Variations of transverse foramina in cervical vertebrae: what happens to the vertebral artery?

  • Aristeidis Zibis
  • Vasileios Mitrousias
  • Nikolaos Galanakis
  • Nikoletta Chalampalaki
  • Dimitrios Arvanitis
  • Apostolos Karantanas
Original Article



The purpose of this study is to examine variations of the foramen transversarium and the vertebral artery in computed tomography angiographies (CTa) of the cervical spine, investigate their coexistence, and present possible considerations regarding such variations in spine surgical procedures.


Fifty CTa of the neck were retrospectively reviewed. Transverse and anteroposterior diameter of the foramen and diameter of the vertebral artery were measured. Variations of the foramen and the vertebral artery were detected.


Cervical CTa of 32 males and 18 females (mean age 66.4 ± 10.78 years), all belonging to the Indo-European race, were reviewed. Variations of the foramen transversarium were found in 17 vertebrae (4.85%) of 15 patients (30%). Duplication of the foramen was the most frequent variation, followed by the open foramen, the absence of the foramen, the triple foramen, and the hypoplastic foramen. Variations of the vertebral artery were found in 7 patients (14%) and asymmetry was found in 12 (24%) patients. Moreover, six patients presented with hypoplastic vertebral arteries (12%). When examining coexistence, 60% of patients exhibiting variations in the transverse foramen were also exhibiting variations or asymmetry in the vertebral artery, compared to 25.7% of patients with no foramen variations (p = 0.02).


Vertebral artery injury is not common but may be a disastrous complication during cervical spine surgery. Proper preoperative planning is essential for any surgeon and exact knowledge of the anatomy in each patient is essential. This study strongly recommends the preoperative use of a CTa when suspicion of a variation is present and implied by a foramen variation.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.


Spine cervical/vertebrae Transverse foramina Anatomic variants Computed tomography/angiography Vertebral arteries/variants 



There are no acknowledgements for this article.

Compliance with ethical standards

Ethical approval

Approval of the local ethics committee was obtained, but no inform consents were collected due to the retrospective nature of the study.

Conflict of interest

Authors declare that they have no conflicts of interest.

Supplementary material

586_2018_5523_MOESM1_ESM.pptx (1.5 mb)
Supplementary material 1 (PPTX 1561 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Anatomy, School of Health SciencesUniversity of ThessalyLarissaGreece
  2. 2.Department of Medical ImagingUniversity HospitalHeraklionGreece
  3. 3.Department of RadiologyMedical School-University of CreteHeraklionGreece

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