C1-2 Fixation Approach for Patients With Vascular Irregularities: A Case Report

In posterior spinal fusion (PSF), the vertebral artery is most vulnerable to injury at C1-2. C2 pedicle screws are often placed into the dorsomedial isthmus of C2. Alternative techniques include C2 laminar screws and wiring techniques. A 67-year-old male underwent PSF for persistent severe intractable neck pain and degeneration at C1-2. The patient had an enlarged left vertebral artery with midline migration into the C2 body. This pattern was within one standard deviation of normal; however, it rendered typical placement of a C2 pedicle screw unsafe. As a salvage, a C2 laminar screw was placed on the left to avoid risk of vertebral artery injury. The operation and recovery were without complication. C2 laminar screws can be viable alternatives to C2 pedicle screws in cases of midline vertebral artery migration or other vascular anomalies preventing normal safe placement of C2 pedicle screws.

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Combined anomalous origin of a left inferior thyroid artery and a left vertebral artery: a case report

Cases Journal ◽

10.1186/1757-1626-2-7400 ◽

2009 ◽

Vol 2 (1) ◽

pp. 7400 ◽

Cited By ~ 2

Author(s):

Konstantinos Natsis ◽

Matthaios Didagelos ◽

Georgios Noussios ◽

Aspasia Adamopoulou ◽

Elisavet Nikolaidou ◽

...

Keyword(s):

Case Report ◽

Vertebral Artery ◽

Inferior Thyroid Artery ◽

Anomalous Origin ◽

Left Vertebral Artery

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Duplication of the left vertebral artery in a patient with dissection of the right internal carotid artery and Ehlers–Danlos syndrome: case report and review of the literature

Anatomical Science International ◽

10.1007/s12565-012-0152-z ◽

2012 ◽

Vol 88 (2) ◽

pp. 109-114 ◽

Cited By ~ 6

Author(s):

Michał Polguj ◽

Kazimierz Jędrzejewski ◽

Mirosław Topol ◽

Julia Wieczorek-Pastusiak ◽

Agata Majos

Keyword(s):

Case Report ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Vertebral Artery ◽

Internal Carotid ◽

Left Vertebral Artery ◽

Review Of The Literature ◽

Ehlers Danlos Syndrome ◽

The Right ◽

Danlos Syndrome

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Treatment of Upper Cervical Spinal Cord Injury (Unstable C1-C2) by Direct Visualization and Nailing Technique and the Advantages of Early MRI

Journal of Healthcare Engineering ◽

10.1155/2021/4562618 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Jamal Alshorman ◽

Lian Zeng ◽

Yulong Wang ◽

Fengzhao Zhu ◽

Kaifang Chen ◽

...

Keyword(s):

Vertebral Artery ◽

Pedicle Screw ◽

Posterior Approach ◽

Cervical Spinal Cord ◽

Pedicle Screws ◽

Atlantoaxial Joint ◽

Direct Visualization ◽

Neck Movement ◽

Screw Insertion ◽

Cord Injury

Background. The treatment of C1-C2 fractures mainly depends on fracture type and the stability of the atlantoaxial joint. Disruption of the C1-C2 combination is a big challenge, especially in avoiding vertebral artery, nerve, and vein sinus injury during the operation. Purpose. This study aims to show the benefit of using the posterior approach and pedicle screw insertion by nailing technique and direct visualization to treat unstable C1-C2 and, moreover, to determine the advantages of performing early MRI in patients with limited neck movement after trauma. Method. Between Jan 2017–Feb 2019, we present 21 trauma patients who suffered from C1, C2, or unstable atlantoaxial joint. X-ray, computed tomography (CT), and magnetic resonance image (MRI) were performed preoperatively. All the patients underwent our surgical procedure (posterior approach and pedicle screw placement by direct visualization and nailing technique). Result. The mean age was 41.1 years old, 8 females and 14 males. The average follow-up time was 2.6 years. Four patients were with C1 fracture, seven with C2 fracture, six with atlantoaxial dislocation, and four with C1 and C2 fractures. The time of MRI was between 12 hours and 48 hours; neck movement symptoms appeared between 2 days and 2 weeks. Conclusion. The posterior approach to treat the C1 and C2 fractures or dislocation by direct visualization and nailing technique can reduce the risk of the vertebral artery, vein sinus, and nerve root injuries with significant improvement. It can show a better angle view while inserting the pedicle screws. An early MRI (12–48 hours) is essential even if no symptoms appear at the time of admission, and if it is normal, it is necessary to repeat it. The presence of skull bleeding can be associated with upper neck instability.

