Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 75603

AbstractMaterial and MethodsResultsDiscussionConclusionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"

Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

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)
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.
On April 2011

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
On Jan 2020

Important Notice

Original article / research
Year : 2023 | Month : June | Volume : 17 | Issue : 6 | Page : AC10 - AC14 Full Version

Morphological and Morphometric Variations in Foramen Transversarium: A Cross-sectional Study in Dried Cervical Vertebrae of Western Odisha Origin

Published: June 1, 2023 | DOI:
Sarita Behera, Mamata Sar, Srikanta Kumar Mishra

1. Assistant Professor, Department of Anatomy, Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Sambalpur, Odisha, India. 2. Professor, Department of Anatomy, Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Sambalpur, Odisha, India. 3. Associate Professor, Department of Anatomy, Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Sambalpur, Odisha, India.

Correspondence Address :
Dr. Sarita Behera,
Assistant Professor, Department of Anatomy, Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Sambalpur-768017, Odisha, India.


Introduction: Foramen transversarium refers to bilateral foramina found lateral to the vertebral body in the transverse process of the cervical vertebrae. Many variations are observed in these foramina which may lead to vertebrobasilar insufficiency, labyrinthine or hearing disturbances along with neurological symptoms due to compression or tortuosity of vertebral artery as it passes through the foramen.

Aim: To study the morphological and morphometric variations of the foramen transversarium in cervical vertebrae.

Materials and Methods: This cross-sectional study was conducted in Department of Anatomy, Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Odisha, India, from June 2022 to August 2022. A total of 367 human cervical vertebrae were procured from the anthropology section of Department of Anatomy. Vertebrae with any damage to foramen transversarium were discarded. Each vertebra was observed for shape, size, symmetry, number of foramen transversarium and osteophytic encroachment. Distance of foramen transversarium from the medial margin of uncinate process was measured bilaterally in C3 to C7 vertebrae. Data collected was tabulated and analysed by Microsoft Excel software 2019.

Results: Mean anteroposterior diameter and transverse diameter in left-side were 5.45 mm and 5.42 mm, respectively and in right-side the measurements were 5.29 mm and 5.23 mm, respectively. Double foramen transversarium was observed in 40 (10.9%) vertebrae. Among them 18 (4.9%) were bilateral and 22 (6.0%) were unilateral. In 2 (0.54%) vertebrae there was triplication of foramen transversarium. In 34 vertebrae (9.26%) there was incomplete duplication of which 9 (2.45%) were bilateral and 25 (6.81%) were unilateral. Six different shapes of foramen transversarium were observed out of which round shape (62.1%) was the most common finding. In 261 (71.1%) of vertebrae the main foramen transversarium was symmetrical in both sides but in 106 (28.9%) it was asymmetrical. Osteophytic encroachment was found in 14 (3.81%) vertebrae. The mean distance of the foramen from medial margin of uncinate process was 5.32 mm on the left and 5.42 mm on the right-side.

Conclusion: The morphological data like very narrow foramina and such a high number of accessory foramina produced through the present study definitely points towards the variations of vertebral vessels.


Foramina, Morphometry, Osteophyte, Spine, Vertebrobasilar

Foramen transversarium refers to bilateral foramina found lateral to the vertebral body in the transverse process of the cervical vertebrae. It is ventrally by ventral bar and dorsally by dorsal bar. Each of the bars end in a tubercle laterally which are connected by intertubercular or costal lamella that forms the lateral boundary of the foramen. Developmentally, it is formed between vestigeal costal element anteriorly and true transverse process posteriorly (1).

These foramina are found only in cervical vertebrae and serve as a good way to identify them. Vertebral artery, vertebral vein and sympathetic plexus arising from inferior cervical ganglion pass through these foramina. Vertebral vein passes through all the seven foramina transversaria whereas the vertebral artery does not pass through the foramen transversarium of the seventh cervical vertebra as it mostly enters at the 6th cervical vertebra level for its vertebral course. Ideally, each cervical vertebra should have two foramen transversaria. But many variations are observed in these foramina. Congenital absence of the transverse foramen and osteophyte formation are reported to be one of the causative factors for vertebrobasilar insufficiency caused by rotation of the head. Vertebrobasilar insufficiency is characterised by headache, migraine and fainting attack. Also, inner labyrinthine or hearing disturbances along with neurological symptoms (2),(3).

