1
|
Valenzuela-Fuenzalida JJ, Rojas-Navia CP, Quirós-Clavero AP, Sanchis-Gimeno J, Rodriguez-Luengo M, Nova-Baeza P, Orellana-Donoso M, Becerra Farfán Á, Bruna-Mejias A, Sepúlveda-Loyola W, Iwanaga J. Anatomy of vertebral artery hypoplasia and its relationship with clinical implications: a systematic review and meta-analysis of prevalence. Surg Radiol Anat 2024; 46:963-975. [PMID: 38762843 DOI: 10.1007/s00276-024-03377-y] [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: 02/20/2024] [Accepted: 04/26/2024] [Indexed: 05/20/2024]
Abstract
PURPOSE The vertebral artery (VA) is a vital branch of the subclavian artery, coursing through the transverse foramina of the cervical vertebrae, and playing a crucial role in irrigating the posterior region of the arterial cerebral circle, also known as the Polygon of Willis. Among the various possible alterations that can affect the VA, vertebral artery hypoplasia (HAV) emerges as a significant variant. This study aims to discern the anatomical features of HAV and its correlation with the clinical conditions of the posterior cerebral circulation. METHODS The databases Medline, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS were searched until January 2024. Two authors independently performed the search, study selection, and data extraction. Methodological quality was evaluated with an assurance tool for anatomical studies (AQUA). Pooled prevalence was estimated using a random effects model. RESULTS A total of 24 studies met the established selection criteria, with a total of 8847 subjects. In this study, 6 articles were included for the meta-analysis with a total of subjects. The average prevalence of VAH reported in each study was 11% (95% CI 10-12%); the studies had a heterogeneity of 41% based on the funnel plot and a low risk of bias. CONCLUSION The prevalence of VAH is low, but in the presence of this condition, the changes are mainly in diameter rather than morphological. If it is present, some clinical safeguards must be taken to avoid complications such as stroke.
Collapse
Affiliation(s)
- Juan José Valenzuela-Fuenzalida
- Department of Morphology and Function, Faculty of Health and Social Sciences, Universidad de Las Américas, 8370040, Santiago, Chile.
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, 8370146, Santiago, Chile.
| | | | - Amanda Paz Quirós-Clavero
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, 8370146, Santiago, Chile
| | - Juan Sanchis-Gimeno
- GIAVAL Research Group, Department of Anatomy and Human Embryology, Faculty of Medicine, University of Valencia, 46001, Valencia, Spain
| | - Macarena Rodriguez-Luengo
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, 8370146, Santiago, Chile
| | - Pablo Nova-Baeza
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, 8370146, Santiago, Chile
| | - Mathias Orellana-Donoso
- Escuela de Medicina, Universidad Finis Terrae, 7501015, Santiago, Chile
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, 8370146, Santiago, Chile
| | - Álvaro Becerra Farfán
- Departamento de Ciencias Química y Biológicas, Facultad de Ciencias de La Salud, Universidad Bernardo O'Higgins, 8370993, Santiago, Chile
| | - Alejandro Bruna-Mejias
- Departamento de Morfología, Facultad de Medicina, Universidad Andrés Bello, 8370146, Santiago, Chile
| | - Walter Sepúlveda-Loyola
- Faculty of Health and Social Sciences, Universidad de Las Américas, 8370040, Santiago, Chile
| | - Joe Iwanaga
- Department of Oral and Maxillofacial Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA
| |
Collapse
|
2
|
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.
Collapse
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.
