Posterior C1 Stabilization Using Superior Lateral Mass as an Entry Point in a Case With Vertebral Artery Anomaly: Technical Case Report

2011 ◽  
Vol 68 (suppl_1) ◽  
pp. onsE246-onsE249 ◽  
Author(s):  
Jae Taek Hong ◽  
Woo Young Jang ◽  
Il Sup Kim ◽  
Seung Ho Yang ◽  
Jae Hoon Sung ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Vertebral Artery ◽  
Computed Tomography Angiography ◽  
Anatomical Variations ◽  
Entry Point ◽  
Screw Placement ◽  
Lateral Mass ◽  
Starting Point ◽  
Bursting Fracture ◽  
The Right

Abstract BACKGROUND AND IMPORTANCE: This is the first report of using the superior lateral mass as an alternative starting point for C1 posterior screw placement, demonstrating the importance of recognizing vertebral artery (VA) anomaly in deciding the surgical strategy for C1 screw placement. CLINICAL PRESENTATION: A 56-year-old man presented with severe neck pain after a fall. Imaging demonstrated an unstable bursting fracture at C4, C1-2 instability, and a subluxation at C2-3. Computed tomography angiography indicated that the persistent first intersegmental artery was located on the left side. The patient underwent anterior-posterior cervical fixation and fusion. Posterior C1 fixation was done with polyaxial screw rod construct using C1 superior lateral mass on the left side and C1 inferior lateral mass on the right side. The patient had no immediate postoperative deficits. At the 8-month follow-up examination, the patient was neurologically intact with a solid cervical fusion. CONCLUSION: The third segment of the VA is heterogeneous; therefore, preoperative radiologic studies should be performed to identify any anatomical variations. Using preoperative 3-dimensional computed tomography angiography, we can precisely identify an anomalous VA, thereby significantly reducing the risk of VA injury. To avoid significant morbidities associated with VA injury, a more optimal entry point for C1 fixation can be selected if a persistent first intersegmental artery or fenestrated VA is detected.

scholarly journals Posterior arch C-1 screw technique: a cadaveric comparison study

2017 ◽  
Vol 26 (6) ◽  
pp. 679-683 ◽  
Author(s):  
Marc Moisi ◽  
Christian Fisahn ◽  
Lara Tkachenko ◽  
Shiveindra Jeyamohan ◽  
Stephen Reintjes ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Nerve Root ◽  
Access Point ◽  
Screw Placement ◽  
Posterior Arch ◽  
Lateral Mass ◽  
Entry Site ◽  
Starting Point ◽  
The Right

OBJECTIVEPosterior atlantoaxial stabilization and fusion using C-1 lateral mass screw fixation has become commonly used in the treatment of instability and for reconstructive indications since its introduction by Goel and Laheri in 1994 and modification by Harms in 2001. Placement of such lateral mass screws can be challenging because of the proximity to the spinal cord, vertebral artery, an extensive venous plexus, and the C-2 nerve root, which overlies the designated starting point on the posterior center of the lateral mass. An alternative posterior access point starting on the posterior arch of C-1 could provide a C-2 nerve root–sparing starting point for screw placement, with the potential benefit of greater directional control and simpler trajectory. The authors present a cadaveric study comparing an alternative strategy (i.e., a C-1 screw with a posterior arch starting point) to the conventional strategy (i.e., using the lower lateral mass entry site), specifically assessing the safety of screw placement to preserve the C-2 nerve root.METHODSFive US-trained spine fellows instrumented 17 fresh human cadaveric heads using the Goel/Harms C-1 lateral mass (GHLM) technique on the left and the posterior arch lateral mass (PALM) technique on the right, under fluoroscopic guidance. After screw placement, a CT scan was obtained on each specimen to assess for radiographic screw placement accuracy. Four faculty spine surgeons, blinded to the surgeon who instrumented the cadaver, independently graded the quality of screw placement using a modified Upendra classification.RESULTSOf the 17 specimens, the C-2 nerve root was anatomically impinged in 13 (76.5%) of the specimens. The GHLM technique was graded Type 1 or 2, which is considered “acceptable,” in 12 specimens (70.6%), and graded Type 3 or 4 (“unacceptable”) in 5 specimens (29.4%). In contrast, the PALM technique had 17 (100%) of 17 graded Type 1 or 2 (p = 0.015). There were no vertebral artery injuries found in either technique. All screw violations occurred in the medial direction.CONCLUSIONSThe PALM technique showed statistically fewer medial penetrations than the GHLM technique in this study. The reason for this is not clear, but may stem from a more angulated ”up-and-in” screw direction necessary with a lower starting point.

