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Davidoiu AM, Rusu MC, Toader C, Rădoi PM. A Prevalence Anatomic-Imaging Study of the Posterior Inferior Cerebellar Artery's Origin. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1397. [PMID: 39336438 PMCID: PMC11434308 DOI: 10.3390/medicina60091397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Revised: 08/22/2024] [Accepted: 08/25/2024] [Indexed: 09/30/2024]
Abstract
Background and Objectives: Typically, the vertebral arteries (VAs) enter the posterior fossa through dural rings and further unite, forming the basilar artery. The posterior inferior cerebellar artery (PICA) is usually a branch of the V4 segment of the VA (intradural origin). It may also leave the V3 suboccipital segment of the VA (extradural origin). The transdural origin of the PICA within the VA's dural ring has been consistently overlooked. A study was designed to determine the topographical patterns of the PICA's origin. Materials and Methods: Determinations were performed in a retrospective sample of 225 computed tomography angiograms. Four types of PICA origin were documented: type 0, absent PICA; type 1, the extradural origin of the PICA from the V3 segment of the VA; type 2, the transdural origin of the PICA within the dural ring; and type 3, the intradural origin of the PICA from the V4 segment of the VA. The bilateral symmetry of types was also investigated. Results: Out of 450 VAs, type 0 (absent PICA) was found in 36%, type 1 (extradural) in 0.44%, type 2 (transdural) in 5.56%, and typical type 3 in just 58%. In types 1 and 2, the PICA entered the posterior fossa through the dural ring and the marginal sinus. In the overall group (N = 225), the type combinations 1_1, 1_2 and 1_3 were not found. Bilaterally absent PICAs occurred in 18.67%. The bilateral combinations 0_1/0_2/0_3/2_2/2_3/3_3 were found, respectively, in 0.89%/3.11%/30.67%/1.78%/4.44%/40.44%. Four of the seventy-eight PICAs opposite to an absent one, three intradural and one transdural, were true bihemispheric PICAs. Conclusions: The PICAs with extradural or transdural origins are facultative contents of the dural ring and are at risk during neurosurgical approaches in the foramen magnum. Rare bihemispheric PICAs could originate either intradurally or within the dural ring.
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Affiliation(s)
- Ana-Maria Davidoiu
- Doctoral School, Faculty of Medicine, "Victor Babeş" University of Medicine and Pharmacy, RO-300041 Timişoara, Romania
| | - Mugurel Constantin Rusu
- Department 1, Division of Anatomy, Faculty of Dentistry, "Carol Davila" University of Medicine and Pharmacy, RO-020021 Bucharest, Romania
| | - Corneliu Toader
- Department 6-Clinical Neurosciences, Division of Neurosurgery, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, RO-020021 Bucharest, Romania
- Clinic of Neurosurgery, "Dr. Bagdasar-Arseni" Emergency Clinical Hospital, RO-041915 Bucharest, Romania
| | - Petrinel Mugurel Rădoi
- Department 6-Clinical Neurosciences, Division of Neurosurgery, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, RO-020021 Bucharest, Romania
- Clinic of Neurosurgery, "Dr. Bagdasar-Arseni" Emergency Clinical Hospital, RO-041915 Bucharest, Romania
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Tang C, Wen X, Zhang Y, Liao YH, Huang XM, Tang Q, Qiu H, Yang SZ, Zhong DJ, Chu TW. Unilateral high-riding vertebral artery is associated with asymmetric morphological changes of the atlantoaxial joint: a novel risk factor for atlantoaxial osteoarthritis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:2322-2331. [PMID: 38676728 DOI: 10.1007/s00586-024-08285-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/10/2024] [Accepted: 04/18/2024] [Indexed: 04/29/2024]
Abstract
PURPOSE This study aimed to investigate the association between unilateral high-riding vertebral artery (HRVA) and morphological changes in the atlantoaxial joint (AAJ) and to determine whether unilateral HRVA is a risk factor for atlantoaxial osteoarthritis (AAOA). METHODS We conducted a retrospective analysis of 2496 patients admitted to our medical center between January 2020 and December 2022 who underwent CT imaging of the cervical spine. Two hundred and seventy-two patients with unilateral HRVA (HRVA group) were identified and a respective 2:1 age- and sex-matched control group without HRVA was built. Morphological parameters, including C2 lateral mass settlement (C2 LMS), C1/2 coronal inclination (C1/2 CI), lateral atlanto-dental interval (LADI), and C1/2 relative rotation angle (C1/2 RRA) were measured. The degree of AAOA was recorded. Risk factors associated with AAOA were identified using univariate and multivariable logistic regression analyses. RESULTS The study included 61.4% women, and the overall average age of the study population was 48.7 years. The morphological parameters (C2 LMS, C1/2 CI, and LADI) in AAJ were asymmetric between the HRVA and the non-HRVA sides in the HRVA group (p < 0.001). These differences in parameters (d-C2 LMS, d-C1/2 CI, and d-LADI) between the HRVA and the non-HRVA sides, and C1/2 RRA were significantly larger than those in the control group. Eighty-three of 816 patients (10.2%) with AAOA had larger values of d-C2 LMS, d-C1/2 CI, d-LADI, and C1/2 RRA compared with the patients without AAOA (p < 0.05). The multivariable logistic regression analysis indicated that unilateral HRVA [adjusted odds ratio (OR) = 2.6, 95% CI: 1.1-6.3, p = 0.029], age in the sixth decade or older (adjusted OR = 30.2, 95% CI: 16.1-56.9, p < 0.001), women (adjusted OR = 2.1, 95% CI: 1.0-5.6, P = 0.034) were independent risk factors for AAOA. CONCLUSION Unilateral HRVA was associated with asymmetric morphological changes of nonuniform settlement of C2 lateral mass, lateral slip of atlas, and atlantoaxial rotation displacement. Besides age ≥ 60 years and females, unilateral HRVA is an independent risk factor for AAOA.
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Affiliation(s)
- Chao Tang
- Department of Orthopedics, The Second Affiliated Hospital (Xinqiao Hospital) of Army Medical University, No. 83, Xinqiao Main Street, Chongqing, China
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Luzhou, China
| | - Xuan Wen
- Department of Orthopedics, The Second Affiliated Hospital (Xinqiao Hospital) of Army Medical University, No. 83, Xinqiao Main Street, Chongqing, China
| | - Ying Zhang
- Department of Orthopedics, The Second Affiliated Hospital (Xinqiao Hospital) of Army Medical University, No. 83, Xinqiao Main Street, Chongqing, China
| | - Ye Hui Liao
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Luzhou, China
| | - Xian Ming Huang
- Department of Orthopedics, The Second Affiliated Hospital (Xinqiao Hospital) of Army Medical University, No. 83, Xinqiao Main Street, Chongqing, China
| | - Qiang Tang
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Luzhou, China
| | - Hao Qiu
- Department of Orthopedics, The Second Affiliated Hospital (Xinqiao Hospital) of Army Medical University, No. 83, Xinqiao Main Street, Chongqing, China
| | - Si Zhen Yang
- Department of Orthopedics, The Second Affiliated Hospital (Xinqiao Hospital) of Army Medical University, No. 83, Xinqiao Main Street, Chongqing, China
| | - De Jun Zhong
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Luzhou, China.
| | - Tong Wei Chu
- Department of Orthopedics, The Second Affiliated Hospital (Xinqiao Hospital) of Army Medical University, No. 83, Xinqiao Main Street, Chongqing, China.
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Miao XZ, Xu Z, Zhu FK, Hu H, Liu Y, Yang JS, Yan ZJ, Deng ZL, Chu L, Shi L. Unilateral Biplanar Screw-Rod Fixation Technique for the Treatment of Odontoid Fractures in Patients with Atlantoaxial Bone or Vascular Abnormalities. World Neurosurg 2024; 186:e173-e180. [PMID: 38537785 DOI: 10.1016/j.wneu.2024.03.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 03/18/2024] [Indexed: 04/20/2024]
Abstract
OBJETIVE This study aims to introduce the unilateral biplanar screw-rod fixation (UBSF) technique (a hybrid fixation technique: 2 sets of atlantoaxial screws were placed on the same side), which serves as a salvage method for traditional posterior atlantoaxial fixation. To summarize the indications of this technique and to assess its safety, feasibility, and clinical effectiveness in the treatment of odontoid fractures. METHODS Patients with odontoid fractures were enrolled according to special criteria. Surgical duration and intraoperative blood loss were documented. Patients were followed up for a minimum of 12 months. X-ray and computerized tomography scans were conducted and reviewed at 1 day, and patients were asked to return for computerized tomography reviews at 3, 6, 9, and 12 months after surgery until fracture union. Recorded and compared the Neck Visual Analog Scale and Neck Disability Index presurgery and at 1 week and 12 months postsurgery. RESULTS Between January 2016 and December 2022, our study enrolled 7 patients who were diagnosed with odontoid fractures accompanied by atlantoaxial bone or vascular abnormalities. All 7 patients underwent successful UBSF surgery, and no neurovascular injuries were recorded during surgery. Fracture union was observed in all patients, and the Neck Visual Analog Scale and Neck Disability Index scores improved significantly at 1 week and 12 months postoperative (P < 0.01). CONCLUSIONS The UBSF technique has been demonstrated to be safe, feasible, and effective in treating odontoid fractures. In cases where the atlantoaxial bone or vascular structure exhibits abnormalities, it can function as a supplementary or alternative approach to the conventional posterior C1-2 fixation.
