Morphologic Changes in the Vertebral Artery Subsequent to Cervical Spine Degeneration and Aging: Analyses by Computed Tomography Angiography Using Multiplanar and 3-Dimensional Reconstructions

Ohnishi, Takashi; Suda, Kota; Komatsu, Miki; Harmon, Satoko Matsumoto; Watanabe, Takahiro; Asukai, Mitsuru; Kadoya, Ken; Takahata, Masahiko; Iwasaki, Norimasa; Minami, Akio

doi:10.1016/j.wneu.2021.03.080

Cited by 2 publications

(3 citation statements)

References 20 publications

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“…From prior studies, it is expected that older patients with more degeneration would lead to higher rates of VAI, but our data determined there was not an increased incidence of VAI in older patients. 9 Spinal degeneration may influence a VAI, but potential hypotheses for the opposite finding include the degree of musculoskeletal tissue strength during dissection, neck circumference, and retraction-based difficulties to afford adequate exposure. Imaging studies for patients are not available through the database, and therefore, it was impossible to determine the extent of spinal degeneration.…”

Section: Discussionmentioning

confidence: 99%

“… 16 Osteophytes change the anatomy of the spine, which causes the corpectomy procedure to be more difficult with their presence. 9 Therefore, males with osteophytes are at an increased risk of damage to additional anatomical structures. Alternatively, women have less muscle mass and smaller body dimensions, which allows the surgeon to navigate their anatomy without excess force.…”

Section: Discussionmentioning

confidence: 99%

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Risk Factors, Incidence and Mortality of Vertebral Artery Injury in Patients Undergoing Anterior Cervical Corpectomy: A Retrospective Large National Data Base Study

Godil

Smith

Wright

et al. 2022

Global Spine Journal

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Study Design Retrospective Cohort Study Objective To determine the incidence of vertebral artery injury (VAI), risk factors, intervention, associated complications, and mortality in patients undergoing anterior cervical corpectomy. Methods We performed a retrospective review of the incidence of VAI during anterior cervical corpectomy using the PearlDiver database from 2010-2017. The CPT code 63 081 to identify corpectomy patients. Patient data extracted included, incidence of VAI, demographic factors, intervention, and future complications of death and stroke. The risk were calculated compared with those patients who did not have VAI. Results 26 126 patients were identified to have undergone cervical corpectomy. Multivariate analysis of risk factors showed that younger age and male sex were associate with higher rate of injury (t = -11.5; P < .0001 and t = 3.8; P = .0001, respectively). Vertebral artery injuries occurred in 78 patients at an incidence of .3%. 11 (14%) VAI patients had a cerebral infarction compared with 1705 (7%) for non-VAI patients (OR = 2.13; 95% CI = [1.18 – 3.85; P = .0179]) during the follow up period. 1-year mortality rates were higher in patients who suffered a VAI (14%) compared to those who did not suffer a VAI (4%; OR = 3.85; CI = [2.04 – 7.14]; P < .0001). Conclusion Consequence of VAI may not be known for months following the injury. Although the same admission mortality is rare with this injury, there is a significant increase in post-discharge complications. This study suggests that further investigations into long term health risk of VAI is needed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Risk Factors, Incidence and Mortality of Vertebral Artery Injury in Patients Undergoing Anterior Cervical Corpectomy: A Retrospective Large National Data Base Study

Godil

Smith

Wright

et al. 2022

Global Spine Journal

View full text Add to dashboard Cite

show abstract

“…The study was limited to ages <50 years given evidence of arterial tortuosity as a biomarker in young populations but with less discrimination in older subjects because of development of tortuosity with aging. 9 , 16 Subjects being evaluated at TCH for the retrospective cohort (cohort 2) were identified using an electronic medical record query identifying patients seen between January 1, 1990, and December 1, 2021. Among patients in cohort 2, those who were contactable were consented prospectively and recruited for additional evaluation, including a research history and physical exam (and were included with those in cohort 1).…”

Section: Methodsmentioning

confidence: 99%

Vertebral Tortuosity Is Associated With Increased Rate of Cardiovascular Events in Vascular Ehlers‐Danlos Syndrome

Stephens,

Shalhub,

Dodd

et al. 2023

JAHA

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Background Arterial tortuosity is associated with adverse events in Marfan and Loeys‐Dietz syndromes but remains understudied in Vascular Ehlers‐Danlos syndrome. Methods and Results Subjects with a pathogenic COL3A1 variant diagnosed at age <50 years were included from 2 institutions and the GenTAC Registry (National Registry of Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions). Height‐adjusted vertebral artery tortuosity index (VTI‐h) using magnetic resonance or computed tomography angiography was calculated. Associations between VTI‐h and outcomes of (1) cardiovascular events (arterial dissection/rupture, aneurysm requiring intervention, stroke), or (2) hollow organ collapse/rupture at age <50 years were evaluated using receiver operator curve analysis (using outcome by age 30 years) and mixed‐effects Poisson regression for incidence rate ratios. Of 65 subjects (54% male), median VTI‐h was 12 (interquartile range, 8–16). Variants were missense in 46%, splice site in 31%, and null/gene deletion in 14%. Thirty‐two subjects (49%) had 59 events, including 28 dissections, 5 arterial ruptures, 4 aneurysms requiring intervention, 4 strokes, 11 hollow organ ruptures, and 7 pneumothoraces. Receiver operator curve analysis suggested optimal discrimination at VTI‐h ≥15.5 for cardiovascular events (sensitivity 70%, specificity 76%) and no association with noncardiovascular events (area under the curve, 0.49 [95% CI, 0.22–0.78]). By multivariable analysis, older age was associated with increased cardiovascular event rate while VTI‐h ≥15.5 was not (incidence rate ratios, 1.79 [95% CI, 0.76–4.24], P =0.185). However, VTI‐h ≥15.5 was associated with events among those with high‐risk variants <40 years (incidence rate ratios, 4.14 [95% CI, 1.13–15.10], P =0.032), suggesting effect modification by genotype and age. Conclusions Increased arterial tortuosity is associated with a higher incidence rate of cardiovascular events in Vascular Ehlers‐Danlos syndrome. Vertebral tortuosity index may be a useful biomarker for prognosis when evaluated in conjunction with genotype and age.

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Morphologic Changes in the Vertebral Artery Subsequent to Cervical Spine Degeneration and Aging: Analyses by Computed Tomography Angiography Using Multiplanar and 3-Dimensional Reconstructions

Cited by 2 publications

References 20 publications

Risk Factors, Incidence and Mortality of Vertebral Artery Injury in Patients Undergoing Anterior Cervical Corpectomy: A Retrospective Large National Data Base Study

Risk Factors, Incidence and Mortality of Vertebral Artery Injury in Patients Undergoing Anterior Cervical Corpectomy: A Retrospective Large National Data Base Study

Vertebral Tortuosity Is Associated With Increased Rate of Cardiovascular Events in Vascular Ehlers‐Danlos Syndrome

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