Skip to main content
Log in

A quantitative analysis of the dimensions and content of the vertebral triangle

  • Anatomic Variations
  • Published:
Surgical and Radiologic Anatomy Aims and scope Submit manuscript

Abstract

Purpose

The vertebral triangle (VT) located in the root of the neck most commonly contains the vertebral artery (VA), cervical sympathetic chain and certain roots of the brachial plexus. Although other structures have been reported, few studies have reported on the overall content of this space. Based on the current literature, there is a general paucity of anatomical information pertaining to the dimensional anatomy of the VT and specifically the structures related to it. Therefore, this study aimed to quantitatively analyze the size, position, content, and anatomical structures in relation to the vertebral triangle in a South African sample.

Methods

Forty-three VTs were dissected on bodies donated to science. Measurements taken include the dimensions of the triangle, as well as distances between prominent structures and landmarks of the VT. Observations were made on the presence/absence of the varying neurovascular structures within the VT.

Results

Mean height was 30.1 ± 1.51 mm (R) and 32.9 ± 1.78 mm (L). Mean width was 18.3 ± 0.74 mm (R) and 19.3 ± 0.98 mm (L). The C8 spinal nerve was found on average approximately halfway [16.4 ± 0.74 mm (R) and 15.9 ± 0.95 mm (L)] in the VT. The VA was present in the VT in 100% of the sample and the C7 spinal nerve and inferior sympathetic ganglia were present in more than 80% of the sample.

Conclusion

Understanding the VT and the content is of the utmost importance and of great interest to neurosurgeons, to avoid these important neurovascular structures and prevent iatrogenic complications during surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Anitha V (2012) Abnormal origin of vertebral artery. Int J Anat Sci 3(1):01–03

    Google Scholar 

  2. Campero AR, Rubino PA, Rhoton AL (2011) Anatomy of the vertebral artery. Pathology and surgery around the vertebral artery. Springer, Paris, pp 29–40

    Chapter  Google Scholar 

  3. Cavdar S, Arisan E (1989) Variations in the extracranial origin of the human vertebral artery. Acta Anat 135:236–238. https://doi.org/10.1159/000146760

    Article  PubMed  CAS  Google Scholar 

  4. Cesmebasi A (2015) Anatomy of the cervical plexus and its branches. Nerves and nerve injuries. Academic Press, Amsterdam, pp 441–449. https://doi.org/10.1016/B978-0-12-410390-0.00032-9

    Chapter  Google Scholar 

  5. Chaudhary B, Tripathy PR, Gaikwad MR (2019) Vertebral arteries bilaterally passing through stellate (cervicothoracic) ganglion. Folia morphol 79(3):621–626. https://doi.org/10.5603/FM.a2019.0115

    Article  Google Scholar 

  6. Civelek E, Karasu A, Cansever T, Hepgul K, Kiris T, Sabancı A, Canbolat A (2008) Surgical anatomy of the cervical sympathetic trunk during anterolateral approach to cervical spine. Eur Spine J 17(8):991–995. https://doi.org/10.1007/s00586-008-0696-8

    Article  PubMed  PubMed Central  Google Scholar 

  7. Eisenberg RA, Vines FS, Taylor SB (1986) Bifid origin of the left vertebral artery. Radiol 159:429–430. https://doi.org/10.1148/radiology.159.2.3961176

    Article  CAS  Google Scholar 

  8. Elias M (2000) Cervical sympathetic and stellate ganglion blocks. Pain Physician 304(3):294

    Article  Google Scholar 

  9. Gluncic V, Ivkic G, Marin D, Percac S (1999) Anomalous origin of both vertebral arteries. Clin Anat 12(4):281–284. https://doi.org/10.1002/(SICI)1098-2353(1999)12:4%3c281::AID-CA8%3e3.0.CO;2-6

    Article  PubMed  CAS  Google Scholar 

  10. Goyal N, Jain A (2019) Variant communication of phrenic nerve in neck. Surg Radiol Anat 41(2):151–152. https://doi.org/10.1007/s00276-018-2123-0

    Article  PubMed  Google Scholar 

  11. Hadimani GA, Desai SD, Bagoji IB, Sahana BN (2013) Bilateral variation in the origin of vertebral artery. J Pharm Sci Res 5(10):196–198

    Google Scholar 

  12. Hadimani GA, Bagoji IB, Bannur BM (2014) Cases of vertebral arterial variations with an emphasis on its development. J Chem Pharm Res 6(11):635–639

    Google Scholar 

  13. Hakeem AH, Hakeem IH, Wani FJ (2016) Phrenic nerve palsy as initial presentation of large retrosternal goitre. Indian J Surg Oncol 7(4):460–463. https://doi.org/10.1007/s13193-016-0540-2

    Article  PubMed  PubMed Central  Google Scholar 

  14. Hamada T, Usami A, Kishi A, Kon H, Takada S (2015) Anatomical study of phrenic nerve course in relation to neck dissection. Surg Radiol Anat 37(3):255–258. https://doi.org/10.1007/s00276-014-1343-1

    Article  PubMed  Google Scholar 

  15. Hammer O, Harper DAT, Ryan, PD (2001) PAST: Paleontological Statistics software package for education. Published by Oyvind Hammer as free software

  16. Hashimoto H, Ohnishi H, Yuasa T, Kawaguchi S (1987) Duplicate origin of the vertebral artery: report of two cases. Neuroradiol 29:301–303. https://doi.org/10.1007/BF00451774