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Affiliation(s)
- Xi-Zi Miao
- Department of Orthopaedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhou Xu
- Department of Orthopaedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China; Department of Orthopaedics, The Ninth People's hospital of Chongqing, Chongqing, China
| | - Fu-Kuan Zhu
- Department of Orthopaedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hao Hu
- Department of Orthopaedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yu Liu
- Chongqing Medical and Pharmaceutical College, Chongqing, China
| | - Jun-Song Yang
- Department of Orthopaedics, Hong Hui Hospital of Xi'an, Xi'an, China
| | - Zheng-Jian Yan
- Department of Orthopaedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China; Geriatric Clinical Research Center of Chongqing, Chongqing, China
| | - Zhong-Liang Deng
- Department of Orthopaedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China; Geriatric Clinical Research Center of Chongqing, Chongqing, China
| | - Lei Chu
- Department of Orthopaedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China; Geriatric Clinical Research Center of Chongqing, Chongqing, China
| | - Lei Shi
- Department of Orthopaedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China; Geriatric Clinical Research Center of Chongqing, Chongqing, China.
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Zhou LP, Zhang RJ, Zhang HQ, Jiang ZF, Shang J, Shen CL. Effect of High-Riding Vertebral Artery on the Accuracy and Safety of C2 Pedicle Screw Placement in Basilar Invagination and Related Risk Factors. Global Spine J 2024; 14:458-469. [PMID: 35719094 PMCID: PMC10802529 DOI: 10.1177/21925682221110180] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To investigate the effect of HRVA on the intrapedicular accuracy of C2PS placement through the freehand method in patients with BI and analyse the possible risk factors for C2PS malpositioning. METHOD A total of 91 consecutive patients with BI who received 174 unilateral C2PS placements through the freehand method were retrospectively included. The unilateral pedicles were assigned to the HRVA and non-HRVA groups. The primary outcome was the intrapedicular accuracy of C2PS placement in accordance with the Gertzbein-Robbins scale. Moreover, the risk factors that possibly affected intrapedicular accuracy were assessed. RESULTS The rate of intrapedicular accuracy in C2PS placement in patients with BI was 23.6%. Results showed that the non-HRVA group had remarkably higher rates of optimal and clinically acceptable C2PS placement than the HRVA group. Nevertheless, the HRVA group exhibited similar results for grade B classification as the non-HRVA group. Moreover, in the HRVA and non-HRVA groups, the most common direction of screw deviations was the lateral direction. Furthermore, the multivariate analyses showed that the obliquity of the lateral atlantoaxial joint in the sagittal plane ≥15°, and that in the coronal plane ≥ 20°, isthmus height < 4.3 mm, and distance from the skin to the spinous process ≥ 2.8 cm independently contributed to a high rate of screw malpositioning in BI patients. CONCLUSION The presence of HRVA in BI patients contributed to the high rate of malpositioning in C2PS placement via the freehand method. However, the rates of intrapedicular accuracy in patients with BI with and without HRVA were considerably low.
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Affiliation(s)
- Lu-Ping Zhou
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Ren-Jie Zhang
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Hua-Qing Zhang
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhen-Fei Jiang
- Department of Orthopedics, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Jin Shang
- Department of Radiology, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Cai-Liang Shen
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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Omotoso BR, Harrichandparsad R, Lazarus L. Prevalence of anatomical variations at the suboccipital (V3) segment of the vertebral artery: a systematic review. Neuroradiology 2023; 65:1677-1684. [PMID: 37878031 PMCID: PMC10654174 DOI: 10.1007/s00234-023-03223-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 09/12/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND AND OBJECTIVE A recent meta-analysis on the incidence of iatrogenic injury to the VA has revealed that patients with variant anatomy are more prone to iatrogenic injury. Therefore, this review is designed to investigate the incidence of variations in the suboccipital component of the vertebral artery in different population groups according to the available literature. METHODS This systematic review was conducted according to PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The review is based on a comprehensive and extensive search of PubMed, Google Scholar, and ResearchGate. The following search terms were used: "vertebral artery" AND "suboccipital segment" AND "anomalies/anatomical variations of the V3 segment." Reference lists of all extracted articles were also extensively searched for references to any further relevant publications. RESULTS A total of 17 papers met the inclusion criteria. The 17 studies corresponded to a total of 10,820 patients. A persistent first intersegmental artery was registered in 1.8% (197 out of 10,820) of the patients. Extradural PICA origin was observed in 1.6% (175 out of 10,820) of the patients. Fenestration was detected in 0.7% (72 out of 10,820) of the patients. CONCLUSION The authors summarize the incidence of vascular variation at the suboccipital segment of the VA in different population groups across the Asian, European, American, and African continents. Awareness of the extent of possible anatomical variation will help interpret radiographs, which will enhance the identification of vascular pathologies and reduce the risk of iatrogenic injury.
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Affiliation(s)
- Bukola R Omotoso
- Discipline of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Westville Campus, Private Bag X54001, Durban, 4000, South Africa.
| | - Rohen Harrichandparsad
- Department of Neurosurgery, School of Clinical Medicine, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Lelika Lazarus
- Discipline of Clinical Anatomy, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Westville Campus, Private Bag X54001, Durban, 4000, South Africa
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Tang C, Liao YH, Wang Q, Tang Q, Ma F, Cai CH, Xu SC, Leng YB, Chu TW, Zhong DJ. The association between unilateral high-riding vertebral artery and atlantoaxial joint morphology: a multi-slice spiral computed tomography study of 396 patients and a finite element analysis. Spine J 2023; 23:1054-1067. [PMID: 36868381 DOI: 10.1016/j.spinee.2023.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/14/2023] [Accepted: 02/23/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND CONTEXT A high-riding vertebral artery (HRVA) can deviate too medially, too posteriorly, or too superiorly to allow the safe insertion of screws. However, it is unknown whether the presence of a HRVA is associated with morphological changes of the atlantoaxial joint. PURPOSE To investigate the association between HRVA and atlantoaxial joint morphology in patients with and without HRVA. STUDY DESIGN A retrospective case-control study and finite element (FE) analysis. PATIENT SAMPLE A total of 396 patients with cervical spondylosis underwent multi-slice spiral computed tomography (MSCT) of cervical spine at our institutions from 2020 to 2022. OUTCOME MEASURES A series of atlantoaxial joint morphological parameters, including C2 lateral mass settlement (C2 LMS), C1-2 sagittal joint inclination (C1-2 SI), C1-2 coronal joint inclination (C1-2 CI), atlanto-dental interval (ADI), lateral atlanto-dental interval (LADI), and C1-2 relative rotation angle (C1-2 RRA) were measured, and lateral atlantoaxial joints osteoarthritis (LAJs-OA) was recorded. The stress distribution on the C2 facet surface under different torques of flexion-extension, lateral bending, and axial rotation was analyzed by FE models. A 2-Nm moment was applied to all models to determine the range of motion (ROM). METHODS A total of 132 consecutive cervical spondylosis patients with unilateral HRVA were enrolled in the HRVA group, and 264 patients without HRVA matched for age and sex were enrolled in the normal (NL) group. Atlantoaxial joint morphological parameters were compared between two sides of C2 lateral mass within HRVA or NL group, and between HRVA and NL groups. A 48-year-old woman with cervical spondylosis without HRVA was selected for cervical MSCT. A three-dimensional (3D) FE intact model of the normal upper cervical spine (C0-C2) was created. We established the HRVA model by simulating atlantoaxial morphological changes of unilateral HRVA with FE method. RESULTS The C2 LMS was significantly smaller on the HRVA side than that on the non-HRVA side in the HRVA group, but C1-2 SI, C1-2 CI, and LADI on HRVA side were significantly larger than those on non-HRVA side. There was no significant difference between left and right sides in the NL group. The difference in C2 LMS (d-C2 LMS) between HRVA side and non-HRVA side in the HRVA group was larger than that in the NL group (P < 0.05). Meanwhile, the differences in C1-2 SI (d-C1/2 SI), C1-2 CI (d-C1/2 CI), and LADI (d-LADI) in the HRVA group were significantly larger than those in the NL group. The C1-2 RRA in the HRVA group was significantly larger than that in the NL group. Pearson correlations showed that d-C1/2 SI, d-C1/2 CI, and d-LADI were positively associated with d-C2 LMS (r=0.428, 0.649, 0.498, respectively, p<.05 for all). The incidence of LAJs-OA in the HRVA group (27.3%) was significantly larger than that in the NL group (11.7%). Compared with the normal model, the ROM of C1-2 segment declined in all postures of the HRVA FE model. We found a larger distribution of stress on the C2 lateral mass surface of the HRVA side under different moment conditions. CONCLUSIONS We suggest that HRVA affects the integrity of the C2 lateral mass. This change in patients with unilateral HRVA is associated with the nonuniform settlement of the lateral mass and an increase in the lateral mass inclination, which may further affect the degeneration of the atlantoaxial joint because of the stress concentration on the C2 lateral mass surface.