| |
Collapse
|
3
|
Akbulut F, Pınar E, Çekiç E, Akdeniz E, Harman F. Radiologic Examination of High Riding Vertebral Artery and Analysis of Secure Areas. World Neurosurg 2024; 183:e772-e780. [PMID: 38211814 DOI: 10.1016/j.wneu.2024.01.025] [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: 12/04/2023] [Accepted: 01/04/2024] [Indexed: 01/13/2024]
Abstract
OBJECTIVE To radiologically examine the pedicle, lamina, and vertebral artery foraminal anatomies at the C2 vertebra for pedicular and laminar screw instrumentation at the axis in a Turkish population. METHODS From 2018 to 2019, we evaluated 100 patients who underwent cervical computed tomography (CT) for various reasons (excluding cervical pathologies) at Marmara University Hospital. The C2 pedicles were measured on CT images using measurement tools. In addition, axial computed tomography was performed at 0.1 mm intervals. Bilateral measurements were performed for each case. RESULTS The median right and left pedicle axial diameters were 5.01 and 5.09 mm, respectively for the male patients and 4.31 and 4.38 mm for the female patients, showing a statistically significant difference between the sexes (P < 0.01). Of the patients, 15% had narrow pedicles. The pedicle sagittal diameters were smaller than 5 mm in 30% of the computed tomographic series. The internal height was <2 mm in 4% of the cases. CONCLUSIONS Our findings suggest significant individual and sex-related differences. Vertebral artery groove anomalies are commonly observed. Before performing a posterior craniocervical instrumentation surgery, a computed tomography (CT) examination is beneficial because high-riding vertebral arteries must be kept in mind in determining the appropriate screw diameter and screw trajectory.
Collapse
Affiliation(s)
- Fatih Akbulut
- Department of Neurosurgery, Marmara University Pendik Training and Research Hospital, İstanbul, Turkey.
| | - Ertuğrul Pınar
- Department of Neurosurgery, Private Pendik Yuzyil Hospital, İstanbul, Turkey
| | - Efecan Çekiç
- Department of Neurosurgery, Polatlı State Hospital, Ankara, Turkey
| | - Esra Akdeniz
- Department of Medical Education, Marmara University, İstanbul, Turkey
| | - Ferhat Harman
- Department of Neurosurgery, Marmara University Hospital, İstanbul, Turkey
| |
Collapse
|
4
|
Shrivastava A, Mittal A, Daniel S, Agrawal A, Raj S, Chouksey P, Nair S. C1 Lateral Mass-C2 Pars Fixation in Occipitalized Atlas with Fenestrated V3 Vertebral Artery-Operative Nuances Step by Step (Video Section). Neurol India 2024; 72:28-33. [PMID: 38442997 DOI: 10.4103/neurol-india.neurol-india-d-23-00570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 01/22/2024] [Indexed: 03/07/2024]
Affiliation(s)
- Adesh Shrivastava
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Amol Mittal
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Santosh Daniel
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Amit Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Sumit Raj
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Pradeep Chouksey
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | | |
Collapse
|
5
|
Dong W, Tian C, Li ZG, Brand D, Cao Y, Liu X, Ma J, Chai A, Myers LK, Yan J, Hasty K, Stuart J, Jiao Y, Gu W, Cai X. Variation of sexual dimorphism and asymmetry in disease expression of inflammatory arthritis among laboratory mouse models with different genomic backgrounds. Lab Anim Res 2023; 39:35. [PMID: 38115139 PMCID: PMC10731690 DOI: 10.1186/s42826-023-00185-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 11/30/2023] [Accepted: 12/11/2023] [Indexed: 12/21/2023] Open
Abstract
Sex difference has shown in the arthritis diseases in human population and animal models. We investigate how the sex and symmetry vary among mouse models with different genomic backgrounds. Disease data of sex and limbs accumulated in the past more than two decades from four unique populations of murine arthritis models were analyzed. They are (1) interleukin-1 receptor antagonist (IL-1ra) deficient mice under Balb/c background (Balb/c KO); (2) Mice with collagen II induced arthritis under DBA/1 background; (3) Mice with collagen II induced arthritis under C57BL/6 (B6) background and (4) A F2 generation population created by Balb/c KO X DBA/1 KO. Our data shows that there is a great variation in sexual dimorphism for arthritis incidence and severity of arthritis in mice harboring specific genetic modifications. For a F2 population, the incidence of arthritis was 57.1% in female mice and 75.6% in male mice. There was a difference in severity related to sex in two populations: B6.DR1/ B6.DR4 (P < 0.001) and F2 (P = 0.023) There was no difference Balb/c parental strain or in collagen-induced arthritis (CIA) in DBA/1 mice. Among these populations, the right hindlimbs are significantly higher than the scores for the left hindlimbs in males (P < 0.05). However, when examining disease expression using the collagen induced arthritis model with DBA/1 mice, sex-dimorphism did not reach statistical significance, while left hindlimbs showed a tendency toward greater disease expression over the right. Sexual dimorphism in disease expression in mouse models is strain and genomic background dependent. It sets an alarm that potential variation in sexual dimorphism among different racial and ethnic groups in human populations may exist. It is important to not only include both sexes and but also pay attention to possible variations caused by disease expression and response to treatment in all the studies of arthritis in animal models and human populations.
