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Correia PN, Meyer IA, Michel P. Osteovascular Conflicts in the Neck Region and Cerebrovascular Events: Illustrative Cases and Literature Review. Global Spine J 2024; 14:1629-1639. [PMID: 38050837 DOI: 10.1177/21925682231220044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
Abstract
STUDY DESIGN Literature Review. OBJECTIVE Abnormal bone structures in the neck can cause headache, neck pain, and difficulty swallowing, but also cerebrovascular events. We introduce the term "osteovascular conflicts" to describe this phenomenon. The objective of this study was to conduct a literature review of such conflicts involving the anterior and posterior cerebral circulation. Furthermore, we aimed at presenting additional illustrative cases from our institution both for increasing awareness for unusual osteovascular conflicts, and for assessing the practice and care of such patients. METHODS We focused on osteovascular conflicts in the neck leading to cerebrovascular events related to an abnormal bone structure causing arterial or venous compression, dissection, and/or occlusion. We excluded pure vascular forms without cerebrovascular repercussions. Our PubMed/MEDLINE search for articles published in any language and for which an English abstract was available (from 1966 to 2022) included Eagle's neurovascular, bow hunter's syndrome, and golfer's stroke, excluding trauma-induced artery dissections or compressions and those concerning systemic bone disorders. We also provided illustrative cases collected by the authors. RESULTS All studies were either case reports or small case series. We found 82 cases of Eagle's neurovascular, 258 of bow hunter's syndrome, and 17 golfer's stroke cases. Mean ages were 52, 48, and 47 years, respectively. Male predominance was evident: 81% for Eagle's, 74% for bow hunter's, and 93% for golfer's. CONCLUSION Osteovascular conflicts are rare but important causes of cerebrovascular events and often go unrecognised. A greater awareness of cerebrovascular symptoms related to these conflicts can facilitate early diagnosis and treatment.
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Affiliation(s)
- Pamela Noella Correia
- Montreal Neurovascular Stroke Program, Department of Neurosciences, University of Montreal, CHUM, Montreal, QC, Canada
- Stroke Unit, Department of Neurology, Bienne Hospital Center, Bienne, Switzerland
| | - Ivo Alexis Meyer
- Department of Clinical Neurosciences, Neurology and Acute Neurorehabilitation Service, Lausanne University Hospital, Lausanne, Switzerland
- Centre for Advanced Research in Sleep Medicine and Integrated Trauma Centre, CIUSSS du Nord-de-lÎle-de-Montréal, Montreal, QC, Canada
| | - Patrik Michel
- Stroke Center, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Sato M, Yamahata H, Yasuda M, Hiwatari T, Yonenaga M, Ishimaru K, Miyanohara O, Shimozuru T, Yoshimoto K. Treatment of rotational/positional vertebral artery occlusion due to degenerative changes in the cervical vertebrae: A case report and review of the literature. J Orthop Sci 2023; 28:1614-1619. [PMID: 35078705 DOI: 10.1016/j.jos.2021.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 09/21/2021] [Accepted: 12/23/2021] [Indexed: 02/09/2023]
Affiliation(s)
- Masanori Sato
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima-shi, Kagoshima, 890-8520, Japan.