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Affiliation(s)
- Chao Tang
- Department of Orthopedics, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing city, China; Department of Orthopedics, Affiliated Hospital of Southwest Medical University, Luzhou city, Sichuan province, China
| | - Ye Hui Liao
- Department of Orthopedics, Affiliated Hospital of Southwest Medical University, Luzhou city, Sichuan province, China
| | - Qing Wang
- Department of Orthopedics, Affiliated Hospital of Southwest Medical University, Luzhou city, Sichuan province, China
| | - Qiang Tang
- Department of Orthopedics, Affiliated Hospital of Southwest Medical University, Luzhou city, Sichuan province, China
| | - Fei Ma
- Department of Orthopedics, Affiliated Hospital of Southwest Medical University, Luzhou city, Sichuan province, China
| | - Chen Hui Cai
- Department of Orthopedics, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing city, China
| | - Shi Cai Xu
- Department of Orthopedics, Affiliated Hospital of Southwest Medical University, Luzhou city, Sichuan province, China
| | - Ye Bo Leng
- Department of Orthopedics, Affiliated Hospital of Southwest Medical University, Luzhou city, Sichuan province, China
| | - Tong Wei Chu
- Department of Orthopedics, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing city, China.
| | - De Jun Zhong
- Department of Orthopedics, Affiliated Hospital of Southwest Medical University, Luzhou city, Sichuan province, China.
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He Q, Cao J, Tian H, Chen B, Fan X, Wang S, Zhao Y, Wei J, Nie L, Pan X, Cheng L. The Classification of Axial Deformity in Patients with Basilar Invagination. Orthop Surg 2022; 14:3150-3158. [PMID: 36222216 PMCID: PMC9732616 DOI: 10.1111/os.13487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 07/21/2022] [Accepted: 08/10/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To summarize the variation types of the axis in patients with basilar invagination (BI), then propose a classification scheme of the axis deformity. METHODS From December 2013 to September 2020, 92 patients (male 42, female 50) who were diagnosed with BI were studied retrospectively. Based on the imaging data of CT, the width and height of the axis pedicle and the sagittal diameter of the lateral mass were measured in each patient. According to the development of axis pedicle and lateral mass, the types of axis variation were summarized, and then the classification scheme of axis deformity was put forward. RESULTS All cases were analyzed and axis deformities were divided into four types. Type I: the axis is basically normal (53 cases, 57.6%). Type II: axis lateral mass is dysplasia (eight cases, 8.7%), which includes two subtypes: type IIA, the axis unilateral lateral mass is dysplasia (three cases); type IIB, the axis bilateral lateral masses are all dysplasia (five cases). Type III: axis pedicle is dysplasia (11 cases, 12%), which is subdivided into two subtypes: type IIIA, the axis unilateral pedicle is dysplasia (six cases); type IIIB, the axis bilateral pedicles are all dysplasia (five cases). Type IV: axis pedicle and lateral mass are all dysplasia (20 cases, 21.7%), this type contains the following four subtypes: type IVA, the unilateral axis pedicle and unilateral lateral mass (contralateral or ipsilateral) are all hypoplasia (four cases); type IVB, the unilateral axis pedicle and bilateral lateral masses are all hypoplasia (five cases); type IVC, the bilateral axis pedicles and unilateral lateral mass are all dysplasia (seven cases); type IVD, the bilateral axis pedicles and bilateral lateral masses are all dysplasia (four cases). The left and right abnormal lateral mass sagittal diameter (Type II) was (7.23 ± 1.39) mm and (5.96 ± 1.37) mm, respectively, the left and right abnormal pedicle width (Type III) was (2.61 ± 1.01) mm and (3.23 ± 0.66) mm, respectively, left and right abnormal pedicle height (Type III) was (5.43 ± 2.19) mm and (4.92 ± 1.76) mm, respectively. Moreover, the classification scheme has good repeatability and credibility. CONCLUSIONS The classification about axis deformity could provide personalized guidance for axis screw placement in the BI and other upper cervical surgery, and axis screw placement errors would be effectively avoided.
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Affiliation(s)
- Qiting He
- Department of Orthopedic Surgery, Qilu Hospital of Shandong University, Cheeloo College of MedicineShandong UniversityJinanChina
| | - Jiankang Cao
- Department of Pain, Qilu Hospital of Shandong University, Cheeloo College of MedicineShandong UniversityJinanChina
| | - Huichao Tian
- Department of Orthopedic SurgeryLiaocheng People's HospitalLiaochengChina
| | - Bin Chen
- Department of Orthopedic Surgery, Qilu Hospital of Shandong University, Cheeloo College of MedicineShandong UniversityJinanChina
| | - Xincheng Fan
- Department of Orthopedic Surgery, Qilu Hospital of Shandong University, Cheeloo College of MedicineShandong UniversityJinanChina,Department of Orthopedic SurgeryTaian City Central HospitalTaianChina
| | - Shaoyi Wang
- Department of Orthopedic Surgery, Qilu Hospital of Shandong University, Cheeloo College of MedicineShandong UniversityJinanChina
| | - Yunpeng Zhao
- Department of Orthopedic Surgery, Qilu Hospital of Shandong University, Cheeloo College of MedicineShandong UniversityJinanChina
| | - Jianlu Wei
- Department of Orthopedic Surgery, Qilu Hospital of Shandong University, Cheeloo College of MedicineShandong UniversityJinanChina
| | - Lin Nie
- Department of Orthopedic Surgery, Qilu Hospital of Shandong University, Cheeloo College of MedicineShandong UniversityJinanChina
| | - Xin Pan
- Department of Orthopedic Surgery, Qilu Hospital of Shandong University, Cheeloo College of MedicineShandong UniversityJinanChina
| | - Lei Cheng
- Department of Orthopedic Surgery, Qilu Hospital of Shandong University, Cheeloo College of MedicineShandong UniversityJinanChina
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Najmuddin M. Prevalence of ponticulus posticus on the posterior arch of the atlas in symptomatic and asymptomatic patients. Oral Radiol 2022; 38:527-533. [PMID: 35088221 DOI: 10.1007/s11282-021-00583-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 12/16/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To calculate the prevalence of ponticulus posticus and its association with headache. METHODS The presence and types of ponticulus posticus were investigated on 640 digital lateral cephalograms. Patients with complete or partial ponticulus posticus were further evaluated and questioned for a history of cervicogenic headache. Dissemination of attain values was analyzed using a Chi-Square test, and p values < 0.05 were considered statistically significant. RESULTS The prevalence of ponticulus posticus in our study was 9.8%, with complete form in 45 (7%) patients of which 29 (64.5%) were male and 16 (35.5%) were female. Partial ponticulus posticus was found in 18 (2.8%) of patients, of which 12 (66.6%) patients were male and six (33.33%) were female. In patients with the complete form of ponticulus posticus, 37 (82.22%) were symptomatic. Among these 37 patients, 22 (59.45%) were male and 15 (40.54%) were female. In complete ponticulus posticus patients, symptoms were slightly worse in males than females. Whereas in partial ponticulus posticus, 13 (72.22%) patients were found to be symptomatic. Of these 13 patients, seven (53.84%) were male and six (46.15%) were female. Of the 72 patients with a history of cervical pain, 50 (69.44%) showed ponticulus posticus on a lateral cephalogram. Of the 568 patients with no history of cervical pain, only 13 (2.2%) showed ponticulus posticus on the lateral cephalogram. CONCLUSION This study examination showed that ponticulus posticus is a common anatomic variation often associated with tension-type headaches.
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Affiliation(s)
- Mohammed Najmuddin
- Department of Maxillofacial Dental Sciences, College of Dentistry, Jazan University, Jazan, Kingdom of Saudi Arabia.
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Zhou LP, Zhang RJ, Jiang ZF, Tao EX, Shang J, Shen CL. Ideal entry point and trajectory for C2 pedicle screw placement in basilar invagination patients with high-riding vertebral artery based on 3D computed tomography. Spine J 2022; 22:1281-1291. [PMID: 35508287 DOI: 10.1016/j.spinee.2022.04.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 04/10/2022] [Accepted: 04/26/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND C2 pedicle screw placement in patients with basilar invagination (BI) is fraught with risks because of a high incidence of anatomical variations and high-riding vertebral artery (HRVA). However, no study can be found in the literature that attempted to identify the ideal entry point and trajectory through the C2 pedicle in BI patients with HRVA. PURPOSE To investigate the parameters of ideal entry point and trajectory for C2 pedicle screw placement in BI patients with HRVA and compare them with those in BI patients without HRVA and patients without BI as control. These parameters would serve as a guide to pedicle screw placement. STUDY DESIGN A retrospective comparative study. PATIENT SAMPLE A total of 396 patients (198 consecutive BI patients and 198 matched patients without BI as control) and 792 unilateral pedicles from April 2017 to October 2021 at two medical centers were included. OUTCOME MEASURES The insertion parameters of mediolateral angle, surface distance, cephalad angle, and vertical distance from the superior border of the lamina were the primary outcome measures for the reference of C2 pedicle screw placement. Furthermore, factors that affect the primary insertion parameters were assessed via multiple linear regression analyses. METHOD According to the diagnosis of BI and HRVA, the unilateral pedicles were assigned into HRVA of BI, non-HRVA of BI, HRVA of control, and non-HRVA of control groups. Subgroup analyses based on Goel types A and B were also performed. Moreover, vertebral artery (VA) anomalies that might result in potentially serious complications were identified and systematically compared. RESULTS The measurements of insertion parameters in BI patients with HRVA indicated a mean mediolateral angle of 27.42°, a mean cephalad angle of 43.02°, a mean surface distance of 9.74 mm, and a mean vertical distance from the superior border of the lamina of 3.85 mm. Compared with that in BI patients without HRVA, the measurements suggested that the entry point in BI patients with HRVA should be shifted upward by 0.38 mm and the trajectory should be angled cephalad by 6.05° and medially by 4.78°. In the control group, changes in the insertion parameters between HRVA and non-HRVA showed a similar trend to the BI group. Multiple linear regression showed that mediolateral angle was significantly associated with the male gender (B=-0.930, p=.017) and the diagnoses of HRVA (B=6.964, p<.001), Goel type A (B=-1.656, p=.003), and Goel type B (B=0.981, p=.030). Moreover, cephalad angle was significantly associated with the length of lateral mass (B=-0.319, p=.001) and the diagnoses of HRVA (B=3.254, p<.001) and Goel type A (B=6.924, p<.001). The VA anomalies were significantly higher in the BI group than in the control group. CONCLUSIONS The insertion parameters of the ideal entry point and trajectory for C2 screw placement in BI patients with HRVA were remarkably different from those of non-HRVA of BI, HRVA of control, and non-HRVA of control cohorts. Preoperative 3D computed tomography (CT) and CT angiography are highly recommended in such patients to improve intraoperative safety and reduce postoperative complications.