It has been reported that vertebral vessels are responsible for formation of foramen transversarium. So variations in the course of the vertebral vessels may be one of the causative factors for variations in foramen transversarium. It is also noted that tortousity of vertebral artery may cause bone erosion or obstruct the complete formation of the foramen transversarium (4). Now-a-days transpedicular screw fixation of cervical spine is preferred surgery for instability due to trauma, tuberculosis, neoplasia or degenerative conditions and screw is placed just medial to foramen transversarium, so the vertebral artery is at risk of injury (5).

As per literature, most of the earlier studies have focused either on morphology or morphometry of foramen transversarium in different populations (6),(7),(8),(9),(10). Study by Nayak G et al., which included the bones of eastern part of Odisha also describes only about the incidence of accessory foramen transversarium (11), they have not studied the morphometric details. Hence, the present study was undertaken to study both the morphological and morphometric variations of foramen transversarium in dry bones of western Odisha population in a comprehensive way, which will definitely be helpful for the neuro and orthopaedic surgeons and the radiologists of this part of India to increase the effectiveness of the surgical and diagnostic procedures and decrease the complications related to injury of vertebral artery.

Material and Methods

This cross-sectional study was conducted from June 2022 to August 2022 in Department of Anatomy, Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Odisha, India. Study was commenced after obtaining approval from the Institutional Ethics Committee (IEC) (IEC no 009-2022/I-F-O/43/Dt.17-05-2022).

Inclusion criteria: Both typical and atypical cervical vertebrae were included in the study.

Exclusion criteria: Vertebrae with damaged foramen transversarium were excluded from the study.

Data collection: A total of 367 human cervical vertebrae of unknown age and sex, were procured from the anthropology section of Department of Anatomy, VIMSAR, Burla. Each vertebra was observed for shape, size, symmetry, osteophytic encroachment and number of foramen transversarium. In vertebrae having accessory foramen transversarium the larger foramen was taken as the main foramen and smaller one as accessory foramen.

The shapes of the foramina were classified into six categories using the criteria by Ambali MP and Jadhav SD with little modifications (12).

• Type-1 round,
• Type-2 elliptical with main diameter (length) anteroposterior,
• Type-3 elliptical with main diameter transverse (breadth),
• Type-4 elliptical with main diameter oblique, from right to left,
• Type-5 elliptical with main diameter oblique from left to right,
• Type-6 as irregular.

The widest anteroposterior and transverse diameters of main transverse foramina taken on the inner side were measured bilaterally using digital Vernier caliper (Table/Fig 1). In C3-C7 vertebrae distance of medial margin of foramen transversarium from the medial margin of uncinate process was measured.

Statistical Analysis

Data collected was tabulated and analysed by Microsoft Excel software 2019. The range, mean and standard deviation of all the measurements like anteroposterior diameter, transverse diameter, mean diameter and distance of medial margin of the foramen transversarium from the uncinate process were calculated. The scatter chart for the mean diameters of foramen transversarium of the right and left-side was plotted.


Mean anteroposterior diameter and transverse diameter in left-side were 5.45±0.81 mm and 5.42±0.79 mm, respectively and in right-side the measurements were 5.29±0.81 mm and 5.23±0.75 mm, respectively. The mean distance of the medial margin of the foramen from the uncinate process was 5.32±1.18 mm on the left and 5.42±1.33 mm on the right-side (Table/Fig 2). Mean diameter of transverse foramen of individual vertebra showed wide range of variation ranging from 1.17-6.95 mm in the right-side and 1.05-6.95 mm in left-side (Table/Fig 3),(Table/Fig 4).

Double foramen transversarium was observed in 40 (10.9%) vertebrae. Among these 18 (4.9%) was bilateral and 22 (6.0%) was unilateral. In 2 (0.54%) vertebrae there was triplication of foramen transversarium. In 261 (71.1%) of vertebrae the foramen transversarium was symmetrical in both sides but in 106 (28.9%) it was asymmetrical. In 34 vertebrae (9.26%) there was incomplete duplication out of which 9 (2.45%) was bilateral and 25 (6.81%) was unilateral. Osteophytic encroachment was found in 14 (3.81%) vertebrae (Table/Fig 5),(Table/Fig 6),(Table/Fig 7). Six different shapes of foramen transversarium were observed. Type-1 or round shape was the most common finding bilaterally (Table/Fig 8),(Table/Fig 9).


