be known by surgeons before spine surgery for better planning.

Can the transverse foramen/vertebral artery ratio of double transverse foramen subjects be a risk for vertebrobasilar transient ischemic attacks?

The C6 is the cervical vertebra into which the vertebral artery enters the passage of the transverse foramen and it is the vertebra most affected by double transverse foramina. There is currently little information about the relation between the vertebral artery and the double transverse foramen in C6. We aimed to test whether subjects with a double transverse foramen in C6 have a reduced transverse foramen/vertebral artery ratio when compared with normal anatomy subjects who possess a single transverse foramen which may be a risk for transient vertebral artery stenosis. We measured the area of the transverse foramen and the vertebral artery in 27 double transverse and 56 normal anatomy subjects using computed tomography angiography. We found significant differences in the area of the transverse foramen between double transverse and normal subjects (P < 0.001) but not between the vertebral artery area of double transverse and normal subjects (P = 0.829). The subjects with double transverse foramina have a reduced transverse foramen/vertebral artery ratio, which may be a possible risk for transient vertebral artery stenosis.

Atlases with Arcuate Foramen Present Cortical Bone Thickening That May Contribute to Lower Fracture Risk

BACKGROUND

To date, no information about the cortical bone microstructural properties in atlas vertebrae with arcuate foramen has been reported. As a result, we aimed to test in an experimental model if there is a cortical bone thickening in an atlas vertebra which has an arcuate foramen that may play a protective role against bone fracture.

METHODS

We analyzed by means of micro-computed tomography the cortical bone thickness, the cortical volume, and the medullary volume (SkyScan 1172 Bruker micro-CT NV, Kontich, Belgium) in cadaveric dry atlas vertebrae with arcuate foramen and without arcuate foramen. We also reviewed a case series of 31 posterior atlas arch fractures to correlate the possible presence in the same atlas of both fracture and arcuate foramen.

RESULTS

The micro-computed tomography study revealed significant differences in cortical bone thickness (P < 0.001), cortical volume (P < 0.004), and medullary volume (P = 0.013) values between the arcuate foramen vertebrae and the nonarcuate foramen vertebrae. The clinical series found no coexistence in the same vertebra of a posterior atlas arch fractures and the arcuate foramen.

CONCLUSIONS

An atlas with arcuate foramen presents cortical bone thickening. This advantage in bone microarchitecture seems to contribute to a lower fracture risk compared to subjects without arcuate foramen as no coexistence in the same vertebra of a posterior atlas arch fractures and arcuate foramen was found.

Unexpected Persistent Dentocentral Synchondrosis of C2

BACKGROUND

The persistence of synchondrosis in adulthood can confound diagnostic decisions made during patient management.

CASE DESCRIPTION

A 59-year-old woman who presented neck pain, acute headache, and acute cervical myelopathy symptoms after suffering whiplash grade 3 in a car rear-end impact underwent a conventional radiologic study that revealed no fracture and no anatomic spine variations. The magnetic resonance imaging study revealed no spinal cord intensity signal changes, but it showed a persistent (remnant) dentocentral synchondrosis that was undetected in a previous conventional radiographic evaluation.

CONCLUSIONS

The localization and level of the remnant of the dentocentral synchondrosis are extremely important from the clinical viewpoint because of odontoid and C2 fractures. Neurosurgeons should thus be aware of the possible presence of a persistent (remnant) C2 dentocentral synchondrosis in adult subjects in order to avoid misdiagnosis with C2 fracture.

Cortical bone thickening in Type A posterior atlas arch defects: experimental report

BACKGROUND CONTEXT

To date, no information about the cortical bone microstructural properties in atlas vertebrae with posterior arch defects has been reported.

PURPOSE

To test if there is an increased cortical bone thickening in atlases with Type A posterior atlas arch defects in an experimental model.

STUDY DESIGN

Micro-computed tomography (CT) study on cadaveric atlas vertebrae.

METHODS

We analyzed the cortical bone thickness, the cortical volume, and the medullary volume (SkyScan 1172 Bruker micro-CT NV, Kontich, Belgium) in cadaveric dry vertebrae with a Type A atlas arch defect and normal control vertebrae.

RESULTS

The micro-CT study revealed significant differences in cortical bone thickness (p=.005), cortical volume (p=.003), and medullary volume (p=.009) values between the normal and the Type A vertebrae.

CONCLUSIONS

Type A congenital atlas arch defects present a cortical bone thickening that may play a protective role against atlas fractures.