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Affiliation(s)
- Lu-Ping Zhou
- Department of Orthopedics, the First Affiliated Hospital of Anhui Medical University, 210 Jixi Rd, Hefei, Anhui 230022, China
| | - Ren-Jie Zhang
- Department of Orthopedics, the First Affiliated Hospital of Anhui Medical University, 210 Jixi Rd, Hefei, Anhui 230022, China
| | - Zhen-Fei Jiang
- Department of Orthopedics, the First Affiliated Hospital of University of Science and Technology of China, 17 Lujiang Rd, Hefei, Anhui 230001, China
| | - Er-Xu Tao
- Department of Orthopedics, the First Affiliated Hospital of Anhui Medical University, 210 Jixi Rd, Hefei, Anhui 230022, China
| | - Jin Shang
- Department of radiology, the First Affiliated Hospital of University of Science and Technology of China, 107 Huanhudong Rd, Hefei, Anhui 230031, China
| | - Cai-Liang Shen
- Department of Orthopedics, the First Affiliated Hospital of Anhui Medical University, 210 Jixi Rd, Hefei, Anhui 230022, China.
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吴 凡, 李 红, 万 盛, 高 涛, 胡 海, 林 旭, 钟 泽, 曾 俊, 吴 超, 谭 伦. [The effect of axis pedicle and intra-axial vertebral artery on C 2 pedicle screw placement]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:866-872. [PMID: 35848184 PMCID: PMC9288901 DOI: 10.7507/1002-1892.202202008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/16/2022] [Indexed: 01/24/2023]
Abstract
Objective To investigate the influence of axis pedicle and intra-axial vertebral artery (IAVA) alignment on C 2 pedicle screw placement by measuring the data of head and neck CT angiography. Methods The axis pedicle diameter (D), isthmus height (H), isthmus thickness (T), and IAVA alignment types were measured in 116 patients (232 sides) who underwent head and neck CT angiography examinations between January 2020 and June 2020. Defined the IAVA offset direction by referencing the vertical line through the center of C 3 transverse foramen on the coronal scan, it was divided into lateral (L), neutral (N), and medial (M). Defined the IAVA high-riding degree by referencing the horizontal line through the outlet of the C 2 transverse foramen, it was divided into below (B), within (W), and above (A). The rate of pedicle stenosis, high-riding vertebral artery, and different IAVA types were calculated, and their relationships were analysed. Simulative C 2 pedicle screws were implanted by Mimics 19.0 software, and the interrelation among the rates of pedicle stenosis, high-riding vertebral artery, IAVA types, and vertebral artery injury were analyzed. Results The rate of C 2 pedicle stenosis was 33.6% (78/232), and the rate of high-riding vertebral artery was 35.3% (82/232). According to the offset direction and the degree of riding, IAVA was divided into 9 types, among which the N-W type (29.3%) was the most, followed by the L-W type (19.0%) and the L-B type (12.9%), accounting for 60.9%. The vertebral artery injury rate of simulative implanted C 2 pedicle screws was 35.3% (82/232). The vertebral artery injury rate in patients with pedicle stenosis and high-riding vertebral artery was significantly higher than that who were not ( P<0.001). The rate of pedicle stenosis, high-riding vertebral artery, and vertebral artery injury were significantly different among IAVA types ( P<0.001), and M-A type was the most common. Conclusion Vertebral artery injury is more common in pedicle stenosis and/or high-riding vertebral artery and/or IAVA M-A type. Preoperative head and neck CT angiography examination has clinical guiding significance.
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Affiliation(s)
- 凡 吴
- 自贡市第四人民医院脊柱及创伤外科(四川自贡 643000)Department of Spine and Trauma Surgery, Zigong Fourth People’s Hospital, Zigong Sichuan, 643000, P. R. China
| | - 红 李
- 自贡市第四人民医院脊柱及创伤外科(四川自贡 643000)Department of Spine and Trauma Surgery, Zigong Fourth People’s Hospital, Zigong Sichuan, 643000, P. R. China
| | - 盛钰 万
- 自贡市第四人民医院脊柱及创伤外科(四川自贡 643000)Department of Spine and Trauma Surgery, Zigong Fourth People’s Hospital, Zigong Sichuan, 643000, P. R. China
| | - 涛 高
- 自贡市第四人民医院脊柱及创伤外科(四川自贡 643000)Department of Spine and Trauma Surgery, Zigong Fourth People’s Hospital, Zigong Sichuan, 643000, P. R. China
| | - 海刚 胡
- 自贡市第四人民医院脊柱及创伤外科(四川自贡 643000)Department of Spine and Trauma Surgery, Zigong Fourth People’s Hospital, Zigong Sichuan, 643000, P. R. China
| | - 旭 林
- 自贡市第四人民医院脊柱及创伤外科(四川自贡 643000)Department of Spine and Trauma Surgery, Zigong Fourth People’s Hospital, Zigong Sichuan, 643000, P. R. China
| | - 泽莅 钟
- 自贡市第四人民医院脊柱及创伤外科(四川自贡 643000)Department of Spine and Trauma Surgery, Zigong Fourth People’s Hospital, Zigong Sichuan, 643000, P. R. China
| | - 俊 曾
- 自贡市第四人民医院脊柱及创伤外科(四川自贡 643000)Department of Spine and Trauma Surgery, Zigong Fourth People’s Hospital, Zigong Sichuan, 643000, P. R. China
| | - 超 吴
- 自贡市第四人民医院脊柱及创伤外科(四川自贡 643000)Department of Spine and Trauma Surgery, Zigong Fourth People’s Hospital, Zigong Sichuan, 643000, P. R. China
| | - 伦 谭
- 自贡市第四人民医院脊柱及创伤外科(四川自贡 643000)Department of Spine and Trauma Surgery, Zigong Fourth People’s Hospital, Zigong Sichuan, 643000, P. R. China
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11
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Golpinar M, Komut E, Salim H, Govsa F. The computed tomographic evaluation of bony bridge of C1 as bleeding risk factor at the screw placement. Surg Radiol Anat 2022; 44:585-593. [PMID: 35286403 DOI: 10.1007/s00276-022-02919-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 02/24/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate the prevalence and morphological characteristics of ponticulus posticus (PP) and ponticulus lateralis (PL) using computed tomography (CT) images on a large study sample of the Anatolian population. The presence of the PP and PL bridges can limit gap available for placement procedure through the bony elements of C1. Routine screw techniques are contraindicated because of high risk of fatal bleeding of vertebral artery (VA). METHODS The CT images of 1000 subjects (500 males, 500 females) were examined for the morphological characteristics and presence of PP and PL. The anteroposterior diameter, superoposterior (transverse) diameter, surface area, and central thickness of the bony bridge of the PP, PL, and transverse foramina (TF). RESULTS The prevalence of PP was 14.8%, and bilateral complete PP was the most common PP type at 6.8%. The prevalence of PL was 4.1% and left-side complete PL was the most common PL type at 1.2%. The prevalence of both PP and PL was more common in males and bilateral complete PP were more predominant in males (p = 0.004, p = 0.038, and p = 0.010, respectively). The surface area of PP and PL were determined to be smaller than the surface area of the ipsilateral TF (p < 0.001 and p = 0.042, respectively). CONCLUSION PP is not an uncommon anatomic anomaly and PL is even less frequently encountered. The prevalence of PP and PL was more common in males and bilateral complete PP was more predominant in males. Detailed information about the prevalence and morphometry of the PP and PL obtained in the present study could guide the clinicians dealing with neurosurgery, physical medicine and rehabilitation, and radiology in their practice.
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Affiliation(s)
- Murat Golpinar
- Department of Anatomy, Faculty of Medicine, Hitit University, Corum, Turkey
| | - Erdal Komut
- Department of Radiology, Faculty of Medicine, Hitit University, Corum, Turkey
| | - Hande Salim
- Department of Anatomy, Faculty of Medicine, Hitit University, Corum, Turkey
| | - Figen Govsa
- Department of Anatomy, Faculty of Medicine, Ege University, TR-35100, Bornova, Izmir, Turkey.