Ascending pharyngeal-vertebral anastomosis demonstrated by computed tomography angiography of the ascending pharyngeal artery: a case report

2011 ◽  
Vol 52 (9) ◽  
pp. 951-953
Author(s):  
Yukihisa Sato ◽  
Nobuo Kashiwagi ◽  
Katsuyuki Nakanishi ◽  
Kunitoshi Yoshino ◽  
Noriyuki Tomiyama1
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Carotid Artery ◽  
Vertebral Artery ◽  
Head And Neck ◽  
Computed Tomography Angiography ◽  
Ascending Pharyngeal Artery ◽  
Neck Area ◽  
Intracranial Arteries ◽  
The Right

Ascending pharyngeal-vertebral anastomosis has been identified by angiography of the carotid artery in several cases. We present a case of ascending pharyngeal-vertebral anastomosis that was found incidentally in computed tomography angiography of the ascending pharyngeal artery. Images revealed that the anastomosis formed through the hypoglossal branch of the neuromeningeal trunk. The anastomosis seemed to be associated with hypoplasia of the right vertebral artery. Interventional radiologists should be aware of this dangerous anastomotic route of the APA to the VA. Discovery of hypoplasia of the major intracranial arteries before intra-arterial chemotherapy or embolization in head and neck area may avoid subsequent complications.

Morphometric Anatomy of the Posterior Aspect of the Atlas and the Vertebral Artery Groove in Relation to Lateral Mass Screw Placement

2021 ◽  
Author(s):  
Selda Aksoy ◽  
Bulent Yalcin
Keyword(s):  
Vertebral Artery ◽  
Screw Placement ◽  
Atlantoaxial Instability ◽  
Posterior Arch ◽  
Lateral Mass ◽  
Lateral Mass Screw ◽  
Entry Zone ◽  
Mean Width ◽  
The Mean ◽  
The Right

Abstract Background Atlantoaxial instability is an important disorder that causes serious symptoms such as difficulties in walking, limited neck mobility, sensory deficits, etc. Atlantal lateral mass screw fixation is a surgical technique that has gained important recognition and popularity. Because accurate drilling area for screw placement is of utmost importance for a successful surgery, we aimed to investigate morphometry of especially the posterior part of C1. Methods One hundred and fifty-eight human adult C1 dried vertebrae were obtained. Measurements were performed directly on dry atlas vertebrae, and all parameters were measured by using a digital caliper accurate to 0.01 mm for linear measurements. Results The mean distance between the tip of the posterior arch and the medial inner edge of the groove was found to be 10.59 ± 2.26 and 10.49 ± 2.20 mm on the right and left, respectively. The mean distance between the tip of the posterior arch and the anterolateral outer edge of the groove was 21.27 ± 2.28 mm (right: 20.96 ± 2.22 mm; left: 21.32 ± 2.27 mm). The mean height of the screw entry zone on the right and left sides, respectively, were 3.86 ± 0.81 and 3.84 ± 0.77 mm. The mean width of the screw entry zone on both sides was 13.15 ± 1.17 and 13.25 ± 1.3 mm. Conclusion Our result provided the literature with a detailed database for the morphometry of C1, especially in relation to the vertebral artery groove. We believe that the data in the present study can help surgeons to adopt a more accurate approach in terms of accurate lateral mass screw placement in atlantoaxial instability.

Anatomical Variations and Dimension of the Intracranial Vertebral Artery: Evaluation With Multidetector Computed Tomography Angiography

2021 ◽  
Author(s):  
Bukola Omotoso ◽  
Rohen Harrichandparsad ◽  
Kapil Satyapal ◽  
Indheresan Moodley ◽  
Lelika Lazarus
Keyword(s):  
Computed Tomography ◽  
Vertebral Artery ◽  
Multidetector Computed Tomography ◽  
South African ◽  
Basilar Artery ◽  
Computed Tomography Angiography ◽  
Anatomical Variation ◽  
Posterior Inferior Cerebellar Artery ◽  
Anatomical Variations ◽  
Multidetector Computed Tomography Angiography

Abstract The intracranial segment of the vertebral artery (VA) is the unique part of the artery where the two VAs join to form a single vascular channel, viz. the basilar artery. In addition to this typical description, anatomical variations have been described; the presence of anatomical variation has been associated with some pathological processes, neurological complications, and the risk of vascular diseases in the posterior circulatory territory. We evaluated the typical anatomical features and variations of the VA4 component of the VA in a South African population to provide useful data on the prevalence of variation and morphometry of the distal VA. The study is an observational, retrospective chart review of 554 consecutive South African patients (Black, Indian, and White) who had been examined with multidetector computed tomography angiography (MDCTA) from January 2009 to September 2019. We observed various anatomical variations in the VA4 segment of the VA. We report the incidence of VA hypoplasia, hypoplastic terminal VA, and atresia. Fenestration and duplicate posterior inferior cerebellar artery (PICA) origin were also observed. The left intracranial VA was significantly larger than the right. Our study shows that anatomical variation of the intracranial VA is common in the population studied, with a total prevalence of 36.5%. Imaging of the entire course of the VA from the origin to the point of convergence to form the basilar artery may be necessary to decide a treatment strategy for interventions in the vicinity of the VA.