Collapse
Affiliation(s)
- Wei Dong
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center, Memphis, TN, 38163, USA
- Department of Gynecology, Harbin Medical University Cancer Hospital, Harbin, 150001, Heilongjiang, China
| | - Cheng Tian
- St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Z Galvin Li
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - David Brand
- Research Service, Veterans Affairs Medical Center, 1030 Jefferson Avenue, Memphis, TN, 38104, USA
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Yanhong Cao
- Institute of Kaschin-Beck Disease, Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Key Laboratory of Etiologic Epidemiology, Education Bureau of Heilongjiang Province & Ministry of Health (23618104), Harbin Medical University, Harbin, 150081, China
| | - Xiaoyun Liu
- Center for Clinical Precision Medication, The First Affiliated Hospital, Guangdong Pharmaceutical University, Guangzhou, 510006, China
- Clinical Pharmacy (School of Integrative Pharmacy, Institute of Integrative Pharmaceutical Research), Guangdong Pharmaceutical University, Guangzhou, 510006, China
| | - Jiamin Ma
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Andy Chai
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Linda K Myers
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Jian Yan
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Karen Hasty
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - John Stuart
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Yan Jiao
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center, Memphis, TN, 38163, USA.
| | - Weikuan Gu
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center, Memphis, TN, 38163, USA.
- Research Service, Veterans Affairs Medical Center, 1030 Jefferson Avenue, Memphis, TN, 38104, USA.
| | - Xiaojun Cai
- Heilongjiang Academy of Sciences of Traditional Chinese Medicine, No. 72 Xiangan Street, Xiangfang District, Harbin, 150036, China.
| |
Collapse
|
6
|
Sakellariou E, Benetos IS, Evangelopoulos DS, Galanis A, Alevrogianni F, Vavourakis M, Marougklianis V, Tsalimas G, Pneumaticos S. Incidence of vertebral artery injury in patients undergoing cervical spine trauma surgery in correlation with surgical approach: A review. Medicine (Baltimore) 2023; 102:e34653. [PMID: 37713867 PMCID: PMC10508423 DOI: 10.1097/md.0000000000034653] [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: 06/14/2023] [Accepted: 07/18/2023] [Indexed: 09/17/2023] Open
Abstract
Spinal cord injuries at the cervical spine level represent the most consequential of the related injuries at all levels of the spine. They can trigger permanent unilateral or bilateral damage with conspicuous disability. Regarding unstable injuries, the gold standard approach is open reduction and osteosynthesis, which can select between anterior and posterior surgical access. Each of the aforementioned approaches demonstrates both advantages and disadvantages; thus, it is up to the surgeon to determine the optimal option concerning the patient's safety. Diligent intraoperative control of anatomical reduction is pivotal to obtaining the best feasible postoperative outcomes. Literature data delineate copious complications following surgical intervention in the cervical spine. Indubitably, the most crucial intraoperative complication accounts for vascular injuries, with the most preponderant being the corrosion of the vertebral artery, as it is potentially life-threatening. This paper aims to provide a succinct and compendious review of the existing literature regarding cervical spinal cord injuries and to deduce many inferences concerning the incidence of iatrogenic vertebral artery injuries in relation to the surgical approach for fracture reduction.
Collapse
Affiliation(s)
- Evangelos Sakellariou
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Athens, Greece
| | - Ioannis S. Benetos
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Athens, Greece
| | | | - Athanasios Galanis
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Athens, Greece
| | | | - Michail Vavourakis
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Athens, Greece
| | - Vasilios Marougklianis
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Athens, Greece
| | - Georgios Tsalimas
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Athens, Greece
| | - Spiros Pneumaticos
- 3rd Department of Orthopaedic Surgery, National & Kapodistrian University of Athens, KAT General Hospital, Athens, Greece
| |
Collapse
|
7
|
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.