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12
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Lvov I, Lukyanchikov V, Grin A, Alekhin E, Roschin S, Talypov A, Ramazanov G, Krylov V. The frequency of vertebral artery sulcus ossification, grades III and IV, in patients with Kimmerle’s anomaly: A systematic review and meta-analysis. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:37-47. [DOI: 10.17116/jnevro202212209137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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13
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Prevalence of Vertebral artery anomaly in upper cervical and its surgical implications: a systematic review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:3607-3613. [PMID: 34601625 DOI: 10.1007/s00586-021-07015-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/23/2021] [Accepted: 09/27/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The presence vertebral artery (VA) abnormalities in the upper cervical may be a potential cause of catastrophic complication in the posterior approach of the upper cervical spine surgery. The aim of this study was to demonstrate the real incidence of the V3 segment anomaly in patients who need upper cervical surgery, and tried to find out the risk factors of V3 segment anomaly to evaluate the necessary of computed tomographic angiography (CTA) for upper cervical surgery. METHOD This systematic review was conducted following the preferred reporting items for systematic reviews and meta-Analyses (PRISMA). Retrospective studies and reports of case series involving human subjects with data on anomalies of vertebral artery in upper cervical spine were included. Data on the prevalence of persistent first intersegmental artery (PIA), fenestration of the VA (FA), posterior inferior cerebellar artery (PICA) were extracted. RESULTS A total of 16 articles involving 5927 subjects met the inclusion criteria. The total incidence of V3 segment anomaly in the patients with bony abnormalities was 25.9% (74/286): PIA was 17.5%, FA was 6.6% and PICA was 1.8%. The total incidence of V3 segment anomaly in the patients without bony abnormalities was 2.7% (152/5671): PIA was 1.76%, FA was 0.4% and PICA was 0.5%. The total incidence of V3 segment anomaly in Asian population without bony abnormalities was 5.8%, while in European and American population was 0.8 and 0.6%, respectively. CONCLUSION Patients with bone abnormalities are high risk factor for VA abnormalities, CTA is of paramount importance to evaluate the variant VA anatomy. However, regarding to the low incidence of V3 variation in normal population, we do not recommend preoperative CT angiography as mandatory part of preoperative.
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Xing XH, Zhang AM, Adu IK, Huang MH, Cui G. Arterial Vascular Structures Running Through Retrotransverse Foramen and Retrotransverse Groove of the Atlas Vertebrae. World Neurosurg 2021; 154:e416-e420. [PMID: 34293524 DOI: 10.1016/j.wneu.2021.07.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 07/12/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Retrotransverse foramen (RTF) and retrotransverse groove (RTG) are anatomic variations of the atlas (C1) vertebrae. RTF contains an anastomotic vein connecting atlanto-occipital and atlanto-axodian venous sinuses. The purpose of this study was to analyze the arterial vascular structures running though the RTF and RTG. METHODS Three-dimensional volume rendered computed tomography angiography (3D VR CTA) images of 427 patients (264 men, 163 women; age 17-87 years) were reviewed and evaluated using the RadiAnt DICOM Viewer (version 5.0.2; Medixant, Poznan, Poland). The incidence of RTF or RTG, the incidence of the V3 segment of vertebral artery variants, and the artery vascular structures inside the RTF and RTG anatomic variation of C1 were analyzed. RESULTS Fifty (11.7%) atlases presented RTF anatomical variant; 113 (26.5%) atlases presented RTG anatomical variants. The incidence of the V3 segment of vertebral artery variants was 0.94% (4 of 427). Three (0.7%) were persistent first intersegmental artery and 1 (0.2%) was the fenestration of the vertebral artery on left side. In 4 cases of C1 vertebral artery V3 segmental variants, there were no RTF and RTG. No artery vascular structure was found in RTF or RTG. CONCLUSIONS The RTF or RTG of C1 was a common anatomical variant. No arterial vascular structure runs though the RTF or RTG. The presence of C1 RTF and RTG variants had no effect on the V3 segmental course of the vertebral artery. Preoperative understanding of these variations using 3D CTA are helpful for the safe execution of the upper cervical posterior approach surgeries.
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Affiliation(s)
- Xi-Hong Xing
- Department of Neurosurgery, First Affiliated Hospital of Soochow University, Suzhou, China; Department of Neurosurgery, Second Hospital of Jingzhou, Affiliated Hospital of Hubei College of Chinese Medicine, Jingzhou, China
| | - Ai-Ming Zhang
- Department of Neurosurgery, Second Hospital of Jingzhou, Affiliated Hospital of Hubei College of Chinese Medicine, Jingzhou, China
| | - Isaac Kumi Adu
- Department of Neurosurgery, Second Hospital of Jingzhou, Affiliated Hospital of Hubei College of Chinese Medicine, Jingzhou, China; Health Science Center, Yangtze University, Jingzhou, China
| | - Man-Hua Huang
- Department of Radiology, First People's Hospital of Jingzhou City, Affiliated Hospital of Yangtze University, Jingzhou, China
| | - Gang Cui
- Department of Neurosurgery, First Affiliated Hospital of Soochow University, Suzhou, China.
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Wang S, Ren WJ, Zheng L, Sun ST, Zhang BH, Chen Y, Xiang LB. Anatomical Variations of the Vertebral Artery: Analysis by Three-Dimensional Computed Tomography Angiography in Chinese Population. Orthop Surg 2021; 13:1556-1562. [PMID: 34105261 PMCID: PMC8313168 DOI: 10.1111/os.13047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/11/2021] [Accepted: 04/13/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To analyze the anatomical variations of V3 and V2 segments of the vertebral artery in the Chinese population. METHODS The current retrospective study was an observational, anatomical, radiological research. Between 1 January 2018 to 31 December 2019, the data of 589 continuous head-and-neck three-dimensional computed tomography angiography were observed and analyzed using the open-source software of Horos. There were 415 males and 174 females with an average age of 44.63 ± 2.5(18-74) years. The variations of the V3 segment were defined as persistent first intersegmental artery (PFIA) and paracondylar processes (PP). The variations of V2 segments were unusual vertebral artery entrance transverse foreman (UE-V2S) and midline migration (MM). The incidences of all variations were summarized and the gender, side characters were compared. RESULTS Among the patients, 4.34% (18/415) males and 4.60% (8/174) females were with the variation of PFIA. Meanwhile, 12.29% (51/415) males and 10.92% (19/174) females were with the variation of PP. Then 18.80% (78/415) males and 16.67% (29/174) females were with UE-V2S. All the variations above were not different in genders. As for the variation of MM, 3.86% (16/415) males and 8.62% (15/174) females were identified, and the difference of genders was significant for this type of variation (P < 0.05). The differences between each side were also observed and analyzed for all variations and no differences were found. CONCLUSION There are several variations of V3 and V2 segments of the vertebral artery are associated with the cervical surgeries, most were without differences in genders and sides, except the variation of MM.
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Affiliation(s)
- Shuang Wang
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang, China
| | - Wei-Jian Ren
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang, China
| | - Liang Zheng
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang, China
| | - Shao-Tong Sun
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang, China
| | - Bo-Hua Zhang
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang, China
| | - Yu Chen
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang, China
| | - Liang-Bi Xiang
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang, China
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Shimizu T, Koda M, Abe T, Shibao Y, Kono M, Eto F, Miura K, Mataki K, Noguchi H, Takahashi H, Funayama T, Yamazaki M. Correlation between osteoarthritis of the atlantoaxial facet joint and a high-riding vertebral artery. BMC Musculoskelet Disord 2021; 22:406. [PMID: 33941142 PMCID: PMC8091766 DOI: 10.1186/s12891-021-04275-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND 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. METHODS We included 215 patients, 94 were with a main lesion from C3 to C7 (subaxial group) and 121 were with a main lesion from T1 to L5 (thoracolumbar group). A HRVA was defined as a maximum C2 pedicle diameter of < 3.5 mm on axial CT. The sex, age of patients, body mass index (BMI), osteoarthritis of the atlantoaxial (C1-2) 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. RESULTS The patients in the subaxial group were younger than those in the thoracolumbar group, but their sex and BMI did not differ significantly between the 2 groups. The mean osteoarthritis grade of the C1-2 facet joints of patients in the subaxial group was significantly higher than that in those in the thoracolumbar group. A HRVA was found in 26 patients of 94 (27.7 %) in the subaxial group and in 19 of 121 (15.7 %) in the thoracolumbar group. The prevalence of a HRVA in the subaxial group was significantly higher and osteoarthritis of C1-2 facet joints correlated significantly with a HRVA. CONCLUSIONS The prevalence of a HRVA in patients with subaxial cervical spine disorders is higher than in those without and osteoarthritis of the C1-2 facet joints is correlated with a HRVA.
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Affiliation(s)
- Tomoaki Shimizu
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, 305-8575, Tsukuba, Ibaraki, Japan.
| | - Masao Koda
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, 305-8575, Tsukuba, Ibaraki, Japan
| | - Tetsuya Abe
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, 305-8575, Tsukuba, Ibaraki, Japan
| | - Yosuke Shibao
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, 305-8575, Tsukuba, Ibaraki, Japan
| | - Mamoru Kono
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, 305-8575, Tsukuba, Ibaraki, Japan
| | - Fumihiko Eto
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, 305-8575, Tsukuba, Ibaraki, Japan
| | - Kousei Miura
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, 305-8575, Tsukuba, Ibaraki, Japan
| | - Kentaro Mataki
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, 305-8575, Tsukuba, Ibaraki, Japan
| | - Hiroshi Noguchi
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, 305-8575, Tsukuba, Ibaraki, Japan
| | - Hiroshi Takahashi
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, 305-8575, Tsukuba, Ibaraki, Japan
| | - Toru Funayama
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, 305-8575, Tsukuba, Ibaraki, Japan
| | - Masashi Yamazaki
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, 305-8575, Tsukuba, Ibaraki, Japan
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Farah K, Meyer M, Reyre A, Cot K, Fuentes S. PICA injury secondary to anterior odontoid screw fixation: Case report of an exceptional complication. Neurochirurgie 2021; 67:310-314. [PMID: 33753130 DOI: 10.1016/j.neuchi.2021.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 02/15/2021] [Accepted: 02/28/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Odontoid fracture is a common injury in the upper cervical spine that can sometimes be managed by anterior odontoid screw fixation. CASE DESCRIPTION We report the first case of iatrogenic postero-inferior cerebellar artery (PICA) injury while performing anterior odontoid screw fixation for a type II odontoid fracture in a 22-year-old man. Fisher grade 4 subarachnoid hemorrhage secondary to iatrogenic pseudoaneurysm formation was managed by the endovascular neuroradiologist. Odontoid fracture was then managed posteriorly using Harm's technique. Postoperative 12-month follow-up revealed good clinical and radiological results. CT scan showed fusion. Complete exclusion of the pseudo aneurysm with a mild stroke in the inferior left cerebellar hemisphere were noted on the MRI. There were no cerebellar ataxia or swallowing disorders. CONCLUSION To the best of our knowledge, this is the first case report of iatrogenic PICA injury in anterior odontoid screw fixation. The patient was well managed in our institution within a multidisciplinary team. We recommend that surgical management of odontoid fractures should be performed in expert centres.