scholarly journals Computed tomography angiography study of variations of the celiac trunk and hepatic artery in 100 patients

2018 ◽  
Vol 51 (1) ◽  
pp. 32-36 ◽  
Author(s):  
Ivelise Regina Canito Brasil ◽  
Igor Farias de Araujo ◽  
Adriana Augusta Lopes de Araujo Lima ◽  
Ernesto Lima Araujo Melo ◽  
Ronaldo de Matos Esmeraldo
Keyword(s):  
Computed Tomography ◽  
Hepatic Artery ◽  
Computed Tomography Angiography ◽  
Celiac Trunk ◽  
Anatomical Variations ◽  
Classification Systems ◽  
Proper Hepatic Artery ◽  
The Common ◽  
One Year ◽  
The Right

Abstract Objective: To describe the main anatomical variations of the celiac trunk and the hepatic artery at their origins. Materials and Methods: This was a prospective analysis of 100 consecutive computed tomography angiography studies of the abdomen performed during a one-year period. The findings were stratified according to classification systems devised by Sureka et al. and Michels. Results: The celiac trunk was "normal" (i.e., the hepatogastrosplenic trunk and superior mesenteric artery originating separately from the abdominal aorta) in 43 patients. In our sample, we identified four types of variations of the celiac trunk. Regarding the hepatic artery, a normal anatomical pattern (i.e., the proper hepatic artery being a continuation of the common hepatic artery and bifurcating into the right and left hepatic arteries) was seen in 82 patients. We observed six types of variations of the hepatic artery. Conclusion: We found rates of variations of the hepatic artery that are different from those reported in the literature. Our findings underscore the need for proper knowledge and awareness of these anatomical variations, which can facilitate their recognition and inform decisions regarding the planning of surgical procedures, in order to avoid iatrogenic intraoperative injuries, which could lead to complications.

Factors affecting lateral mass screw placement at C-7

2011 ◽  
Vol 14 (3) ◽  
pp. 405-411 ◽  
Author(s):  
Kalil G. Abdullah ◽  
Amy S. Nowacki ◽  
Michael P. Steinmetz ◽  
Jeffrey C. Wang ◽  
Thomas E. Mroz
Keyword(s):  
Sagittal Plane ◽  
Anatomical Variation ◽  
Axial Plane ◽  
Screw Placement ◽  
Lateral Mass ◽  
Lateral Mass Screw ◽  
Modified Technique ◽  
Modified Method ◽  
Starting Point ◽  
Lateral Mass Screws

Object The C-7 lateral mass has been considered difficult to fit with instrumentation because of its unique anatomy. Of the methods that exist for placing lateral mass screws, none particularly accommodates this anatomical variation. The authors have related 12 distinct morphological measures of the C-7 lateral mass to the ability to place a lateral mass screw using the Magerl, Roy-Camille, and a modified Roy-Camille method. Methods Using CT scans, the authors performed virtual screw placement of lateral mass screws at the C-7 level in 25 male and 25 female patients. Complications recorded included foraminal and articular process violations, inability to achieve bony purchase, and inability to place a screw longer than 6 mm. Violations were monitored in the coronal, axial, and sagittal planes. The Roy-Camille technique was applied starting directly in the middle of the lateral mass, as defined by Pait's quadrants, with an axial angle of 15° lateral and a sagittal angle of 90°. The Magerl technique was performed by starting in the inferior portion of the top right square of Pait's quadrants and angling 25° laterally in the axial plane with a 45° cephalad angle in the sagittal plane. In a modified method, the starting point is similar to the Magerl technique in the top right square of Pait's quadrant and then angling 15° laterally in the axial plane. In the sagittal plane, a 90° angle is taken perpendicular to the dorsal portion of the lateral mass, as in the traditional Roy-Camille technique. Results Of all the morphological methods analyzed, only a combined measure of intrusion of the T-1 facet and the overall length of the C-7 lateral mass was statistically associated with screw placement, and only in the Roy-Camille technique. Use of the Magerl technique allowed screw placement in 28 patients; use of the Roy-Camille technique allowed placement in 24 patients; and use of the modified technique allowed placement in 46 patients. No screw placement by any method was possible in 4 patients. Conclusions There is only one distinct anatomical ratio that was shown to affect lateral mass screw placement at C-7. This ratio incorporates the overall length of the lateral mass and the amount of space occupied by the T-1 facet at C-7. Based on this virtual study, a modified Roy-Camille technique that utilizes a higher starting point may decrease the complication rate at C-7 by avoiding placement of the lateral mass screw into the T1 facet.

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