Collapse
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.
| |
Collapse
|
8
|
Wang Y, Song C, Ji Y, Xia J, Chen C, Haque M, Zhuang J, Zhou C, Zu J, Li X, Yan J. Clinical and Radiographic Features of the Atlantoaxial Dislocation Associated With Kashin-Beck Disease. World Neurosurg 2023; 171:e1-e7. [PMID: 36049725 DOI: 10.1016/j.wneu.2022.08.108] [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: 05/06/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Keshin-Beck disease (KBD) is a particular type of osteoarthritis that affects many joints. However, the deformity of atlantoaxial joint has been rarely reported in KBD, and therefore its clinical and radiograph features have not been identified. METHODS We reviewed data in 14 patients who were diagnosed with atlantoaxial dislocation (AAD) in KBD at our institution. The demographic data, clinical history, imaging data, operative data, and Japanese Orthopaedic Association score were collected for evaluation. RESULTS The mean age at presentation was 50 ± 1.7 years old. The most common features of AAD in KBD were the osteoarthritis, characterized by hypertrophic dens and anterior arch of the atlas. The average inner anteroposterior diameter (IAPD) of C1 was 28 ± 3.5 mm and the average spinal canal diameter was 14 ± 3.3 mm, which were respectively lower than the control level. Five patients had severe C1 stenosis (IAPD < 26mm). Separated odontoid process, like os odontoideum, was seen 9 patients. The tip of dens fused to C1 was observed in 4 patients; 12 patients had high-riding vertebral artery; and 5 patients had severe C1 stenosis, and they underwent C1 laminectomy with C1-C2 interarticular fusion or occipital-cervical fusion. All the patients displayed neurologic improvement after surgery. CONCLUSIONS The atlantoaxial level could be affected by KBD, which may lead to typical abnormalities and cause AAD. A C1 laminectomy with an C1-C2 interarticular fusion or occipital-cervical fusion is recommended for the patient with severe stenosis.
Collapse
Affiliation(s)
- Yufu Wang
- Department of Orthopedic Surgery, Harbin Medical University-the Second Affiliated Hospital, Harbin, China
| | - Chengchao Song
- Department of Orthopedic Surgery, Harbin Medical University-the Second Affiliated Hospital, Harbin, China
| | - Ye Ji
- Department of Orthopedic Surgery, Harbin Medical University-the Second Affiliated Hospital, Harbin, China
| | - Jingjun Xia
- Department of Orthopedic Surgery, Harbin Medical University-the Second Affiliated Hospital, Harbin, China
| | - Chao Chen
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Moinul Haque
- College of Medicine and Health, University College Cork, Cork, Ireland
| | - Jinpeng Zhuang
- Department of Orthopedic Surgery, Harbin Medical University-the Second Affiliated Hospital, Harbin, China
| | - Changlong Zhou
- Department of Orthopedic Surgery, Harbin Medical University-the Second Affiliated Hospital, Harbin, China
| | - Jianing Zu
- Department of Orthopedic Surgery, Harbin Medical University-the Second Affiliated Hospital, Harbin, China
| | - Xuefeng Li
- Department of Orthopedic Surgery, Harbin Medical University-the Second Affiliated Hospital, Harbin, China
| | - Jinglong Yan
- Department of Orthopedic Surgery, Harbin Medical University-the Second Affiliated Hospital, Harbin, China.
| |
Collapse
|
9
|
Pediatric craniocervical fusion: predictors of surgical outcomes, risk of recurrence, and re-operation. Childs Nerv Syst 2022; 38:1531-1539. [PMID: 35511272 DOI: 10.1007/s00381-022-05541-4] [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] [Received: 11/11/2021] [Accepted: 04/22/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Craniocervical junction abnormalities include a wide variety of disorders and can be classified into congenital or acquired. This study aimed to review the surgical outcome of pediatric patients who underwent craniocervical and/or atlantoaxial fusion. METHODS This is a retrospective cohort study including all pediatric patients (≤ 18 years) who underwent craniocervical and/or atlantoaxial fusion between 2009 and 2019 at quaternary medical city. RESULTS A total of 25 patients met our criteria and were included in the study. The mean age was 9 years (range: 1-17 years). There was a slight female preponderance (N = 13; 52%). Most patients (N = 16; 64%) had non-trauamatic/chronic causes of craniocervical instability. Most patients presented with neck pain and/or stiffness (N = 14; 56%). Successful fusion of the craniocervical junction was achieved in most patients (N = 21; 84%). Intraoperative complications were encountered in 12% (N = 3) of the patients. Early postoperative complications were observed in five patients (20%). Five patients (20%) experienced long-term complications. Revision was needed in two patients (8%). Older age was significantly associated with higher fusion success rates (p = 0.003). The need for revision surgery rates was significantly higher among younger age group (3.75 ± 2, p = 0.01). CONCLUSIONS The study demonstrates the surgical outcome of craniocervical and/or atlantoaxial fusion in pediatric patients. Successful fusion of the craniocervical junction was achieved in most patients. Significant association was found between older age and successful fusion, and between younger age and need for revision surgery.