| | - Hitoshi Yamahata
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima-shi, Kagoshima, 890-8520, Japan
| | - Muneyoshi Yasuda
- Division of Neurosurgery, Ichinomiyanishi Hospital, Ichinomiya,1 Kaimeihira, Ichinomiya-shi, Aichi, 494-0001, Japan
| | - Takaaki Hiwatari
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima-shi, Kagoshima, 890-8520, Japan
| | - Masanori Yonenaga
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima-shi, Kagoshima, 890-8520, Japan
| | - Koichi Ishimaru
- Division of Neurosurgery, Kushikino Neurosurgical Center, 5391-3, Seifuku, Ichikikushikino-shi, Kagoshima, 896-0078, Japan
| | - Osamu Miyanohara
- Division of Neurosurgery, Kushikino Neurosurgical Center, 5391-3, Seifuku, Ichikikushikino-shi, Kagoshima, 896-0078, Japan
| | - Tetsuro Shimozuru
- Division of Neurosurgery, Kushikino Neurosurgical Center, 5391-3, Seifuku, Ichikikushikino-shi, Kagoshima, 896-0078, Japan
| | - Koji Yoshimoto
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima-shi, Kagoshima, 890-8520, Japan
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Bithalamic Infarction (Artery of Percheron Occlusion) after Anterior Cervical Discectomy and Fusion. Case Rep Neurol Med 2019; 2019:9438089. [PMID: 31011457 PMCID: PMC6442480 DOI: 10.1155/2019/9438089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 02/05/2019] [Indexed: 01/04/2023] Open
Abstract
Bithalamic infarction resulting from occlusion of the artery of Percheron after cervical spine surgery is a rare pathological entity. Diagnosis and early detection are challenging. Prompt management may help to improve the outcome. We present a case of a 39-year-old male patient, smoker, diagnosed with multiple cervical disc herniations, who underwent Anterior Cervical Discectomy and Fusion (ACDF) for C3-C4, C4-C5, and C5-C6. During the 2-hour and 50-minute surgery, the patient was lying supine with his neck hyperextended. The intraoperative procedure was uneventful. During surgery, blood pressure ranged around 110 mmHg∖50 mmHg. At the end of surgery, the patient's recovery from general anesthesia was normal with no delaying or complication; on next the day, patient developed a sudden loss of consciousness. Urgent brain computed tomography (CT) was normal; two days later, follow-up CT and CT Angiography (CTA) revealed bilateral thalamic infarction with right vertebral artery occlusion from its origin. Intraoperative surgical manipulation, hypotensive anesthesia, and prolonged neck hyperextension might have contributed to stroke in this patient. ACDF carries a potential risk for posterior circulation stroke. Artery of Percheron infarction should be considered in the differential diagnosis of patients developing a sudden loss of consciousness after ACDF. Vertebral artery thrombosis should be taken into account as an important possible cause of embolism.
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Kushchayev SV, Glushko T, Jarraya M, Schuleri KH, Preul MC, Brooks ML, Teytelboym OM. ABCs of the degenerative spine. Insights Imaging 2018; 9:253-274. [PMID: 29569215 PMCID: PMC5893484 DOI: 10.1007/s13244-017-0584-z] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 11/28/2017] [Accepted: 12/06/2017] [Indexed: 12/13/2022] Open
Abstract
Degenerative changes in the spine have high medical and socioeconomic significance. Imaging of the degenerative spine is a frequent challenge in radiology. The pathogenesis of this degenerative process represents a biomechanically related continuum of alterations, which can be identified with different imaging modalities. The aim of this article is to review radiological findings involving the intervertebral discs, end plates, bone marrow changes, facet joints and the spinal canal in relation to the pathogenesis of degenerative changes in the spine. Findings are described in association with the clinical symptoms they may cause, with a brief review of the possible treatment options. The article provides an illustrated review on the topic for radiology residents. TEACHING POINTS • The adjacent vertebrae, intervertebral disc, ligaments and facet joints constitute a spinal unit. • Degenerative change is a response to insults, such as mechanical or metabolic injury. • Spine degeneration is a biomechanically related continuum of alterations evolving over time.