Inhibition of activity of the protease from bovine leukemia virus

In view of the close similarity between bovine leukemia virus (BLV) and human T-cell leukemia virus type I (HTLV-I) we investigated the possibility of developing specific inhibitors of the proteases of these retroviruses using the purified enzyme from BLV. We tested the ability of this protease to specifically cleave various short oligopeptide substrates containing cleavage sites of BLV and HTLV-I proteases, as well as a recombinant BLV Gag precursor. The best substrate, a synthetic decapeptide bearing the natural cleavage site between the matrix and the capsid proteins of BLV Gag precursor polyprotein, was used to develop an inhibition assay. We determined the relative inhibitory effect of synthetic Gag precursor-like peptides in which the cleavable site was replaced by a non-hydrolyzable moiety. The encouraging inhibitory effect of these compounds indicates that potent non-peptidic inhibitors for retroviral proteases are not unattainable.

Modelling, synthesis and biological activity of a BLV proteinase, made of (only) 116 amino acids

Bovine leukaemia virus (BLV) is the aetiological agent of Leukosis enzootica bovis [Viral Oncology (1980), G. Klein (Ed.) Raven Press, New York, pp. 231-238], a widely spread disease in cattle. BLV is reported as the animal model of human T-cell leukaemia virus (HLTV) which is the causative agent of adult T-cell leukaemia and tropical spastic paraparesis. Like the viruses themselves, the two retroviral proteinases (PR) are very closely related [Virology 142 (1985) 357-377]. BLV and HTLV-I PR are reported as putative proteins made of 126 [J. Virol. 57 (1986) 826-832] and 125 [FEBS Lett. 293 (1991) 106-110] amino acids, respectively (long sequences), belonging to the aspartyl proteinase family [Nature 329 (1987) 351-354], with the aid of molecular modelling, we show that BLV and HTLV-I proteinases made of only 116 and 115 amino acids, respectively (short sequences), display three-dimensional structures similar to that observed for other retroviral aspartyl proteinases. The models are based on three-dimensional structures of Rous sarcoma virus (RSV PR) and the human immunodeficiency virus (HIV-1 PR). We used solid phase peptide synthesis to produce the putative proteolytic enzyme of BLV (116 amino acids). In this study, we show that the folded synthetic protease accurately hydrolyzes a decapeptide corresponding to the sequence of the Matrice-Capside (MA/CA) cleavage site of the gag polyprotein. In addition, the proteolytic activity is inhibited by a statine ((4S,3S)-4-amino-3-hydroxyl-6-methylheptanoic acid) containing an analogous sequence.

Conformational study of a putative HLTV-1 retroviral protease inhibitor

The crystal structure of prolyl-glutaminyl-valyl-statyl-alanyl-leucine (Pro-Gln-Val-Sta-Ala-Leu, C(32)H(57)N(7)0(9).5H(2)0, M(r) = 683.9 + 90.1), a putative HTLV-1 protease inhibitor based on one of the consensus retroviral protease cleavage sequences, and containing the statine residue [(4S,3S)-4-amino-3-hydroxy-6-methylheptanoic acid], has been determined by X-ray diffraction. The same molecule has been modelled in the active site of the HTLV-1 protease and both conformations have been compared. The peptide crystallizes as a pentahydrate in space group P2(1) with a = 10.874(2), b = 9.501(2), c = 21.062(5) A, beta = 103.68 (1) degrees, Z = 2, V= 2114.3 A(3), D(x) = 1.21 g cm(-3), micro = 8.02 cm(-1), T= 293 K, lambda(Cu Kalpha) = 1.5418 A. The structure has been refined to an R value of 0.070 for 2152 observed reflections. The peptide main chain can be described as extended and adopts the usual zigzag conformation from the prolyl to the statyl residue. The main difference in conformation between the individual observed and modelled molecules is located on the Sta, Ala and Leu residues with the main chain of the modelled molecule rotated by about 180 degrees as compared to the observed conformation in the crystal state.

Modifications of biological activities of heparin and fraxiparine induced by the size and the age of a thrombus. Experimental study

Heparin and its fractions have often been tested on fresh experimental thrombosis. However in human clinic, drugs are administered not on fresh, but rather on old constituted thrombi. In order to evaluate the effects of antithrombotic agents in these conditions, both drugs (unfractionated heparin and Fraxiparine) were administered on 150 rats at different times and so, could take effect on thrombi with different ages. Heparin was more active as its fraction on fresh thrombi (2 hours old), but no more effects could be observed for all drugs when the thrombus was 52 hours old. Biological activities (A.P.T.T., anti-IIa and anti-Xa activities) decreased as the thrombi increased in weight and age.