High riding vertebral artery

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High riding vertebral artery

Jin S. Yeom , Jacob M. Background context: To our knowledge, no large series comparing the risk of vertebral artery injury by C1-C2 transarticular screw versus C2 pedicle screw have been published. Purpose: To compare the risk of vertebral artery injury by C1-C2 transarticular screw versus C2 pedicle screw in an overall patient population and subsets of patients with a high-riding vertebral artery and a narrow pedicle using computed tomography CT scan images and three-dimensional 3D screw trajectory software. Study design: Radiographic analysis using CT scans. Patient sample: Computed tomography scans of consecutive patients, for a total of potential screw insertion sites for each type of screw. Outcome measures: Cortical perforation into the vertebral artery groove of C2 by a screw. Methods: We simulated the placement of 4. We then compared the frequency of C2 vertebral artery groove violation by the two different fixation methods. Results: There were 78 high-riding vertebral arteries Overall, 9. Conclusions: Overall, neither technique has more inherent anatomic risk of vertebral artery injury. However, in the presence of a high-riding vertebral artery, placement of a pedicle screw is significantly safer than the placement of a transarticular screw.

Close Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Although, a HRVA is more frequent in those with congenital skeletal anatomy [ 6 ]. Furthermore, screws have to possess high biomechanical strength to bear the shear force after atlantoaxial high riding vertebral artery [ 24 ].

Metrics details. A high-riding vertebral artery HRVA is an intraosseous anomaly that narrows the trajectory for C2 pedicle screws. The prevalence of a HRVA is high in patients who need surgery at the craniovertebral junction, but reports about HRVAs in subaxial cervical spine disorders are limited. We sought to determine the prevalence of HRVAs among patients with subaxial cervical spine disorders to elucidate the potential risk for VA injury in subaxial cervical spine surgery. We included patients, 94 were with a main lesion from C3 to C7 subaxial group and were with a main lesion from T1 to L5 thoracolumbar group. The sex, age of patients, body mass index BMI , osteoarthritis of the atlantoaxial C facet joints, and prevalence of a HRVA in the 2 groups were compared and logistic regression was used to identify the factors correlated with a HRVA.

Its reported prevalence has varied widely. If overlooked during the approach for craniocervical fusion, injury to the vertebral arteries can occur, affecting the outcome. The present meta-analysis aimed to provide the pooled prevalence of HRVAs. Methods: A comprehensive database search was conducted by 3 of us. Peer-reviewed studies that had followed the strict definition for HRVAs and had reported its prevalence were included. The risk of bias was assessed using the anatomical quality assessment tool.

High riding vertebral artery

At the time the article was last revised Rohit Sharma had no financial relationships to ineligible companies to disclose. The vertebral arteries VA are paired arteries, each arising from the respective subclavian artery and ascending in the neck to supply the posterior fossa and occipital lobes, as well as provide segmental vertebral and spinal column blood supply. The origin of the vertebral arteries is usually from the posterior superior part of the subclavian arteries bilaterally, although the origin can be variable:. When the origin is from the arch, then it is common for the artery to enter the foramen transversarium at a level higher than normal C5 instead of C6. Rarely, the right vertebral artery can have an aberrant origin distal to the left subclavian; see vertebral arteria lusoria. The vertebral artery is typically divided into 4 segments :. Also known as the extraosseous segment, V1 arises from the first part of the subclavian artery.

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Klepinowski et al. A forest plot of the analyzed studies indicating that rheumatoid arthritis is a risk factor for high-riding vertebral artery. We were unable to conclude whether an acquired factor or a congenital factor is of more importance in forming of a HRVA, and a HRVA could have both an acquired and a congenital nature. Identification of HRVA is crucial before approaching craniocervical junction fusion, as it determines a surgical method [ 8 ]. At the time the article was last revised Rohit Sharma had no financial relationships to ineligible companies to disclose. The length of the subfacetal screws was View author publications. To check for normality, a Shapiro-Wilk test was used. Meta-analysis was conducted by means of MetaXL 5. In particular, PSs for the axis C2 PSs have been used more frequently because they are the most feasible and reliable anchor for posterior instrumentation surgery in the cervical spine. Accepted : 06 November Conflict of interest The authors declare that they have no conflict of interest.

High-riding vertebral artery HRVA and narrow C2 pedicles C2P pose a great risk of injuring the vessel during C2 pedicle or transarticular screw placement. Recent meta-analysis revealed a paucity of European studies regarding measurements and prevalence of these anatomical variants.

We analyzed the medical records of consecutive patients who underwent subaxial cervical spine surgery subaxial group and who underwent myelography for thoracolumbar disorders thoracolumbar group at our institute from December to June Final control angiography demonstrated patency of the left vertebral artery with anterograde flow to the basilar and distal obliteration of the right vertebrovenous fistula Figure 4I. View full fingerprint. In the latter case, please turn on Javascript support in your web browser and reload this page. Surgical techniques to control hemorrhage see Techniques. VAI is a known potential complication of cervical spine surgery. Search Search by keyword or author Search. Sorry, a shareable link is not currently available for this article. Vanek et al. Bone fusion was observed using follow-up CT.