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Affiliation(s)
- Sergiy V. Kushchayev
- Department of Radiology, Mercy Catholic Medical Center, 1500 Lansdowne Ave, Darby, PA 19023 USA
| | - Tetiana Glushko
- Department of Radiology, Mercy Catholic Medical Center, 1500 Lansdowne Ave, Darby, PA 19023 USA
| | - Mohamed Jarraya
- Department of Radiology, Mercy Catholic Medical Center, 1500 Lansdowne Ave, Darby, PA 19023 USA
| | - Karl H. Schuleri
- Department of Radiology, Mercy Catholic Medical Center, 1500 Lansdowne Ave, Darby, PA 19023 USA
| | - Mark C. Preul
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, 350 West Thomas Rd, Phoenix, AZ USA
| | - Michael L. Brooks
- Department of Radiology, Mercy Catholic Medical Center, 1500 Lansdowne Ave, Darby, PA 19023 USA
| | - Oleg M. Teytelboym
- Department of Radiology, Mercy Catholic Medical Center, 1500 Lansdowne Ave, Darby, PA 19023 USA
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Yin Y, Qin X, Huang R, Xu J, Li Y, Yu L. Musculoskeletal Ultrasound: A Novel Approach for Luschka's Joint and Vertebral Artery. Med Sci Monit 2016; 22:99-106. [PMID: 26749333 PMCID: PMC4712965 DOI: 10.12659/msm.896242] [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] [Indexed: 11/12/2022] Open
Abstract
Background Cervical vertigo has been a controversial diagnosis for several years, and the lack of a diagnostic test is a critical problem. Musculoskeletal ultrasound (MSUS) is a real-time dynamic approach that is used to investigate the musculoskeletal and vascular systems. Material/Methods In this study, MSUS was used to examine whether there is a relationship among vertigo, the vertebral artery (VA), and Luschka’s joint proliferation in patients with cervical vertigo. Results MSUS clearly revealed the size, shape, and characteristics of the Luschka’s joint, the VA, and the surrounding structures. The Luschka’s joint proliferation was not distributed uniformly, but the predilection sites were C4/5 (50.5%) and C5/6 (32.3%). The proliferation from C4/5 and C5/6 Luschka’s joints was the major cause of the grade 2/3 VA tortuosity. Moreover, there was a significant correlation between VA compression from Luschka’s joint proliferation and the symptoms of cervical vertigo. Conclusions MSUS is a real-time and noninvasive technique that can be used to locate and observe Luschka’s joint and the VA during research and clinical applications. In future practice MSUS could be used as a diagnostic approach for patients with suspected cervical vertigo.
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Affiliation(s)
- Ying Yin
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland)
| | - Xiaoxia Qin
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland)
| | - Rongzhong Huang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland)
| | - Jing Xu
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland)
| | - Yamei Li
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland)
| | - Lehua Yu
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China (mainland)
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Endovascular Embolization of a Nondominant Vertebral Artery Compressed by an Osteophyte to Prevent Recurrence of Vertebrobasilar Infarctions. J Stroke Cerebrovasc Dis 2015; 24:e257-9. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.05.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 05/07/2015] [Accepted: 05/19/2015] [Indexed: 12/14/2022] Open
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Liu B, Li Z, Xie P. Angioplasty and stenting for severe vertebral artery orifice stenosis: effects on cerebellar function remodeling verified by blood oxygen level-dependent functional magnetic resonance imaging. Neural Regen Res 2015; 9:2095-101. [PMID: 25657727 PMCID: PMC4316475 DOI: 10.4103/1673-5374.147937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2014] [Indexed: 01/13/2023] Open
Abstract
Vertebral artery orifice stenting may improve blood supply of the posterior circulation of the brain to regions such as the cerebellum and brainstem. However, previous studies have mainly focused on recovery of cerebral blood flow and perfusion in the posterior circulation after interventional therapy. This study examined the effects of functional recovery of local brain tissue on cerebellar function remodeling using blood oxygen level-dependent functional magnetic resonance imaging before and after interventional therapy. A total of 40 Chinese patients with severe unilateral vertebral artery orifice stenosis were enrolled in this study. Patients were equally and randomly assigned to intervention and control groups. The control group received drug treatment only. The intervention group received vertebral artery orifice angioplasty and stenting + identical drug treatment to the control group. At 13 days after treatment, the Dizziness Handicap Inventory score was compared between the intervention and control groups. Cerebellar function remodeling was observed between the two groups using blood oxygen level-dependent functional magnetic resonance imaging. The improvement in dizziness handicap and cerebellar function was more obvious in the intervention group than in the control group. Interventional therapy for severe vertebral artery orifice stenosis may effectively promote cerebellar function remodeling and exert neuroprotective effects.