Anatomically foramen transversarium has been described to be divided by fibrous or bony ridge, separating artery and vein, the smaller posterior part that encloses a branch of vertebral nerve and vein is called accessory foramen transversarium. Separate area in the form of complete accessory foramen transversarium for vertebral vein and nerve offers limited space. Any irritation or inflammation of nerve causes pressure effect on nerve and vein as well. Such duplication of foramen transversarium or accessory foramen transversarium may be suggestive of duplication of vertebral artery or separate area for vertebral vein and nerve. Awareness of such variation and its incidence is clinically important for spine surgeons to prevent intraoperative complications by damaging vertebral artery and vein (4).

Duplication of foramen transversarium may be associated with developmental anomalies of vertebral artery, such as duplication and fenestration or due to abnormality during formation of vertebra itself. Vertebral arteries are formed by fusion of the longitudinal anastomosis, connecting the cervical intersegmental arteries. The intersegmental arteries regress during the embryonal development except the 7th intersegmental artery, which forms the proximal portion of the subclavian artery and initial part of the vertebral artery. Persistence of a portion of primitive dorsal aorta with two intersegmental arteries results in duplication of vertebral artery. This may lead to accessory foramen transversarium (2).

Accessory vertebral arteries if present may potentially be protective against ischaemic attacks to the brain by providing collateral blood flow to the basilar artery. However, fenestrated vertebral arteries have been demonstrated histologically to be weak with irregular elastic fibres in the vessel wall. There may be a higher risk of thrombus development and embolisation leading to a severe transient ischaemic attack in people with fenestrated or duplicated vertebral arteries (13).

During development of vertebra, double rib bone element may fuse to the original transverse process resulting in unusual number of foramen transversarium (12). Study by Gupta M and Agarwal S on 319 foramen transversarium of 161 cervical vertebrae at Lady Hardinge Medical College, Delhi in 2019 found accessory foramen transversarium in 26.09% where majority were at C6 level and nil at C1 and C2 level (14). Similar report was made by Patil NP et al., in a study on 175 cervical vertebrae at Ambjogai, Maharashtra in 2014 that the accessory foramen transversarium was more common in lower cervical vertebrae (15). Present study found it to be 54.7% in C6 and nil in C1 and C2.

Vasuki AKM et al., in their study on 300 cervical vertebrae at Coimbatore in 2018 found triple foramen in right-side in one (0.003%) vertebra (4). In the present study, in two (0.54%) vertebrae there was triplication of foramen transversarium.

Anatomical variations in the vertebral artery, embryological factors and functional conditions may play an important role in the formation of incomplete transverse foramen. It was noted that the tortousity of vertebral artery may cause bony erosion or obstruct the complete formation of foramen transversarium (4),(16). Vasuki AKM et al., found unilateral incomplete duplication in 3% and bilateral incomplete duplication in 2% out of 125 vertebrae showing variation (4). Shah ST et al., in their study on 210 vertebrae at Gujarat in 2014 found unilateral incomplete duplication in 3.8% (6). In the present study, in 34 vertebrae (9.26%) there was incomplete duplication out of which 9 (2.45%) was bilateral and 25 (6.81%) was unilateral.

Size of transverse foramen is directly proportional to the calibre of vertebral artery. Size of transverse foramen carries clinical significance as vertebrobasilar insufficiency may be seen in case of narrowing of foramen transversarium. During the development of bone, new layers are added to the pre-existing surfaces. Reduced foramen area of some cervical vertebrae may be attributed to periosteal growth at foramen margins to fit around their neurovascular and other contents (4).

Bow hunter’s stroke is a symptomatic vertebrobasilar insufficiency caused by stenosis or occlusion of the vertebral artery with head rotation (7). Ambali MP and Jadhav SD in their study on 163 cervical vertebrae at Maharashtra in 2016 observed the average diameter of the foramen transversarium on the right-side to be 5.46 mm and on the left to be 5.80 mm (12). In present study, the largest diameter was 7.30 mm and smallest was 1 mm. Previous studies had shown that the two vertebral arteries are not equal in size in 75% of people and of these,10% have quite narrow vertebral arteries in right-side (7). Agrawal D et al., conducted a study on 160 cervical vertebrae of eastern Odisha in 2012 and reported asymmetrical foramen transversarium only in one specimen in typical vertebrae (17). Ambali MP and Jadhav SD, observed symmetrical foramen transversarium in 91 (55.82%) out of 163 vertebrae (12). In the present study asymmetrical foramen transversarium were found in 106 out of 367 vertebrae (28.9%).

