European Spine Journal

, Volume 27, Issue 6, pp 1272–1277 | Cite as

Retrotransverse foramen of the atlas: prevalence and bony variations

  • Juan A. Sanchis-Gimeno
  • Esther Blanco-Perez
  • Marcelino Perez-Bermejo
  • Susanna Llido
  • Shahed Nalla
Original Article



To analyze the prevalence of the retrotransverse foramen (RTF) and its bony variations.


One hundred ten atlases of living adult subjects, 161 twentieth century dry adult cervical atlases and four dry adult cervical atlases from medieval skeletons were studied to detect the RTF and its abnormal bony variations. The 110 living adult subjects underwent a computed tomography study to detect the RTF.


In the in vivo sample (n = 110; 100%), the RTF was found in four (3.6%) atlases. It was bilateral in all cases, but three (2.7%) patients showed complete RTF and the other patient presented a complete RTF in the left transverse process and an unclosed RTF in the right transverse process. In addition, the RTF was observed in combination with an unclosed transverse foramen in two cases (1.8%). In the twentieth century skeletal sample (n = 206; 100%) the RTF was found in 15 (7.3%) C1 vertebrae. It was bilateral in three (1.5%) vertebrae and unilateral in another 12 (5.8%) vertebrae. In the medieval skeletal sample (n = 4; 100%) one cadaveric atlas (25%) presented a bilateral RTF with special bony characteristics which presented an unexpected spicula in the left RTF.


The RTF is a nonmetric variant of the atlas vertebra that can present non-degenerative and non-traumatic spiculae or it can be unclosed. In addition, it can be associated with the presence of unclosed transverse foramina.


Atlas Bony variations Cervical spine Nonmetric variant Retrotransverse foramen 



The authors wish to thank Mr. Francesc Xavier Duarte Martinez and Mr. Luis Lozano Perez, heads of the archeological intervention at the Almudin Square in Segorbe, Mr. Vicente Palomar-Macian, head of the Museo Municipal de Arqueología y Etnología de Segorbe, and Mr. Alfred Sanchis and the staff of the Servicio de Investigación Prehistórica (SIP) del Museo de Prehistoria de Valencia for their technical assistance during the preparation of this manuscript. We also wish to thank the Dirección General De Cultura y Patrimonio de la Conselleria de Educación, Investigación, Cultura y Deporte de la Comunidad Valenciana.

Compliance with ethical standards

Sources of support


Conflict of interest

The authors declare that there is no conflict of interest regarding the publication of this paper.


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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.Department of Anatomy and Human Embryology, Faculty of MedicineUniversity of ValenciaValenciaSpain
  2. 2.Department of RadiologyUniversity Hospital de La RiberaValenciaSpain
  3. 3.University San Vicente MartirValenciaSpain
  4. 4.Department of Human Anatomy and Physiology, Faculty of Health SciencesUniversity of JohannesburgJohannesburgSouth Africa

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