Mukesh Singla

Morphometric Analysis of Axis and Its Clinical Significance -An Anatomical Study of Indian Human Axis Vertebrae

BACKGROUND The atlas and axis vertebra have unique shape and complex relationship with vertebral artery. Fracture of dens of axis accounts for 7-27% of all cervical spine fractures, but surgeries in these regions are highly risky because of the reported incidences of vertebral artery injury. AIM AND OBJECTIVES The study was designed to measure morphometric data of human axis vertebra, of Indian origin. The different anatomical parameters on dry specimen of human axis vertebrae were established and the results were compared with other studies. MATERIALS AND METHODS Thirty intact human axis vertebrae were measured with digital vernier caliper and mini-inclinometer. Various linear and angular parameters of axis were observed. RESULTS The mean distance from the midline of body to the tip of transverse process of axis was 29.32 mm on right side and 29.06mm on left side. The mean distance from the midline of body to the lateral most edge of superior articulating facet was 22.8 mm on right side and 22.6 mm on left side. The mean value of anterior and posterior height of axis was 34.33±2.69mm and 30.56±2.78mm respectively. The anterior and posterior height of body of axis was 19.67 mm and 16.67mm respectively. Mean A-P and transverse diameter of inferior surface of axis was 15.42mm and 17.7mm respectively. Mean transverse diameter and mean A-P diameter of odontoid process was 9.32 mm and 10.1 mm respectively. Mean anterior and posterior height of the odontoid process was 14.66 mm and 13.89mm respectively. Mean of dens axis sagittal angle (angle between an axis that was imagined to pass longitudinally through the dens axis and the vertical line on a sagittal plane) was 13.23 degree. The shape of superior articulating facets of C2 varies from oval to circular. In the present study, 84% of SAF were oval and 16% were circular. Inferior articulating facets were circular in shape in 90% cases, and oval in 10% vertebra. Mean pedicle width was 10.07mm on right side and 10.52mm on left side. Mean transverse diameter of vertebral canal was 22.37±1.73mm. Mean of A-P diameter of vertebral canal at inlet was 18.31±2.05mm and mean of A-P diameter of vertebral canal at outlet was 14.84±1.63mm. CONCLUSION These results obtained from this study may be helpful for the surgeons in avoiding and minimizing complications such as vertebral artery injury, cranial nerve damage and injury to other vital structures while doing surgery around cranio-vertebral region.

Duplication of Optic Canal in Human Skulls

Abstract Duplication of optic canal is a rare anomaly. 194 Human skulls were collected from the Department of Anatomy, Subharti Medical College Meerut, LLRM Medical College Meerut and Seema Dental College Rishikesh. These skulls were of the age between 18-70 years and included both male and female skulls. Out of these, 5 skulls showed duplication of optic canal. 3 skulls showed bilateral duplication and 2 skulls showed unilateral duplication . It is important to know this anatomical variation during interventional procedures of optic canal and surrounding regions especially during endoscopic tumor removal and optic nerve decompression.

Transverse Cerebellar Diameter - A Marker for Estimation of Gestational Age

The cerebellum lies in the posterior cranial fossa. In the embryo, cerebellum appears at the end of fifth week. The cerebellum is easily visualized sonographically. Measurement and demonstration of fetal cerebellum is a new and unique parameter of fetal brain growth and also useful in assessing gestational age. The prospective study was carried out on 50 antenatal patients (20–40 years of age) between 14–40 weeks of pregnancy attending the clinic for routine ultrasound examination. Ultrosonographic measurement of Transverse cerebellar diameter (TCD) was done to assess the Gestational age. Mean TCD was 17.32 mm in 14–20 weeks of gestation, 26.63 mm in 21–30 weeks and 40.73mm in 31–40 weeks. Regression analysis indicates a significant relationship between TCD and gestational age, indicating that TCD is a good marker for estimation of gestional age.

Variations in the External Morphology of Gall Bladder

Abstract Variations of extrahepatic biliary tract are commonly encountered in surgery. Study was carried out to determine the external morphology of the gall bladder obtained from sixty embalmed cadavers. Differences in dimensions and shalie of the gall bladder, apart from other variations such as folded neck and folded fundus (Phrygian cap anomaly) were found. The variations are essentially due to aberration or arrest in normal embryological development. The growing importance of such variations, lie not only from the point of biliary disease but also with respect to the various invasive techniques in the treatment of gallbladder and extrahepatic bile duct disease.