As per literature, osteophytes are more common along the medial or lateral margins of the foramen transversarium reducing the transverse diameter, type 2 where the main diameter is along the anteroposterior direction is most likely to be involved in compression of the vertebral artery whereas type 3 where main diameter is along the transverse axis is at minimal risk [18,19]. Ambali MP and Jadhav SD, found seven different shapes of foramen transversarium. Out of them oval and tilted to right was the most common shape (44.78%) (12). Vasuki AKM et al., found five different shapes out of which Type-1 or round shape was the most frequent (43.6%) (4). Patra A et al., in their study on 200 cervical vertebrae of south central Asian cadavers in 2022 observed type 1 or round shape (27.13%) to be the most common in right-side and type-4 or elliptical with main diameter from right to left (27.63) in left-side (18). In present study, six different shapes were observed and round shape was the most common (62.1%) in both sides. Most of the studies describe unilateral accessory foramen to be more common than bilateral which was consistent with present study (Table/Fig 10) (2),(4),(6),(7),(8),(9),(10),(11),(12),(20),(21),(22),(23),(24),(25),(26).

Ambali MP and Jadhav SD, found bony spicules in 12 (7.36%) out of 163 vertebrae (12). Sangari SK et al., observed osteophytic encroachment in 21.3% of vertebrae studied (7). Patra A et al., observed osteophytes in 21.3% (18). In present study, authors observed osteophytic encroachment in 14 (3.81%) out of 367 vertebrae. The osteophytes encroaching the transverse foramina are potential sites of trauma to the vertebral artery which may also compress it resulting in its narrowing leading to vertebrobasilar insufficiency.

To avoid vertebral artery injury during anterior cervical disc surgery, the medial margin of the uncovertebral joint may be the safe landmark. The distance of foramen transversarium from uncinate process found in the present study which was consistent with findings of previous studies (Table/Fig 11) (7),(14),(16),(18),(23). The risk of vertebral artery laceration may be increased, especially when osteophytes are removed from uncinate process by lateral decompression. So, it is better to perform this procedure under direct visualisation with opening of the anterior walls of the transverse foramen and retracting the vertebral artery laterally (7).


As the study was done in dried vertebrae collected from the anthropology section, age and sex correlation could not be done.


Finding of extremely narrow foramen transversarium as small as 1 mm in diameter and accessory foramina in such a good number of vertebrae in the present study raises questions about the integrity of the contained structures. This factor leading to vertebral artery compression should not be ignored while searching for the differential diagnosis of complaints like headache, migraine and fainting attacks. So, the results generated through this osteological study should be correlated by undertaking radiological studies to confirm the variations of the vertebral vessels. Further, though the other morphometric details of foramen transversarium have been studied in different populations of India, the distance of uncinate process from its medial margin generated through this study will be first of its kind.


