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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Vertebral Artery Groove in the Atlas and Its Clinical Significance
Correspondence Address :
Dr. D. Ravichandran MD (Anatomy)
Department of Anatomy,
Vinayaka Mission Kirupananda Variyar Medical College,
Salem, Tamil Nadu , INDIA
Ph. No: (0) 9952090673
e-mail: drravianatmd@gmail.com.
ntroduction: The vertebral artery groove is located on the superior surface of the posterior arch of atlas vertebra lodging the third part of the vertebral artery. The morphometric data of the groove including the groove length, width and thickness of the bone forming the floor of the groove is scarce in Indian literature. The distance between the groove and the posterior midline is of surgical importance. Iatrogenic injury to the vertebral artery is common in posterior approaches of the atlas vertebra. The objective of the present study is to obtain the morphometric data of the groove and to assess the distance of the groove from the posterior midline for providing a safety guideline to the surgeons.
Materials and Methods: 75 dry human atlas vertebrae were measured manually using vernier calipers. The morphometry of VAG and its distance from midline were evaluated through eight linear measurements. The results were analysed stastically using SPSS 16 version.
Results: The inner groove length was 7.71 mm and 7.49 mm on the right and left sides respectively. The outer groove length was 8.1 mm on the right and 8.24 mm on the left side. The mean width was 7.89 mm on the right and 8.08 mm on the left side. The mean thickness was 4.7 mm on the right and 4.55 mm on the left side. The safe zone from the midline during posterior approach to C1 to avoid potential injury to vertebral artery was found to be 11.26mm.
Discussion: Iatrogenic injury to vertebral artery is the most commonest per-operative complication during a posterior approach. The distance of the groove from the posterior midline and knowledge of the morphometric data of the groove is important for instrumentation procedures in the atlas vertebra.
Conclusion: The present study reveals the morphometry of the vertebral artery groove and recommends a safe zone of 11.26 mm from the midline in posterior approach for atlas vertebrae.
Atlas, Vertebral artery, Morphometry, Safe zone, Surgical approach
The surgical treatment of pathologies in the skull- the cervical region is one of the complex areas in the field of orthopaedics and neurosurgery. Cervical instability which results from fractures often requires stabilization. The stabilization procedures include wiring, transarticular screw fixation and plate fixation. Iatrogenic injuries to the neurovascular structures including the vertebral artery, the hypoglossal nerve, the internal carotid artery and the second cervical sympathetic ganglion are possible in the instrumentation of the posterior arch of the atlas (1). Of these, injury to the vertebral artery is the most frequent peroperative complication (2). The foramen arcuale, a rare anatomical accident which occurs in the atlas, might further complicate the surgical access in this region, thus resulting in damage to the vertebral artery (3),(4). The foramen arcuale is an osseous bridge which converts the groove of the vertebral artery into an osseous tunnel through which the vertebral artery traverses.
The third part of the vertebral artery runs in the vertebral artery groove (VAG) which is situated behind the lateral mass of the atlas.
The groove is an impression which is caused by the third part of the vertebral artery on the superior surface of the posterior arch of the atlas. It extends horizontally from the medial edge of the foramen transversarium to the medial edge of the posterior arch. The groove is also called as the sulcus arteriae vertebralis or the sulcus for the vertebral artery. It is reported to be thicker and wider on the left side due to the vertebral artery dominance on the left side (42% dominance on the left side, 32% dominance on the right side and 26% symmetrical) (5). Sometimes, the distal part of the groove forms a full bone bridge to the upper edge of the superior articular facet of the atlas, thus forming the foramen arcuale or the retroarticular canal for the vertebral artery. The incidence of this variation has been variedly reported to be ranging from 5.14% to 51% (5). The geometrical description of the groove including its length and width and the thickness of the bone which forms the floor of the groove in the Indian literature, is scarce. The objective of the present study was to measure the morphometric parameters of the groove, including the length, width and the thickness of the bone which formed the floor of the groove in the human atlasvertebra in the Indian population and to provide a safety guideline for the surgeons to avoid potential injury to the vertebral artery.
Seventy five atlas (C1) vertebra without any obvious pathology and belonging to the bone banks of Vinayaka Mission’s Kirupananda Variyar Medical College, Salem, Tamil Nadu, Annapoorana Medical College, Salem, Tamil Nadu, Vinayaka Mission’s Homeopathy Medical College, Salem and the Govt. Mohan Kumaramangalam Medical College, Salem, Tamil Nadu were utilized for the study. The gender and the age of the bones were not considered in the present study.
Eight linear measurements were taken bilaterally (right and left) by using a vernier caliper. The measurements were repeated by an independent second observer with the first results being blinded to the second observer. Both the observers were qualified anatomists (first and second authors) The anatomical parameters which were measured were groove length (inner and outer), groove width, thickness of the bone which forms the floor of the groove, proximal medial projection (D1), proximal lateral projection (D2), distal medial projection (D3) and distal lateral projection (D4).
The VAG was identified. All the parameters were measured according to the instructions which were given by Max Franco et al5 at the appropriate places (Table/Fig 1) (Table/Fig 2) . The length of thegroove was taken as the maximum anteroposterior distance along the inner and outer edges of the groove. The width of the groove is the distance between the inner and outer edges at the middle of the groove. The thickness of the bone which formed the floor of the groove is the distance between the superior and inferior surfaces of the posterior arch at the middle of the groove. The proximal medial projection (D1) is the distance between the midline and the inner edge of the groove at the initial portion of the groove. D2 is the distance between the midline and the outer edge of the groove at the initial portion of the groove. D3, the distal medial projection is the distance between the midline and the inner edge of the groove at the final portion of the groove. D4 is the distance between the midline and the outer edge of the groove at the final portion of the groove.