Classification and Fascicular Analysis of Variant Branching Pattern of Femoral Nerve for Microsurgical Intervention: A Series of Thirteen Cadavers

La neuropatia femoral asociada con el miembro inferior es tratada por intervencion quirurgica a traves de activacion, regeneracion e injerto de fibras nerviosas mediante un implante de electrodo de manguito de nervios o neuro-protesis. Estos procedimientos requieren un conocimiento detallado y preciso de las variantes neuro-anatomicas del nervio femoral y su anatomia fascicular de modo que la lesion del nervio pueda ser investigada y tratada de manera mas eficiente. El objetivo del estudio fue descubrir las variaciones tanto en el nervio femoral y sus ramas y clasificarlos a partir de la anatomia fascicular utilizando una hipotesis basada en el principio de la continuidad y trazabilidad de los fasciculos correspondientes. El estudio se llevo a cabo en el Departamento de Anatomia AIIMS Rishikesh utilizando 13 miembros inferiores pareados (26 nervios femorales) de 13 cadaveres. El nervio femoral se expuso en el triangulo femoral y fue trazado en la pared abdominal posterior. Se analizaron las variaciones en la forma, tamano y trayecto del nervio femoral y sus ramas. El patron fascicular fue conceptulizado de acuerdo a la hipotesis planteada. Se detectaron anomalias clasificadas en: siete clases, division alta, anomalias de tronco, semi-dispersos, patron de ramificacion dispersa, pectocutaneo, nervio cutaneo lateral y nervio del musculo sartorio. Las clasificaciones junto con el patron fascicular correspondientes seran de gran utilidad para los neurocirujanos, radiologos, anestesistas y anatomistas en el diagnostico y tratamiento de la neuropatia femoral.

Anatomy of posterior cruciate ligament retained in a posterior cruciate ligament retaining total knee replacement: a cadaveric study

Background: Recent evidence has highlighted a risk that the majority of posterior cruciate ligament (PCL) is removed while making bone cuts in tibia and femur during total knee replacement surgery. Aim of this cadaveric study is to calculate how much PCL footprint is retained in a PCL retaining prosthesis after routine tibial and femoral cuts are made. Methods: Twelve paired formalin-fixed Indian cadaveric knees were studied. Knees were disarticulated and all soft tissues were circumferentially removed from the tibia and femur. Footprints of antero-lateral and postero-medial bundles were marked on tibia and femur. Proximal tibial and distal femoral cuts were made using standard cutting jigs (Zimmer NexGen LPS). Digital photographs were taken with a magnification marker attached on the bone before and after making the cuts. Area of PCL insertion before and after the bone cuts was measured using software ImageJ (National Institute of Health). Results: Footprint on tibial side was reduced by 9.1%, and on femoral side by 21.8%. Footprint of AL bundle was reduced by 24.3% on the tibial side and by 15.3% on the femoral side. Footprint of PM bundle on tibia was not affected by the bone cut but was reduced by 18.5% on the femoral side. Conclusion: Tibial and femoral insertions of PCL are relatively well preserved after bone cuts are made in a posterior cruciate retaining TKR. There is differential sectioning of antero-lateral and postero-medial bundles of PCL on tibial and femoral sides.

A study on the morphometric asymmetry of atlas

The commonly used examination procedures of the upper cervical spine depend upon the symmetry for comparison and interpretation of joint functions. If symmetry is not normal, then these assessments may mislead the examiners, allowing them implementation of incorrect treatment plans. Objectives of this study are to explore the possibility that asymmetry is more common than symmetry and, if it is true, to find out the effects of asymmetry on the biomechanics of these joints. The study was carried out on 30 atlas vertebrae of cadavers of Indian origin. The different intra-atlas distances were measured on both sides by digital vernier calliper. All the parameters studied showed statistically significant differences between the right and left side i.e. a p value of < 0.05. The antero-posterior diameter of the foramen transversarium, the transverse diameter of the foramen transversarium, the distance from the midline to medial edge of the vertebral artery groove (inner as well as outer cortex) and the length of the superior articular facets were more on the right side as compared to the left side. The breadth as well as the length of the inferior articular facet, the breadth of the superior articular facet and the difference of posterior arch thickness at the site of vertebral artery groove were more on the left side as compared to the right side. These differences may be explained by the handedness of an individual, which influences the intra-osteal asymmetry in a characteristically distinct manner, which needs to be confirmed or refuted in a further study.

Mini Inclinometer: A New Cost Effective and Simple Device to Measure Small Angles

Measurement of different angles of articular surface, their inclination in different cardinal planes and angles formed at bifurcation of arteries is of utmost importance for various surgical and orthopedic procedures. The present work is an attempt to develop an instrument to measure the angle of inclinations of small articular surfaces.