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Traumatic Vertebral Artery Dissection and Basilar Artery Occlusion/Stroke in a 7-Year-Old Child: A Case Report

Journal of Pediatric Intensive Care ◽

10.1055/s-0039-1692670 ◽

2019 ◽

Vol 08 (04) ◽

pp. 233-237

Author(s):

Binh Phung ◽

Trusha Shah

Keyword(s):

Case Report ◽

Vertebral Artery ◽

Basilar Artery ◽

Vertebral Artery Dissection ◽

Artery Occlusion ◽

Basilar Artery Occlusion ◽

Left Vertebral Artery ◽

Artery Dissection ◽

Life Threatening ◽

Computed Tomography Angiogram

AbstractVertebral artery dissection (VAD) followed by basilar artery occlusion/stroke (BAO/BAS) is a rare but potentially life-threatening complication. We present a case report of a 7-year-old boy with VAD complicated by BAO/BAS 4 days after falling off a scooter. Symptoms included left-sided weakness and facial droop preceded by a 20-minute episode of altered sensorium. Magnetic resonance imaging showed ischemic changes in the left posterior inferior cerebellum and right pons. Computed tomography angiogram confirmed dissection of the left vertebral artery with occlusion/thrombosis of the basilar artery. Heparinization for 96 hours, followed by 6 months of low-molecular weight heparin injection, resulted in improvement of his neurological symptoms.

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Right Vertebral Artery Transection With a Vertical Distraction of C5-6: Case Report of a Patient Survival

The American Surgeon ◽

10.1177/0003134820919725 ◽

2020 ◽

Vol 86 (5) ◽

pp. 531-533

Author(s):

Jared Griffard ◽

Reagan Bollig

Keyword(s):

Spinal Cord ◽

Case Report ◽

Vertebral Artery ◽

Spinal Cord Injuries ◽

Patient Survival ◽

Multidisciplinary Treatment ◽

Vertebral Artery Dissection ◽

Spinal Column ◽

Left Vertebral Artery ◽

Artery Dissection

Spinal column injuries are very commonly diagnosed in the multitrauma population, and extensive distraction injuries are often fatal due to cerebrovascular injuries or spinal cord injuries. We present a 62-year-old female who presented after an MVC with a 2-cm vertical distraction injury of C5-6 with a right vertebral artery transection and left vertebral artery dissection. She received multidisciplinary treatment which resulted in her survival, albeit with severe neurologic deficits. We challenge the current literature that suggests a blunt vertebral artery transection is 100% fatal.

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Bilateral Internal Carotid and Left Vertebral Artery Dissection after Blunt Trauma: A Case Report and Literature Review

Neurologia medico-chirurgica ◽

10.2176/nmc.cr.2018-0239 ◽

2019 ◽

Vol 59 (4) ◽

pp. 154-161 ◽

Cited By ~ 1

Author(s):

Kenichi ARIYADA ◽

Keita SHIBAHASHI ◽

Hidenori HODA ◽

Shinta WATANABE ◽

Masahiro NISHIDA ◽

...

Keyword(s):

Case Report ◽

Literature Review ◽

Vertebral Artery ◽

Blunt Trauma ◽

Internal Carotid ◽

Vertebral Artery Dissection ◽

Left Vertebral Artery ◽

Artery Dissection

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Recurrence of a Vertebral Artery Dissecting Pseudoaneurysm after Successful Stent-supported Coil Embolization: Case Report

Neurosurgery ◽

10.1227/01.neu.0000080065.49651.48 ◽

2003 ◽

Vol 53 (3) ◽

pp. 754-761 ◽

Cited By ~ 67

Author(s):

Christopher I. MacKay ◽

Patrick P. Han ◽

Felipe C. Albuquerque ◽

Cameron G. McDougall

Keyword(s):

