Prevalence of High-Riding Vertebral Artery: A Meta-Analysis of the Anatomical Variant Affecting Choice of Craniocervical Fusion Method and Its Outcome

Klepinowski, Tomasz; Pala, Bartłomiej; Cembik, Jagoda; Sagan, Leszek

doi:10.1016/j.wneu.2020.07.182

Cited by 21 publications

(17 citation statements)

References 29 publications

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“…This erodes the isthmus, rendering it insufficient in terms of screw placement. Evident cervical erosions in conventional radiographs are noticed in 16% of RA patients at 9-year follow-up [2] but much more often in CT scans [8].…”

Section: Presumed Pathophysiology Explaining the Findingsmentioning

confidence: 99%

“…Modality of imaging used to diagnose HRVA is usually computed tomography angiograms (CTA). The overall prevalence of HRVA in general population is 25,3% [8]. It is speculated that in RA it might be higher, approximately 42,9% [8].…”

Section: Introductionmentioning

confidence: 98%

“…Mainly, its anomalies are rather congenital than acquired [20]. However, recent data suggests that one of its variants, namely high-riding vertebral artery, might be more common in patients with RA [8]. High-riding vertebral artery (HRVA) is defined as internal height of C2 ≤ 2 mm and/or C2 isthmus height ≤ 5 mm measured at the level 3 mm lateral to the border of spinal canal [16].…”

Section: Introductionmentioning

confidence: 99%

“…High-riding vertebral artery (HRVA) is defined as internal height of C2 ≤ 2 mm and/or C2 isthmus height ≤ 5 mm measured at the level 3 mm lateral to the border of spinal canal [16]. Identification of HRVA is crucial before approaching craniocervical junction fusion, as it determines a surgical method [8]. Modality of imaging used to diagnose HRVA is usually computed tomography angiograms (CTA).…”

Section: Introductionmentioning

confidence: 99%

“…The overall prevalence of HRVA in general population is 25,3% [8]. It is speculated that in RA it might be higher, approximately 42,9% [8]. The literature, though, is not unanimous, with some papers stating to the contrary [10], and relative risk (RR) has not been estimated yet.…”

Section: Introductionmentioning

confidence: 99%

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Risk of the high-riding variant of vertebral arteries at C2 is increased over twofold in rheumatoid arthritis: a meta-analysis

2020

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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.

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Section: Presumed Pathophysiology Explaining the Findingsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%