High riding vertebral artery

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Rheumatoid arthritis RA might lead to atlantoaxial instability requiring transpedicular or transarticular fusion. High-riding vertebral artery HRVA puts patients at risk of injuring the vessel. However, to date, no relative risk RR has been calculated in order to quantitatively determine a true impact of RA as its risk factor. To the best of our knowledge, this is the first attempt to do so. RA patients were qualified into the exposed group group A , whereas non-RA subjects into the unexposed group group B. Risk of bias was explored by means of Newcastle-Ottawa Scale.

High riding vertebral artery

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Selective vertebral artery angiography revealed a focal dissection and occlusion of the midcervical vertebral artery at the C6 vertebral level with distal reconstitution by an ascending cervical artery Figure 4C. Short C2 isthmus height solid line. Annotations submission service.

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.

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. It angles posteriorly between longus colli medially and scalenus anterior laterally, through the colliscalene triangle , and behind the common carotid artery to enter the transverse foramen of C6. V2 ascends through the transverse foramina of the cervical vertebrae, normally C6-C3. Here it is accompanied by the vertebral veins and the sympathetic nerves.

High riding vertebral artery

Rheumatoid arthritis RA might lead to atlantoaxial instability requiring transpedicular or transarticular fusion. High-riding vertebral artery HRVA puts patients at risk of injuring the vessel. However, to date, no relative risk RR has been calculated in order to quantitatively determine a true impact of RA as its risk factor. To the best of our knowledge, this is the first attempt to do so. RA patients were qualified into the exposed group group A , whereas non-RA subjects into the unexposed group group B. Risk of bias was explored by means of Newcastle-Ottawa Scale. MOOSE checklist was followed to ensure correct structure.

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Results: The data from 20 studies with subjects sides were analyzed. Choose 2. An anterior cervical plate was applied C4—T1. Associated Data Data Availability Statement The data that support the findings of this study are available from the corresponding author, TK, upon reasonable request. Case 5: fenestration Case 5: fenestration. Therefore, combining the new information from the present study with already existing literature may further increase safety of the C1-C2 fusion and improve the overall outcome. In case of discrepancy, a senior neurosurgeon LS was called in so as to reach consensus. You can also search for this author in PubMed Google Scholar. For those with a HRVA in the subaxial group 31 sides of 26 patients , 9 sides had a laminar screw inserted, and in 22 sides no screw was inserted Table 3. A HRVA was found in 26 patients of 94 Google Scholar Download references. This weakens the findings of the meta-analysis highlighting the need for more studies. Fingerprint Dive into the research topics of 'Risk of vertebral artery injury: Comparison between C1-C2 transarticular and C2 pedicle screws'. Post-operative management following iatrogenic injury. The data that support the findings of this study are available from the corresponding author, TK, upon reasonable request.

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. Three hundred eighty-three consecutive cervical spine CT scans with potential screw insertion sites were analyzed independently by two trained observers.

Variation of the groove in the axis vertebra for the vertebral artery. Keywords: Atlantoaxial fusion; C2 isthmus; Craniocervical fusion; High-riding vertebral artery; Transarticular fusion; Transpedicular fixation; Vertebral artery anomaly. Methods: The clinical data of 12 patients with basilar invagination and atlantoaxial dislocation underwent atlantoaxial reduction and fixation in the Department of Neurosurgery, the First Affiliated Hospital of University of Science and Technology of China between January and November were retrospectively analyzed. The preoperative and postoperative JOA score and the main radiological measurements, including the anterior atlantodental interval ADI , the distance of the odontoid tip above the Chamberlain line, the clivus-canal angle, were collected and compared by paired t -test. The selected entry point was approximately 3 to 4 mm below the midpoint of the posterior edge of the superior articular surface and parallel to the superior articular surface or slightly downward. Thus, for patients with KFS, narrow C2 pedicles and HRVAs, choosing an appropriate and effective screw trajectory is difficult but necessary for a successful surgery. Anomalous vertebral arteries in the extra- and intraosseous regions of the craniovertebral junction visualized by 3-dimensional computed tomographic angiography: analysis of consecutive surgical cases and review of the literature. C2 pedicle erosion. Brisbane, Australia and Statistica Shane Tubbs, Mohammadali M. Topic Podcast. Failure to notice a high-riding vertebral artery preoperatively at the planning stage may lead to choosing a risky method of craniocervical fusion, ultimately ending up in injuring the VA, massive blood loss, and neurological deficits. Conclusions: Craniocervical fusion should be preceded by examination of the vertebral arteries at the level of C2 because the presence of HRVAs is common and might preclude the safe insertion of transarticular or transpedicular screws.