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Affiliation(s)
- K Farah
- Neurosurgery department, Aix-Marseille University, APHM, CHU Timone, Marseille, France.
| | - M Meyer
- Neurosurgery department, Aix-Marseille University, APHM, CHU Timone, Marseille, France
| | - A Reyre
- Endovascular neuroradiology department, Aix-Marseille University, APHM, CHU Timone, Marseille, France
| | - K Cot
- Anesthesiology-intensive care department, Aix-Marseille University, APHM, CHU Timone, Marseille, France
| | - S Fuentes
- Neurosurgery department, Aix-Marseille University, APHM, CHU Timone, Marseille, France
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Prevalence of high-riding vertebral arteries and narrow C2 pedicles among Central-European population: a computed tomography-based study. Neurosurg Rev 2021; 44:3277-3282. [PMID: 33559797 PMCID: PMC8592946 DOI: 10.1007/s10143-021-01493-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/12/2021] [Accepted: 02/01/2021] [Indexed: 11/26/2022]
Abstract
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 766 potential screw insertion sites were analyzed independently by two trained observers. C2 internal height (C2InH), C2 isthmus height (C2IsH), and C2P width were measured. Kappa statistics for inter- and intraobserver reliability as well as for inter-software agreement were calculated. HRVA was defined as C2IsH of ≤ 5 mm and/or C2InH of ≤ 2 mm. Narrow C2P was defined as C2P width ≤ 4 mm. STROBE checklist was followed. At least 1 HRVA was found in 25,3% (95% CI 21,1–29,8) of patients (16,7% of potential sites). At least 1 narrow C2P was seen in 36,8% (95% CI 32,1–41,7) of patients (23,8% of potential sites). Among those with HRVA, unilateral HRVA was present in 68,0% (95% CI 58,4–77,0), whereas bilateral HRVA in 32,0% (95% CI 23,0–41,6). No difference in terms of laterality (right or left) was seen neither for HRVA nor narrow C2P. Significant differences were found between females and males for all measurements. Each parameter showed either good or excellent inter- or intraobserver, and inter-software agreement coefficients. HRVA and narrow C2P are common findings in Central-European population and should be appreciated at the planning stage before craniocervical instrumentation. Measurements can be consistently reproduced by various observers at varying intervals using different software.
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Harper B, Miner D, Vaughan H. Proposing a new algorithm for premanipulative testing in physical therapy practice. J Phys Ther Sci 2020; 32:775-783. [PMID: 33281296 PMCID: PMC7708008 DOI: 10.1589/jpts.32.775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 08/04/2020] [Indexed: 11/24/2022] Open
Abstract
In the field of physical therapy, there is debate as to the clinical utility of
premanipulative vascular assessments. Cervical artery dysfunction (CAD) risk assessment
involves a multi-system approach to differentiate between spontaneous versus mechanical
events. The purposes of this inductive analysis of the literature are to discuss the link
between cervical spine manipulation (CSM) and CAD, to examine the literature on
premanipulative vascular tests, and to suggest an optimal sequence of premanipulative
testing based on the differentiation of a spontaneous versus mechanical vascular event.
Knowing what premanipulative vascular tests assess and the associated clinical application
facilitates an evidence-informed decision for clinical application of vascular assessment
before CSM.
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Affiliation(s)
- Brent Harper
- Crean College of Health and Behavior Sciences, Chapman University: 9401 Jeronimo Road, Irvine, CA 92618, USA
| | - Daniel Miner
- Department of Physical Therapy, Waldron College of Health and Human Services, Radford University, USA
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20
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Risk of the high-riding variant of vertebral arteries at C2 is increased over twofold in rheumatoid arthritis: a meta-analysis. Neurosurg Rev 2020; 44:2041-2046. [PMID: 33106959 PMCID: PMC8338830 DOI: 10.1007/s10143-020-01425-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/01/2020] [Accepted: 10/16/2020] [Indexed: 10/31/2022]
Abstract
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. RA is hypothesized to increase a risk of HRVA. 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. All major databases were scanned for cohort studies combining words "rheumatoid arthritis" and "high-riding vertebral artery" or synonyms. 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. Fixed-effects model (inverse variance) was employed. Four studies with a total of 308 subjects were included in meta-analysis. One hundred twenty-five subjects were in group A; 183 subjects were in group B. Mean age in group A was 62,1 years, whereas in group B 59,9 years. The highest risk of bias regarded "comparability" domain, whereas the lowest pertained to "selection" domain. The mean relative risk of HRVA in group A (RA) as compared with group B (non-RA) was as follows: RR = 2,11 (95% CI 1,47-3,05), I2 = 15,19%, Cochrane Q = 3,54 with overall estimate significance of p < 0,001. Rheumatoid arthritis is associated with over twofold risk of developing HRVA, and therefore, vertebral arteries should be meticulously examined preoperatively before performing craniocervical fusion in every RA patient.
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21
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Hung ND, Duc NM, Dung LV, Sy TV, Dung LT, Hue ND. A Computed Tomographic Study of Vietnamese C1-C2 Morphology for Atlantoaxial Crew Fixation Techniques. J Clin Imaging Sci 2020; 10:63. [PMID: 33194305 PMCID: PMC7656043 DOI: 10.25259/jcis_121_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 09/08/2020] [Indexed: 11/28/2022] Open
Abstract
Objectives: This study aimed to define variations in radiological C1 and C2 measurements among Vietnamese subjects and to determine the feasibility of implementing C1-2 fixation techniques. Material and Methods: From October 2017 to April 2018, 120 patients underwent thin slide computed tomography (CT) scans of the cervical spine, in our hospital. Various dimensions of the C1 and C2 were analyzed, using axial and sagittal reconstructions of CT images. Differences in characteristics between the two sides and between sexes were investigated, using Student’s t-test, with significance at P < 0.05. Results: The mean anteroposterior dimension and the transverse width of the C1 lateral mass were 19.7 ± 2.1 mm and 12.2 ± 1.7 mm, respectively. The mean angles of the screw, directed to the maximal medial, lateral, cranial, and caudal directions, were 36.6 ± 2.8°, 28.2 ± 3.0°, 49.6 ± 4.1°, and 26.4 ± 5.5°, respectively. The average isthmus height, internal height, and pedicle width of the C2 were 5.8 ± 1.0 mm, 4.8 ± 1.3 mm, and 5.0 ± 1.3 mm, respectively. No significant differences were observed for any parameters, between the left and right side of the C1 or C2 or between the two sexes. Conclusion: This study revealed that the morphology of the C1 and C2 did not differ between genders in the studied subjects, but morphologic variations exist between Vietnamese subjects and other populations. Pre-operative anatomy evaluations based on CT data are essential be performed for screw placement and trajectory planning to avoid neurovascular complications and to enhance the treatment outcome.
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Affiliation(s)
- Nguyen Duy Hung
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam,
- Department of Radiology, Viet Duc Hospital, Hanoi, Vietnam,
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam,
- Department of Radiology, Children’s Hospital 2, Ho Chi Minh City, Vietnam,
| | - Le Viet Dung
- Department of Radiology, Viet Duc Hospital, Hanoi, Vietnam,
| | - Than Van Sy
- Department of Radiology, Viet Duc Hospital, Hanoi, Vietnam,
| | - Le Thanh Dung
- Department of Radiology, Viet Duc Hospital, Hanoi, Vietnam,
| | - Nguyen Duy Hue
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam,
- Department of Radiology, Viet Duc Hospital, Hanoi, Vietnam,
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Salmas M, Chronopoulos E, Nikolaou VS, Babis GC, Kaseta MK, Skandalakis GP, Chytas D. Letter to the Editor Regarding: "Usefulness of 3D Printed Models in the Management of Complex Craniovertebral Junction Anomalies: Choice of Treatment Strategy, Design of Screw Trajectory, and Protection of Vertebral Artery.". World Neurosurg 2020; 142:558. [PMID: 32987598 DOI: 10.1016/j.wneu.2020.06.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Marios Salmas
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Nea Ionia, Greece
| | - Efstathios Chronopoulos
- Second Orthopedic Department, School of Medicine, National and Kapodistrian University of Athens, Nea Ionia, Greece
| | - Vasileios S Nikolaou
- Second Orthopedic Department, School of Medicine, National and Kapodistrian University of Athens, Nea Ionia, Greece
| | - George C Babis
- Second Orthopedic Department, School of Medicine, National and Kapodistrian University of Athens, Nea Ionia, Greece
| | - Maria-Kyriaki Kaseta
- Second Orthopedic Department, School of Medicine, National and Kapodistrian University of Athens, Nea Ionia, Greece
| | - Georgios P Skandalakis
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dimitrios Chytas
- Department of Anatomy, School of Medicine, European University of Cyprus, Nicosia, Cyprus.