Standring S, Borley NR, Newell RLM, et al. editors. Gray’s Anatomy- The antomical basis of clinical practice. 40th ed. Edinburgh: Churchill Livingstone/ Elsevier; 2008. Pp. 717,718, 449.
Kaya S, Yilmaz ND, Pusat S, Kural C, Kirik A, Izci Y. Double foramen transversarium variation in ancient byzantine cervical vertebrae: Preliminary report of an anthropological study. Turk Neurosurg. 2011;21(4):534-38. [crossref]
Kotil K, Kilincer C. Sizes of the transverse foramina correlate with bloodflow and dominance of vertebral arteries. Spine J. 2014;14(6):933-37. [crossref][PubMed]
Vasuki AKM, Jamuna M, Nirmaladevi M, Hebzibah DJ, Radhika K, Krishnan K. An osteological study of foramen transversarium of cervical vertebrae and its clinical significance. Int J Anat Res. 2018;6(1.2):4906-13.
Gupta RP, Rai A, Gupta N. A study of anatomical variations in foramen transversarium and its clinical importance. Int J Contemp Surg. 2014;2(1):147. [crossref]
Shah ST, Arora K, Shah KP. Study of accessory foramen transversarium in cervical vertebrae. GCSMC J Med Sci. 2014;3(2):21-24.
Sangari SK, Dossous PM, Heineman T, Mtui EP. Dimensions and anatomical variants of the foramen transversarium of typical cervical vertebrae. Anat Res Int. 2015:391823. [crossref][PubMed]
Katikireddi RS, Setty SNRS. A study of double foramen transversarium in dried cervical vertebra. Int J Heal Sci Res. 2014;4(1):59-61.
Akhtar MJ, Madhukar PK, Rahman S, Kashyap N. A morphometric study of foramen transversarium of dried cervical vertebrae. Int J Res Med Sci. 2015;3(4):912-16. [crossref]
Gujar SM, Oza SG, Shekhawat JP. A study of accessory foramen transversarium in dry cervical vertebrae and its clinical implications. Natl J Integr Res Med. 2015;6(6):27-30.
Nayak G, Mohanty BB, Baisakh P, Das SR, Panda SK, Chinara PK. Study of accessory foramina transversaria in cervical vertebrae and their surgical and morphological importance. Res J Pharm Biol Chem Sci. 2016;7(3):1370-73.
Ambali MP, Jadhav SD. Anatomical variations in foramen transversarium of typical cervical vertebrae and its clinical significance. Int J Anat Res. 2017;5(1):3426-29. [crossref]
Ionete C, Omojola MF. MR angiographic demonstration of bilateral duplication of the extracranial vertebral artery: Unusual course and review of the literature. Am J Neuroradiol. 2006;27(6):1304-06.
Gupta M, Agarwal S. Morphometric study of foramina transversaria and the incidence of accessory foramina in cervical spine of Indian population. J Clin Diag Res. 2019;13(3):AC07-AC11. [crossref]
Patil NP, Dhapate SS, Porwal S, Bhagwat VB. The study of incidence of accessory foramen transversaria in the cervical vertebrae. IOSR J Dent Med Sci. 2014;13(7):85-87. [crossref]
Molinet GM, Robles FP, Roa I. Anatomical variations of the foramen transversarium in cervical vertebrae. Int J Morphol. 2017;35(2):719-22. [crossref]
Agrawal D, Mohanty BB, Shetty S, Parija B, Hazary SK, Chinara PK. Variations in foramen transversarium: An ostiological study in eastern India. Int J Curr Res. 2012;4(9):120-22.
Patra A, Chaudhary P, Kaur H. Variations in the foramen transversarium of cervical spine and their surgical importance: An osteological study in dried cervical vertebrae of north Indian origin. Turk Neurosurg. 2022; 32(1):36-42. [crossref][PubMed]
Aziz JN, Morgan M. Morphological study of the foramen transversarium of the atlas vertebra among Egyptian population and its clinical significance. Anatomy Physiol Biochem Int J. 2018;4(4):00163-67.
Murlimanju BV, Latha VP, Shilpa K, Rai R, Dhananjaya KVN, Jiji PJ. Accessory transverse foramina in the cervical spine: Incidence, embryological basis, morphology and surgical importance. Turk Neurosurg. 2011;21(3):384-87. [crossref][PubMed]
Rathnakar P, Remya K, Swathi B. Study of accessory foramen transversaria in cervical vertebrae. J Heal Allied Sci NU. 2013;3(4):97-99. [crossref]
Chandravadiya L, Patel S, Goda J, Chavda V, Ruparelia S, Patel S. Double foramen transversarium in cervical vertebra: Morphology and clinical importance. Int J Res Med. 2013;2(1):103-05.
Rekha BS, Neginhal DD. Variations in foramen transversarium of atlas vertebra: An osteological study in South Indians. Int J Res Heal Sci. 2014;2(1):224-28.
Murugan M, Verma S. A study on variations of foramen transversarium of cervical vertebrae. Natl J Clin Anat. 2014;3(1):04-07. [crossref]
Patra A, Kaur H, Chhabra U, Kaushal S, Kumar U. Double foramen transversarium in dried cervical vertebra: An osteological study with its clinical implications. Indian J Oral Sci. 2015;6(1):07-09. [crossref]
Shivaleela C, Khizer Hussain Afroze M, Ramesh P, Lakshmiprabha S. An osteological study of anatomical variations of foramen of cervical vertebrae and its clinical implications. Int J Anat Res. 2021;9(4):8145-50.[crossref]

DOI and Others

DOI: 10.7860/JCDR/2023/63927.18035

Date of Submission: Mar 09, 2023
Date of Peer Review: Apr 04, 2023
Date of Acceptance: May 23, 2023
Date of Publishing: Jun 01, 2023

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. No

• Plagiarism X-checker: Mar 11, 2023
• Manual Googling: May 01, 2023
• iThenticate Software: May 20, 2023 (20%)

ETYMOLOGY: Author Origin


JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)