Collapse
|
10
|
[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] [Subscribe] [Scholar Register] [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.
Collapse
|
11
|
Klepinowski T, Sagan L. EuroQol-5 dimensions health-related quality of life questionnaire in craniovertebral instability treated with posterior fixation with or without occipital plating: A comparative study with matched datasets. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2022; 13:72-79. [PMID: 35386241 PMCID: PMC8978853 DOI: 10.4103/jcvjs.jcvjs_125_21] [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: 09/27/2021] [Accepted: 10/28/2021] [Indexed: 11/04/2022] Open
Abstract
Objective: Methods: Results: Conclusions:
Collapse
|
12
|
Oswald KA, Deml MC, Heldner MR, Seiffge D, Bigdon SF, Albers CE. Intraoperative color-coded duplex ultrasound for safe surgical reduction of displaced hangman fractures in patients with atypical course of the vertebral artery: A case report of two patients. Trauma Case Rep 2021; 37:100573. [PMID: 34917739 PMCID: PMC8669451 DOI: 10.1016/j.tcr.2021.100573] [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] [Accepted: 12/05/2021] [Indexed: 11/19/2022] Open
Abstract
An atypical course of the vertebral artery can be medically relevant in displaced Hangman fractures, especially if the artery course runs within the fracture gap of the C2 isthmus. During surgical reduction, the artery can be occluded inside the fracture, potentially leading to ischemic conditions of the brain. The aim of this study was to report two cases according to the CARE (case reporting) guidelines, in which intraoperative color-coded duplex-ultrasound was performed to secure safe surgical reduction of hangman fractures in two patients with an atypical course of the vertebral artery. Two patients with displaced hangman fractures (Effendi-Levine type II) were diagnosed with an atypical course of the vertebral artery running inside the fracture gap. This endangered safe surgical management with the risk of iatrogenic occlusion or injury during reduction through entrapment of the vessel inside the fracture gap. Therefore, an intraoperative color-coded duplex-ultrasound of the vertebral artery was conducted before and after reduction of the fracture, as well as at the end of the surgery. The surgical treatment in both cases included posterior unilateral spondylodesis, followed by anterior cervical discectomy and fusion (ACDF). In both patients, a safe reduction of the fracture was performed. Neither occlusion nor dissection of the vertebral artery occurred. The duplex ultrasound before and after reduction, and at the end of the procedure showed normal blood flow and morphology of both vertebral arteries. At follow-up examinations, the patients showed a favorable clinical outcome, radiographic signs of fusion, and no irregularity of the vertebral arteries. This case report serves as proof-of-concept, demonstrating the feasibility of this regimen to minimize the risk of entrapment or occlusion of the vertebral artery in the surgical management of displaced Hangman fractures with atypical course of the vertebral artery running inside the fracture gap.
Collapse
Affiliation(s)
- Katharina A.C. Oswald
- Department of Orthopaedic Surgery & Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Corresponding author at: Department of Orthopaedic Surgery & Traumatology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland.
| | - Moritz C. Deml
- Department of Orthopaedic Surgery & Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mirjam R. Heldner
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - David Seiffge
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sebastian F. Bigdon
- Department of Orthopaedic Surgery & Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph E. Albers
- Department of Orthopaedic Surgery & Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
13
|
Zileli M, Akıntürk N. Commentary: Transarticular Fixation Following Mobilization of "High-Riding" Vertebral Artery. Oper Neurosurg (Hagerstown) 2021; 21:E61-E62. [PMID: 33822138 DOI: 10.1093/ons/opab082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 01/31/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mehmet Zileli
- Ege University Neurosurgery Department, Izmir, Turkey
| | | |
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
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.
Collapse
|
16
|
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.
Collapse
|