The Prevalence of Skeletotopy Variation of the Atlas and Vertebral Arteries Among Lithuanians and Its Significance for Physical Medicine Procedures and Rehabilitation

Abstract

Research background. Vertebral artery relation with atlas anatomical variations can lead to sensomotor disorders of head and neck, and vertebrobasilar insuffciency. Kimmerle’s anomaly, a bony ring around vertebral artery, is also known as a risk factor for physical medicine procedures. To the best of our knowledge, this is the frst study of Ponticulus posticus prevalence in Lithuania. Aim. The research aim was to investigate the prevalence of skeletotopy variations of the posterior arch and vertebral artery among Lithuanian orthodontic patients of various ages and both genders. Research methods. We randomly selected 870 digital lateral cephalograms of Lithuanian orthodontic patients of various ages and both genders. 706 images with good visualization of VA bony socket shadow on the superior surface of the atlas posterior arch were chosen for the investigation. According to the degree of depth of the bony socket we categorized them into three variations: sulcus, groove and bony ring. If contours around VA of bony arch were equal or greater than 180°, we included those cases into the group of bony groove. Research results. We estimated predominance of sulcus (67.6%) of bony socket variations. A bony groove of various depths was found in 24.0% and a bony ring was found in 7.5% of the subjects studied. Vertebral artery groove was found to be more prevalent in females than in males and bony ring was more common in males than in females, but there was no signifcant difference (p > 0.05). Statistically signifcant predominace of bony ring in the age group of 17–20 years (13.2%) was observed and it was higher than in the age group of 8–16 years (5.1%) (p < 0.05). Conclusions. 1. Variations of bony socket including sulcus, groove, and bony ring (Kimmerle’s anomaly) develop in adolescence when ossifcation is most active. 2. The bony ring and semi open groove, which limit mobility of distal part of the vertebral artery, can be a risk factor of physical medicine procedures, especially in the elderly, whose artery walls are less elastic.

Keywords: Ponticulus posticus, Kimmerle’s anomaly, atlas, vertebral artery, manual therapy of neck.