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Klepinowski T, Pala B, Cembik J, Sagan L. Prevalence of High-Riding Vertebral Artery: A Meta-Analysis of the Anatomical Variant Affecting Choice of Craniocervical Fusion Method and Its Outcome. World Neurosurg 2020; 143:e474-e481. [PMID: 32750514 DOI: 10.1016/j.wneu.2020.07.182] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/24/2020] [Accepted: 07/26/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE A high-riding vertebral artery (HRVA) has been defined as a C2 isthmus height of ≤5 mm and/or internal height of ≤2 mm measured 3 mm lateral to the border of the spinal canal. 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. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. The pooled prevalence was calculated using a random effects model. RESULTS The data from 20 studies with 3126 subjects (7496 sides) were analyzed. The overall pooled prevalence of ≥1 HRVA was 25.3% (95% confidence interval [CI], 19.6%-31.5%). The prevalence in those without the most important confounding factor, rheumatoid arthritis (RA), was 20.9% (95% CI, 16.5%-25.8%). Patients with RA had a prevalence of 42.9% (95% CI, 23.8%-63.1%). The difference between the non-RA and RA groups was statistically significant (P < 0.001, test of homogeneity, χ2). No geographical differences were noted (P = 0.20, test of homogeneity, χ2). Among those with HRVA, unilateral HRVA was present in 70.3% (95% CI, 65.2%-75.2%) and bilateral in 29.7% (95% CI, 24.8%-34.8%). No left or right side predilection was found (left, 50.8%; 95% CI, 33.8%-67.6%; right, 49.2%; 95% CI, 32.4%-66.2%). 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.
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Affiliation(s)
- Tomasz Klepinowski
- Department of Neurosurgery, Public Clinical Hospital No. 1, Pomeranian Medical University, Szczecin, Poland.
| | - Bartłomiej Pala
- Department of Neurosurgery, Public Clinical Hospital No. 1, Pomeranian Medical University, Szczecin, Poland
| | | | - Leszek Sagan
- Department of Neurosurgery, Public Clinical Hospital No. 1, Pomeranian Medical University, Szczecin, Poland
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24
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Chytas D, Korres DS, Babis GC, Chronopoulos E, Kaseta MK, Markatos K, Nikolaou VS. Letter to the Editor Regarding "Proposal of a New Safety Margin for Placement of C2 Pedicle Screws on Computed Tomography Angiography". World Neurosurg 2020; 135:409. [PMID: 32143264 DOI: 10.1016/j.wneu.2019.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 12/02/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Dimitrios Chytas
- 2nd Orthopaedic Department, School of Medicine, National and Kapodistrian University of Athens, "Konstantopoulio-Patission" Hospital, Nea Ionia, Greece.
| | - Demetrios S Korres
- 2nd Orthopaedic Department, School of Medicine, National and Kapodistrian University of Athens, "Konstantopoulio-Patission" Hospital, Nea Ionia, Greece
| | - George C Babis
- 2nd Orthopaedic Department, School of Medicine, National and Kapodistrian University of Athens, "Konstantopoulio-Patission" Hospital, Nea Ionia, Greece
| | - Efstathios Chronopoulos
- 2nd Orthopaedic Department, School of Medicine, National and Kapodistrian University of Athens, "Konstantopoulio-Patission" Hospital, Nea Ionia, Greece
| | - Maria-Kyriaki Kaseta
- 2nd Orthopaedic Department, School of Medicine, National and Kapodistrian University of Athens, "Konstantopoulio-Patission" Hospital, Nea Ionia, Greece
| | | | - Vasileios S Nikolaou
- 2nd Orthopaedic Department, School of Medicine, National and Kapodistrian University of Athens, "Konstantopoulio-Patission" Hospital, Nea Ionia, Greece
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Lofrese G, Cultrera F, Visani J, Nicassio N, Essayed WI, Donati R, Cavallo MA, De Bonis P. Intraoperative Doppler ultrasound as a means of preventing vertebral artery injury during Goel and Harms C1-C2 posterior arthrodesis: technical note. J Neurosurg Spine 2019; 31:824-830. [PMID: 31419805 DOI: 10.3171/2019.5.spine1959] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 05/28/2019] [Indexed: 11/06/2022]
Abstract
Vertebral artery injury (VAI) is a potential catastrophic complication of Goel and Harms C1-C2 posterior arthrodesis. Meticulous study of preoperative spinal CT angiography together with neuronavigation plays a fundamental role in avoiding VAI. Doppler ultrasonography may be an additional intraoperative tool, providing real-time identification of the vertebral artery (VA) and thus helping its preservation.Thirty-three consecutive patients with unstable odontoid fractures underwent Goel and Harms C1-C2 posterior arthrodesis. Surgery was performed with the aid of lateral fluoroscopic control in 16 cases (control group) that was supplemented by Doppler ultrasonography in 17 cases (Doppler group). Two patients in each group had a C1 ponticulus posticus. In the Doppler group, Doppler probing was performed during lateral subperiosteal muscle dissection, stepwise drilling, and tapping. Blood flow velocity in the V3 segment of the VA was recorded before and after posterior arthrodesis. All patients had a 12-month outpatient follow-up, and outcome was assessed using the Smiley-Webster Pain Scale. Neither VAI nor postoperative neurological impairments were observed in the Doppler group. In the control group, VAIs occurred in the 2 patients with C1 ponticulus posticus. In the Doppler group, 1 patient needed intra- and postoperative blood transfusions, and no difference in terms of Doppler signal or VA blood flow velocity was detected before and after C1-C2 posterior arthrodesis. In the control group, 3 patients needed intra- and postoperative blood transfusions.Useful in supporting fluoroscopy-assisted procedures, intraoperative Doppler may play a significant role even during surgeries in which neuronavigation is used, reducing the chance of a mismatch between the view on the neuronavigation screen and the actual course of the VA in the operative field and supplying the additional data of blood flow velocity.
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Affiliation(s)
| | | | - Jacopo Visani
- 2Neurosurgery Division, University Hospital S. Anna, Cona di Ferrara, Italy; and
| | | | - Walid Ibn Essayed
- 3Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Pasquale De Bonis
- 2Neurosurgery Division, University Hospital S. Anna, Cona di Ferrara, Italy; and
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Effects of different CT angiography technology-based nursing methods on patients with coronary artery heart diseases. J Infect Public Health 2019; 13:2045-2048. [PMID: 31296480 DOI: 10.1016/j.jiph.2019.06.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/16/2019] [Accepted: 06/21/2019] [Indexed: 12/27/2022] Open
Abstract
To study the nursing effects of different CT angiography (CTA) technology-based nursing methods on patients with coronary artery heart diseases (CHD), CHD patients treated in Dongying People's Hospital were selected as the research objects and were divided into the control group and the observation group. Different coronary CTA nursing methods, i.e. the routine nursing and the psychological nursing, were performed to the control group and the observation group respectively. During the experiment, patients performed self-evaluations, which included the Self-rating Anxiety Scale (SAS) and the Self-rating Depression Scale (SDS). Biological indicators of patients, including heart rate (HR), diastolic blood pressure (DBP), and systolic blood pressure (SBP), were measured before and after patients accepted different nursing methods. In addition, the quality of coronary CTA images was evaluated. The results showed that HR, DBP, SBP, SAS scores, and SDS scores of patients in the observation group were obviously lower than those in the control group, and the differences were statistically significant, besides, the image quality of the observation group was significantly greater than that of the control group, which was helpful for diagnosis and had statistical significances. Therefore, it is proved that the psychological nursing of CHD patients can effectively reduce the negative emotions of patients, such as anxiety and depression, which is conducive to CTA and can assist clinical diagnosis. The results provide a basis and ideas for more accurate research in the future.
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Di G, Fang X, Hu Q, Zhou W, Jiang X. A Microanatomical Study of the Far Lateral Approach. World Neurosurg 2019; 127:e932-e942. [PMID: 30995558 DOI: 10.1016/j.wneu.2019.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 03/31/2019] [Accepted: 04/01/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The far-lateral approach (FLA) remains a challenge for neurosurgeons due to the complex anatomy of this region, especially in patients with anatomical variations. There is therefore an urgent need for better quantitative knowledge of the microsurgical anatomy of the FLA. METHODS The study was performed using the dried skulls and atlas vertebrae of 50 Chinese adults, in which significant clinical parameters were measured. We further used 12 cadaveric heads to simulate the FLA to explore the step-by-step anatomy entailed by this procedure, enabling us to obtain key images and related information. RESULTS Limited to hypoglossal canal, the occipital condyle posterior was abraded by roughly 10 mm, which provided good exposure to the ventral front of the foramen magnum. When occipital artery exits the occipital groove, the mean diameter was 2.20 mm. The average occipital artery suboccipital segment length was 65.26 mm. The posterior spinal artery (PSA) and posterior inferior cerebellar artery (PICA) generally originated from the fourth vertebral artery segment intradurally, and the mean distances from the PSA and PICA to the dural entry point of the vertebral artery were 2.62 mm and 8.71 mm, respectively. The incidence of PSA and PICA arising from the third vertebral artery segment was 16.67% and 4.17%, respectively. CONCLUSIONS Understanding the important anatomic structures of the CVJ region and developing improved knowledge of the microsurgical anatomy of the FLA offer an opportunity to ensure safe exposure and treatment of lesions in the ventral and ventrolateral regions of the CVJ.