Subarachnoid Hemorrhage ◽

Neck Pain ◽

Vertebral Artery ◽

Coil Embolization ◽

Artery Aneurysm ◽

Left Vertebral Artery ◽

Parent Vessel ◽

Computed Tomographic ◽

Computed Tomographic Scan

Abstract OBJECTIVE AND IMPORTANCE Dissecting aneurysms of the intracranial vertebral artery are increasingly recognized as a cause of subarachnoid hemorrhage. We present a case involving technical success of the stent-supported coil embolization but with recurrence of the dissecting pseudoaneurysm of the intracranial vertebral artery. The implications for the endovascular management of ruptured dissecting pseudoaneurysms of the intracranial vertebral artery are discussed. CLINICAL PRESENTATION A 36-year-old man with a remote history of head injury had recovered functionally to the point of independent living. He experienced the spontaneous onset of severe head and neck pain, which progressed rapidly to obtundation. A computed tomographic scan of the head revealed subarachnoid hemorrhage centered in the posterior fossa. The patient underwent cerebral angiography, which revealed dilation of the distal left vertebral artery consistent with a dissecting pseudoaneurysm. INTERVENTION Transfemoral access was achieved under general anesthesia, and two overlapping stents (3 mm in diameter and 14 mm long) were placed to cover the entire dissected segment. Follow-up angiography of the left vertebral artery showed the placement of the stents across the neck of the aneurysm; coil placement was satisfactory, with no residual aneurysm filling. Approximately 6 weeks after the patient's initial presentation, he developed the sudden onset of severe neck pain. A computed tomographic scan showed no subarachnoid hemorrhage, but computed tomographic angiography revealed that the previously treated left vertebral artery aneurysm had recurred. Angiography confirmed a recurrent pseudoaneurysm around the previously placed Guglielmi detachable coils. A test balloon occlusion was performed for 30 minutes. The patient's neurological examination was stable throughout the test occlusion period. Guglielmi detachable coil embolization of the left vertebral artery was then performed, sacrificing the artery at the level of the dissection. After the procedure was completed, no new neurological deficits occurred. On the second day after the procedure, the patient was discharged from the hospital. He was alert, oriented, and able to walk. CONCLUSION We appreciate the value of preserving a parent vessel when a dissecting pseudoaneurysm of the intracranial vertebral artery ruptures in patients with inadequate collateral blood flow, in patients with disease involving the contralateral vertebral artery, or in patients with both. However, our case represents a cautionary note that patients treated in this fashion require close clinical follow-up. We suggest that parent vessel occlusion be considered the first option for treatment in patients who will tolerate sacrifice of the parent vessel along its diseased segment. In the future, covered stent technology may resolve this dilemma for many of these patients.

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Duplicated Origin of the Left Vertebral Artery: A Case Report and Embryological Review

Neurointervention ◽

10.5469/neuroint.2016.11.1.50 ◽

2016 ◽

Vol 11 (1) ◽

pp. 50 ◽

Cited By ~ 5

Author(s):

Seunguk Jung ◽

Cheolkyu Jung ◽

Yun Jung Bae ◽

Byung Se Choi ◽

Jae Hyoung Kim

Keyword(s):

Case Report ◽

Vertebral Artery ◽

Left Vertebral Artery

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C2 medial pedicle screw: a novel “in-out-in” technique as an alternative option for posterior C2 fixation in cases with a narrow C2 isthmus

Journal of Neurosurgery Spine ◽

10.3171/2020.2.spine191517 ◽

2020 ◽

Vol 33 (3) ◽

pp. 281-287

Author(s):

Yue-Qi Du ◽

Yi-Heng Yin ◽

Guang-Yu Qiao ◽

Xin-Guang Yu

Keyword(s):

Vertebral Artery ◽

Pedicle Screw ◽

Clinical Outcomes ◽

Pedicle Screws ◽

Vertebral Artery Injury ◽

Rigid Fixation ◽

Complication Rates ◽

Artery Injury ◽

Alternative Option ◽

Inner Cortex

OBJECTIVEThe authors describe a novel “in-out-in” technique as an alternative option for posterior C2 screw fixation in cases that involve narrow C2 isthmus. Here, they report the preliminary radiological and clinical outcomes in 12 patients who had a minimum 12-month follow-up period.METHODSTwelve patients with basilar invagination and atlantoaxial dislocation underwent atlantoaxial reduction and fixation. All patients had unilateral hypoplasia of the C2 isthmus that prohibited insertion of pedicle screws. A new method, the C2 medial pedicle screw (C2MPS) fixation, was used as an alternative. In this technique, the inner cortex of the narrow C2 isthmus was drilled to obtain space for screw insertion, such that the lateral cortex could be well preserved and the risk of vertebral artery injury could be largely reduced. The C2MPS traveled along the drilled inner cortex into the anterior vertebral body, achieving a 3-column fixation of the axis with multicortical purchase.RESULTSSatisfactory C2MPS placement and reduction were achieved in all 12 patients. No instance of C2MPS related vertebral artery injury or dural laceration was observed. There were no cases of implant failure, and solid fusion was demonstrated in all patients.CONCLUSIONSThis novel in-out-in technique can provide 3-column rigid fixation of the axis with multicortical purchase. Excellent clinical outcomes with low complication rates were achieved with this technique. When placement of a C2 pedicle screw is not possible due to anatomical constraints, the C2MPS can be considered as an efficient alternative.

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