The mean measurements of each of the parameters were compared separately between the two readers by using ANOVA paired ‘t’ tests and correlation coefficients and the ‘p’ values were calculated. For each of the measurements, the right side values and the left side values of the two observers were compared individually. The SPSS version 16 statistical package was used for analysis.
The results of the measurements of observer 1 are tabulated in (Table/Fig 3). The mean values (+ SD) for the inner groove length onthe right side was 7.71 + 1.16 mm and on the left side, it was found to be 7.49 + 1.33 mm. The outer groove length on the right side was 8.1 +1.58 mm and on the left side, it was 8.24 + 1.37 mm.
The mean width (+ SD) on the right side was 7.89 + 1.29 mm and on the left side, it was 8.08 + 1.37 mm.
The mean thickness of the bone which formed the floor of the groove (+ SD) on the right side was 4.7 + 0.98 mm and on the left side, it was 4.55 + 0.84 mm.
The mean (+ SD) D1 on the left side was 11.06 + 1.61 mm and on the right side, it was 11.46 + 1.62 mm. The mean (+ SD) of the projection D2 on the left side was 17.82+1.70 mm and on the right side, it was 17.04 + 1.97 mm. The mean (+ SD) D3 on the left and right sides were 14.3 + 2.03 mm and 14.26 + 1.69 mm respectively. The mean (+ SD) D4 on the left side was 23.14 + 1.65 mm and on the right side, it was 22.7 + 1.84 mm.
The parameters D1 and D2 alone showed a statistically significant difference between the right and left sides (p = 0.036 and 0.002 respectively). All the other parameters (length, width, thickness, D3 and D4) did not show significant differences between the sides.
The inter observer variation between observers 1 and 2 was not statistically significant (p > 0.05). The measurements for all the parameters correlated highly with the correlation co-efficient of 0.97to 0.99 (p< 10–5). The results of the analysis of the inter-observer variation are presented in (Table/Fig 4).
The third part of the vertebral artery, after its exit from the foramen transversarium produces an impression on the superior surface of the posterior arch of the atlas, behind the lateral mass of the atlas vertebra. This groove is called as the vertebral artery groove (VAG) (5). In the superior view, the groove appears to be curved from the lateral to the medial view [6,7]. The morphology of the VAG, including the length, width and the thickness of the bone which formed its floor has scarcely been reported in the Indian literature.
The length, width and the thickness of the groove did not show any statistically significant difference between the right and left sides in the present study. The outer groove length was found to be significantly longer on both the sides (p values, rt < 0.05 and lt < 0.001) ) than the inner groove length. A comparison of our morphometric results with that of another author (Max Franco de Carvalho) is presented in (Table/Fig 5).
The distance between the longitudinal midline of the atlas vertebra and the VAG carries surgical importance. Surgeries involving the atlas include plate osteosynthesis, posterior cervical arthrodesis,wiring and lateral mass fixation. A posterior approach through a midline longitudinal incision is the commonly advocated approach to the upper cervical region (8). When exposing the upper cervical spine, care has to be taken to avoid injury to the vertebral arteries. Iatrogenic injury to the vertebral artery is the most commonest intraoperative complication during a posterior approach (5),(6),(7),(8),(9),(10),(11).
Considering the more anterior position of the artery in the groove, the projection, D1 (proximal medial projection at the initial portion of the groove) would suggest the distance between the midline and the VAG. In our study, D1 was found to be 11.06 mm + 1.61 on the left side and 11.46 + 1.62 on the right side. Although the numerical difference which was noted between the right and left side values was statistically significant (p = 0.036), it does not carry much clinical significance. However, the values which were observed on both the sides were close to 11 mm. Therefore, the mean distance between the midline and the edge of the VAG as observed in our study would be 11.26 mm, which could be taken as the safe zone from the midline.
Various authors have quoted the safe zone for surgical manipulations on the posterior arch of the atlas to avoid iatrogenic injury to the vertebral artery. According to Simpson et al (12), the surgical exposure of the posterior arch should not exceed 15 mm from the midline in adults and 10 mm in children. Max franco5 suggested that the posterior dissection of the posterior arch should be limited to a distance of 11.2 mm from the midline. Stauffer ES (13) recommends a safe zone of 10 mm from the posterior midline. Ebraheim et al (14) noted the safe zone as 10 mm for males and 9 mm for females from the posterior midline. All these data belong to the Western literature. Our results coincide with the results which were observed by Max franco (5). However, the standard textbooks on posterior exposure suggest a safe distance of 15 mm from the midline (8).
The authors recommend future studies with a larger sample size, including the age and gender of the bones.
This study which was done on 75 atlas vertebra provides morphological data about the vertebral artery groove. The knowledge of the safe zone for surgical manipulations from the posterior midline in the local population is mandatory for the surgeons who operate in this area. The present study recommends a safe zone of 11.26 mm from the midline in the posterior approach for the atlas vertebra.
The morphometric data of the vertebral artery groove in the atlas in Indians and the safe zone from the posterior midline was assessed as 11.26 mm for a posterior surgical approach in the atlas vertebrae.
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