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Affiliation(s)
- Guangfu Di
- Department of Neurosurgery, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Xinyun Fang
- Department of Neurosurgery, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Qianxin Hu
- Department of Neurosurgery, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Wei Zhou
- Department of Neurosurgery, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Xiaochun Jiang
- Department of Neurosurgery, Yijishan Hospital, Wannan Medical College, Wuhu, China.
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Atlas posterior arch and vertebral artery’s groove variants: a classification, morphometric study, clinical and surgical implications. Surg Radiol Anat 2019; 41:985-1001. [DOI: 10.1007/s00276-019-02256-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 05/09/2019] [Indexed: 10/26/2022]
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Chang CC, Huang WC, Tu TH, Chang PY, Fay LY, Wu JC, Cheng H. Differences in fixation strength among constructs of atlantoaxial fixation. J Neurosurg Spine 2019; 30:52-59. [PMID: 30485212 DOI: 10.3171/2018.6.spine171390] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 06/13/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVETo avoid jeopardizing an aberrant vertebral artery, there are three common options in placing a C2 screw, including pedicle, pars, and translaminar screws. Although biomechanical studies have demonstrated similar strength among these C2 screws in vitro, there are limited clinical data to address their differences in vivo. When different screws were placed in each side, few reports have compared the outcomes. The present study aimed to evaluate these multiple combinations of C2 screws.METHODSConsecutive adult patients who underwent posterior atlantoaxial (AA) fixation were retrospectively reviewed. Every patient uniformly had bilateral C1 lateral mass screws in conjunction with 2 C2 screws (1 C2 screw on each side chosen among the three options: pedicle, pars, or translaminar screws, based on individualized anatomical consideration). These patients were then grouped according to the different combinations of C2 screws for comparison of the outcomes.RESULTSA total of 63 patients were analyzed, with a mean follow-up of 34.3 months. There were five kinds of construct combinations of the C2 screws: 2 pedicle screws (the Ped-Ped group, n = 24), 2 translaminar screws (the La-La group, n = 7), 2 pars screws (the Pars-Pars group, n = 6), 1 pedicle and 1 pars screw (the Ped-Pars group, n = 7), and 1 pedicle and 1 translaminar screw (the Ped-La group, n = 19). The rate of successful fixation in each of the groups was 100%, 57.1%, 100%, 100%, and 78.9% (Ped-Ped, La-La, Par-Par, Ped-Par, and Ped-La, respectively). The patients who had no translaminar screw had a higher rate of success than those who had 1 or 2 translaminar screws (100% vs 73.1%, p = 0.0009). Among the 5 kinds of construct combinations, 2 C2 pedicle screws (the Ped-Ped group) had higher rates of success than 1 C2 pedicle and 1 C2 translaminar screw (the Ped-La group, p = 0.018). Overall, the rate of successful fixation was 87.3% (55/63). There were 7 patients (4 in the Ped-La group and 3 in the La-La group) who lost fixation/reduction, and they all had at least 1 translaminar screw.CONCLUSIONSIn AA fixation, C2 pedicle or pars screws or a combination of both provided very high success rates. Involvement of 1 or 2 C2 translaminar screws in the construct significantly lowered success rates. Therefore, a C2 pars screw is recommended over a translaminar screw.
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Affiliation(s)
- Chih-Chang Chang
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei
- 2School of Medicine, National Yang-Ming University, Taipei
| | - Wen-Cheng Huang
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei
- 2School of Medicine, National Yang-Ming University, Taipei
| | - Tsung-Hsi Tu
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei
- 2School of Medicine, National Yang-Ming University, Taipei
- 5Taiwan International Graduate Program in Molecular Medicine, National Yang-Ming University and Academia Sinica, Taipei, Taiwan
| | - Peng-Yuan Chang
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei
- 2School of Medicine, National Yang-Ming University, Taipei
- 4Department of Neurosurgery, Tao-Yuan General Hospital, Ministry of Health and Welfare, Tao-Yuan; and
| | - Li-Yu Fay
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei
- 2School of Medicine, National Yang-Ming University, Taipei
| | - Jau-Ching Wu
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei
- 2School of Medicine, National Yang-Ming University, Taipei
| | - Henrich Cheng
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei
- 3Institute of Pharmacology, National Yang-Ming University, Taipei
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Arslan D, Ozer MA, Govsa F, Kıtıs O. The Ponticulus Posticus as Risk Factor for Screw Insertion into the First Cervical Lateral Mass. World Neurosurg 2018; 113:e579-e585. [PMID: 29486308 DOI: 10.1016/j.wneu.2018.02.100] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 02/15/2018] [Accepted: 02/16/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Awareness of the osseous anomaly of ponticulus posticus (PP) is crucial in avoiding vertebral artery (VA) injuries during C1 instrumentation. The aim of this study was to investigate PP and its relationship with the VA with three-dimensional computed tomography angiography. METHODS PP and the VA were investigated as intraoperative landmarks. The intersection of the VA to the posterior arch of C1 and the medial line and the posterior arch and VA curve around lateral masses were measured as intraoperative references. RESULTS PP was identified in 14.3% of samples. The anomaly was more common in women and on the right side. Of cases, 48.2% had PP bilaterally. In PP cases, the VA had variable courses through C2 before it passed under its bony bridges on the posterior arch of C1. Mean distances were found at the intersection of the VA to the posterior arch of C1 and the medial line to be larger and the posterior arch of C1 and the VA curve around lateral masses to be narrower than normal cases. Dual computed tomography scan data from C1 with PP were used to create three-dimensional patient-specific life-sized cervical spine models. Models revealed how the bone bridge affected the VA. The feasibility (>4 mm) of a safe lateral mass screw fixation was not influenced by PP anomalies. CONCLUSIONS The presence of the PP loop can limit space available for placement of the screw through the bony elements of C1. Standard screw techniques are contraindicated owing to the unacceptable high risk of VA injury.
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Affiliation(s)
- Dilek Arslan
- Department of Neurosurgery, Tepecik Research and Training Hospital, Izmir, Turkey
| | - Mehmet Asim Ozer
- Department of Anatomy, Digital Imaging and Modelling Laboratory, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Figen Govsa
- Department of Anatomy, Digital Imaging and Modelling Laboratory, Faculty of Medicine, Ege University, Izmir, Turkey.
| | - Omer Kıtıs
- Department of Radiology, Faculty of Medicine, Ege University, Izmir, Turkey
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Vanek P, Bradac O, de Lacy P, Pavelka K, Votavova M, Benes V. Treatment of atlanto-axial subluxation secondary to rheumatoid arthritis by short segment stabilization with polyaxial screws. Acta Neurochir (Wien) 2017; 159:1791-1801. [PMID: 28752203 DOI: 10.1007/s00701-017-3274-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 07/12/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The main aim of this study was to analyse the compex clinical and radiographic findings in a group of RA patients with atlanto-axial slip (AAS) treated with free-hand short C1 lateral mass and C2 trans-pedicular screw fixation. The surgical technique used and the pathology treated were the same in all patients, producing a very homogeneous cohort of patients This allowed the study and measurement of radiographic parameters and fusion process. METHODS Twenty-nine patients (21 female, 8 male, mean age 54.9 years, duration of RA 17.3 years) with AAS and without CS were treated by short C1/2 fixation. Mean follow-up was 4.5 years. Pain intensity was monitored using VAS. Radiographic assessment consisted of lateral cervical radiographs in neutral and dynamic views, MR and CT of the cervical spine. The AADI, PADI, AAA, sub-axial cervical Cobb angle and canal-clivus angle (CCA) were measured pre-operatively and during the follow-up. RESULTS Significant malposition was recorded in 4 (3.4%) out of 116 inserted screws. AADI, PADI, AAA and CCA values changed significantly after surgery and remained stable during follow-up. The Cobb C angle value showed no significant change after surgery. There was a significant decrease of the VAS after the surgery. Fusion or a stable situation was achieved in all patients at 2-year follow-up. Pannus regression was observed in the vast majority of patients; only in two cases was rheumatic tissue detected on MR at 2 years post-operatively. CONCLUSION C1 lateral mass and C2 trans-pedicular fixation with polyaxial screws followed by an autograft between C1 and C2 lamina allowed, with an acceptable complication rate and favourable clinical results, adequate slip reposition, introduction of optimal sagittal alignment in terms of the final AAA with no radiographic consequences for the sub-axial cervical spine and assurance of long-term stability.
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Affiliation(s)
- Petr Vanek
- Department of Neurosurgery and Neurooncology, Military University Hospital and Charles University, First Medical Faculty, Prague, Czech Republic
| | - Ondrej Bradac
- Department of Neurosurgery and Neurooncology, Military University Hospital and Charles University, First Medical Faculty, Prague, Czech Republic.
| | - Patricia de Lacy
- Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield, UK
| | - Karel Pavelka
- Institute of Rheumatology, Charles University, First Medical Faculty, Prague, Czech Republic
| | - Martina Votavova
- Institute of Rheumatology, Charles University, First Medical Faculty, Prague, Czech Republic
| | - Vladimir Benes
- Department of Neurosurgery and Neurooncology, Military University Hospital and Charles University, First Medical Faculty, Prague, Czech Republic
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