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Affiliation(s)
- Bo Liu
- Department of Neurology, Yongchuan Hospital, Chongqing Medical University, Chongqing, China ; Institute of Neuroscience, Chongqing Medical University, Chongqing, China ; Chongqing Key Laboratory of Neurobiology, Chongqing Medical University, Chongqing, China
| | - Zhiwei Li
- Department of Neurology, Yongchuan Hospital, Chongqing Medical University, Chongqing, China
| | - Peng Xie
- Department of Neurology, Yongchuan Hospital, Chongqing Medical University, Chongqing, China ; Institute of Neuroscience, Chongqing Medical University, Chongqing, China ; Chongqing Key Laboratory of Neurobiology, Chongqing Medical University, Chongqing, China ; Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Chen CC, Chung CY, Lee TH, Chang WH, Tang SF, Pei YC. Increased risk of posterior circulation infarcts among ischemic stroke patients with cervical spondylosis. Neuropsychiatr Dis Treat 2015; 11:273-8. [PMID: 25678792 PMCID: PMC4322877 DOI: 10.2147/ndt.s77967] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Cervical spondylosis is one of the extrinsic factors causing vertebral artery stenosis. Several case studies have reported compression of the vertebral artery induced by cervical osteophytes that has resulted in posterior circulation infarcts (POCI). However, to the best of our knowledge, no studies have yet analyzed differences in the risk factors and stroke subtypes between ischemic stroke patients with cervical spondylosis and those without. PURPOSE In the case-controlled study reported here, we analyzed the risk factors and stroke subtypes in ischemic stroke patients with and without cervical spondylosis. Characteristics in all the recruited patients with POCI and non-POCI were further compared to extract other risk factors that could predict the occurrence of POCI. METHODS AND PATIENTS We filtered out ischemic stroke patients with cervical spondylosis ("Stroke+C" group) by International Classification of Diseases, Ninth Revision codes. We analyzed the data of 38 subjects in the Stroke+C group and 152 sex- and age-comparable ischemic stroke patients without cervical spondylosis ("Stroke-C" group). We recorded the demographic characteristics including sex and age, and stroke risk factors, including diabetes mellitus, hypertension, heart disease, hyperlipidemia, and smoking habits. The stroke classifications were defined by the Oxford Community Stroke Project classification. All subjects were further categorized into POCI or non-POCI groups. The ultrasound findings of the vertebral arteries (extracranial and intracranial) in the Stroke+C group were also recorded. RESULTS More patients in the Stroke+C group tended to have POCI (34.2%) than patients in the Stroke-C group (17.5%) (odds ratio [OR] =2.41, P<0.05). Furthermore, hypertension (OR=3.41, P<0.01) and cervical spondylosis (OR=2.41, P<0.05) were two independent risk factors for POCI in ischemic stroke patients. CONCLUSION Ischemic stroke patients with cervical spondylosis are more prone to POCI than those without cervical spondylosis. Hypertension is another identified risk factor for POCI in ischemic stroke patients. The occurrence of POCI should be highlighted for patients with cervical spondylosis.
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Affiliation(s)
- Chih-Chi Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Chia-Ying Chung
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Tsong-Hai Lee
- Department of Neurology, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Wei-Han Chang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Simon Ft Tang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Yu-Cheng Pei
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan ; Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
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Hartman J. Anatomy and clinical significance of the uncinate process and uncovertebral joint: A comprehensive review. Clin Anat 2014; 27:431-40. [PMID: 24453021 DOI: 10.1002/ca.22317] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 08/11/2013] [Accepted: 08/11/2013] [Indexed: 11/09/2022]
Abstract
INTRODUCTION The uncinate process and its associated uncovertebral articulation are features unique to the cervical spine. This review examines the morphology of these unique structures with particular emphasis on the regional anatomy, development and clinical significance. MATERIALS AND METHODS Five electronic databases were utilized in the literature search and additional relevant citations were retrieved from the references. A total of 74 citations were included for review. RESULTS This literature review found that the uncinate processes and uncovertebral articulations are rudimentary at birth and develop and evolve with age. With degeneration they become clinically apparent with compression of related structures; most importantly affecting the spinal nerve root and vertebral artery. The articulations have also been found to precipitate torticollis when edematous and be acutely damaged in severe head and neck injuries. The uncinate processes are also important in providing stability and guiding the motion of the cervical spine. CONCLUSION This review is intended to re-examine an often overlooked region of the cervical spine as not only an interesting anatomical feature but also a clinically relevant one.
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Affiliation(s)
- Jeffrey Hartman
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada, S7N 5E5
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