    Article  CAS  Google Scholar 

  17. Iyer AA (1927) Some anomalies of origin of the vertebral artery. J Anat 62(1):121–122

    PubMed  PubMed Central  CAS  Google Scholar 

  18. Kiss J (1968) Bifid origin of the right vertebral artery: a case report. Radiol 91(5):931. https://doi.org/10.1148/91.5.931

    Article  CAS  Google Scholar 

  19. Momeni E, Esfandiari E (2016) Anatomical variations of vertebral artery. Anat Sci J 13(1):61–62

    Google Scholar 

  20. Ostrowska M, de Carvalho M (2015) Injuries of the nerves of the thorax. Nerves and nerve injuries. Academic Press, Amsterdam, pp 525–543. https://doi.org/10.1016/B978-0-12-802653-3.00083-X

    Chapter  Google Scholar 

  21. Park HK, Jho HD (2012) The management of vertebral artery injury in anterior cervical spine operation: a systematic review of published cases. Eur Spine J 21(12):2475–2485. https://doi.org/10.1007/s00586-012-2423-8

    Article  PubMed  PubMed Central  Google Scholar 

  22. Premchandran D, Madhyastha S (2013) Anomalous origin of the left vertebral artery. Rev Arg de Anat Clin 5(1):33–38. https://doi.org/10.31051/1852.8023.v5.n1.14050

    Article  Google Scholar 

  23. Rath G, Prakash R (1984) Double vertebral artery in an Indian cadaver. Anatomia clinica 6(2):117–119. https://doi.org/10.1007/BF01773163

    Article  PubMed  CAS  Google Scholar 

  24. Rieger P, Huber G (1983) Fenestration and duplicate origin of the left vertebral artery in angiography. Neuroradiol 25(1):45–50. https://doi.org/10.1007/BF00327480

    Article  CAS  Google Scholar 

  25. Sakellariou VI, Badilas NK, Mazis GA, Stavropoulos NA, Kotoulas HK, Kyriakopoulos S, Tagkalegkas I, Sofianos IP (2014) Brachial plexus injuries in adults: evaluation and diagnostic approach. ISRN orthop 2014:9. https://doi.org/10.1155/2014/726103

    Article  Google Scholar 

  26. Shankar VV, Radhika PM, Sheshgiri C (2013) Anomalous origin of left vertebral artery. Int J Health Allied Sci 2(3):216–218. https://doi.org/10.4103/2278-344X.120597

    Article  Google Scholar 

  27. Singal A, Gupta T, Sahni D, Aggarwal A (2020) Anatomy of scalenovertebral triangle: a vade mecum for clinicians. Morphol 104(346):174–181. https://doi.org/10.1016/j.morpho.2019.12.004

    Article  CAS  Google Scholar 

  28. Siqueira MG, Martins RS (2011) Surgical treatment of adult traumatic brachial plexus injuries. Arq Neuropsiquiatr 69(3):528–535. https://doi.org/10.1590/S0004-282X2011000400023

    Article  PubMed  Google Scholar 

  29. Stranding S (2016) Gray’s anatomy, 41st edn. Elsevier Limited, Edingburgh

    Google Scholar 

  30. Suzuki S (1979) Angiographic aspects of anomalies of vertebral artery. Rinsho Hoshasen 24:3–14

    PubMed  CAS  Google Scholar 

  31. Takasato Y, Hayashi H, Kobayashi T, Hashimoto Y (1992) Duplicated origin of right vertebral artery with rudimentary and accessory left vertebral arteries. Neuroradiol 34(4):287–289. https://doi.org/10.1007/BF00588183

    Article  CAS  Google Scholar 

  32. Tasiou A, Giannis T, Brotis AG, Siasios I, Georgiadis I, Gatos H, Tsianaka E, Vagkopoulos K, Paterakis K, Fountas KN (2017) Anterior cervical spine surgery-associated complications in a retrospective case-control study. J Spine Surg 3(3):444. https://doi.org/10.21037/jss.2017.08.03

    Article  PubMed  PubMed Central  Google Scholar 

  33. Thanawala V, Dedhia J (2012) Stellate Ganglion Block Anaesth Tutor Week 256:1–7

    Google Scholar 

  34. Tubbs RS, Salter EG, Wellon JC III, Blount JP, Oakes WJ (2005) The triangle of the vertebral artery. Oper Neurosurg 2(56):252–255. https://doi.org/10.1227/01.NEU.0000156797.07395.15

    Article  Google Scholar 

  35. Vorster W, Du Plooy PT, Meiring JH (1998) Abnormal origin of internal thoracic and vertebral arteries. Clin Anat 11(1):33–37. https://doi.org/10.1002/(SICI)1098-2353(1998)11:1%3c33::AID-CA5%3e3.0.CO;2-T

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

The authors would like to thank the following individuals: Dr Alfred Musekiwa, senior lecturer in the Health Measurement Sciences division at the University of Pretoria specializing in biostatistics, for his contributions to the data analyses in this study. Ms Helene Biemond for her wonderful drawings and assistance.

Author information

Authors and Affiliations

Authors

Contributions

SG: protocol development, data collection, data analysis, manuscript writing. LP: project co-supervisor, manuscript editing. NK: project co-supervisor, manuscript editing, data analysis. AvS: project supervisor, project development, manuscript editing.

Corresponding author

Correspondence to Shavana Govender.

Ethics declarations

Conflict of interest

The above-mentioned authors certify that there are no financial gains or associations that may pose a conflict of interest in connection to this article.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Govender, S., Prigge, L., Keough, N. et al. A quantitative analysis of the dimensions and content of the vertebral triangle. Surg Radiol Anat 43, 881–888 (2021). https://doi.org/10.1007/s00276-020-02645-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00276-020-02645-x

Keyword

Navigation