Transarticular Fixation Following Mobilization of “High-Riding” Vertebral Artery

Goel, Atul; Prasad, Apurva; Shah, Abhidha; Sasane, Sumeet; Hawaldar, Akshay; Biswas, Chandrima; Thomas, Antony

doi:10.1093/ons/opaa456

Cited by 5 publications

(6 citation statements)

References 10 publications

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“…performed this technique in clinical cases. [ 8 ] It was shown for the first time on a cadaver in this study. In cases where C2 corpus is involved, and pedicle screw placement is not possible, such as tumor and infection, VA mobilization and C1-C2 transarticular screw placement technique can provide strong stabilization.…”

Section: Discussionmentioning

confidence: 56%

“…However, the high-riding VA increases the risk of injury while placing the C2 pedicle screw. This risk can be decreased, and safe placement of a screw into the pedicle can be performed by mobilization of the VA[ 8 , 9 ] [Figures 1 and 2a and b ]. Before placement of the screw, the posterior wall of the VA Groove should be drilled or removed by a Kerrison rongeur about 5 mm from lateral to medial.…”

Section: Discussionmentioning

confidence: 99%

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Different C2 screw placement techniques with mobilization of the vertebral artery in high-riding vertebral artery cases: Cadaver dissection

Harman,

Oglin,

Yilmaz

et al. 2023

Journal of Craniovertebral Junction and Spine

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Objective: In neurosurgery, posterior approaches intended at the craniovertebral junction are frequently used. The most popular procedures for treating upper cervical instability are C1 lateral mass, C2 pedicle, and C1-C2 transarticular screw stabilization. Due to their proximity to neural structures and the presence of the high-riding vertebral artery (VA), these techniques are complicated. The risk of VA damage can be decreased by mobilizing the VA. Using cadaveric specimens in this study was aimed to demonstrate C2 pedicle and C1-C2 transarticular screw placement with VA mobilization and a novel C2 inferior corpus screw placement technique. Methods: In this study, twelve adult cadaveric specimens and two adult dry cadaveric C2 bones were used with the permission and decision of the University Research Ethics Committee. Colored silicone was injected into the arteries and veins of these twelve cadaveric specimens. Then, muscle dissection was performed stepwise, and the C2 vertebrae of the cadavers were revealed with a surgical microscope. Each specimen and entire stages of the dissections were recorded photographically. After cadaver dissections, screw placement was performed with three different techniques. Finally, radiological imaging was done with fluoroscopy. Results: After dissection, the lateral mass of the C2 vertebra was observed, and lateral to it, the transverse process and foramen were detected with the help of a hook. Next, the posterior wall of the VA groove was removed using a 1 mm thin plate Kerrison rongeur until the VA loop could partially be observed the VA. This enables us to find the top of the loop of the VA and mobilize it inferiorly using a dissector. Following this step, the C1-2 transarticular, C2 pedicle, and the novel C2 inferior corpus screw placement can be performed safely by directly visualizing the artery. Conclusions: Due to the nearby neurologic and vascular structures, placing the C2 pedicle and C1-2 transarticular screw is a challenging procedure, especially in high-riding VA cases. However, it is possible to place the C2 pedicle, C1-2 transarticular, and novel C2 inferior corpus screw after the mobilization of the VA. This study aimed to show all of them together on a cadaver for the first time, to understand the anatomy of the C2 vertebra, and to use screw placement techniques to minimize the risk of complications.

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Section: Discussionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Different C2 screw placement techniques with mobilization of the vertebral artery in high-riding vertebral artery cases: Cadaver dissection

Harman,

Oglin,

Yilmaz

et al. 2023

Journal of Craniovertebral Junction and Spine

View full text Add to dashboard Cite

show abstract

“…Additionally, Goel performed the VA transposition technique, using two smaller screws for fixation. However, this technique requires a careful separation of the VA, which is difficult to perform [9]. [17,20].…”

Section: Discussionmentioning

confidence: 99%

Application of C2 subfacetal screws for the management of atlantoaxial dislocation in patients with Klippel-Feil syndrome characterized by a narrow C2 pedicle and high-riding vertebral artery

et al. 2022

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Objective This study aims to investigate the clinical application and feasibility of C2 subfacetal screws in patients with Klippel-Feil syndrome (KFS), narrow C2 pedicles, and high-riding vertebral arteries (HRVAs). Methods The clinical data of seven patients with KFS, atlantoaxial dislocation, narrow C2 pedicles, and HRVAs treated with C2 subfacetal screws were analyzed in this retrospective study. The internal height, isthmus height, and pedicle width of C2 vertebra were measured using preoperative computed tomography (CT). Subfacetal screws were inserted for 7 patients (12 sides). The position and length of the screws were observed using postoperative CT. Intraoperative dura mater and vertebral artery (VA) injuries were recorded. Bone fusion was observed using follow-up CT. Results The internal height was 10.5 ± 3.2 mm, the isthmus height was 3.7 ± 1.8 mm, the pedicle width was 3.0 ± 1.4 mm, and the screw length was 19.7 ± 1.5 mm. All patients had HRVAs and narrow pedicles. No injury to the dura mater and vertebral artery (VA) occurred in this group of patients. Bone fusion was achieved in all patients during follow-up. Conclusions In patients with KFS, HRVA, and a narrow C2 pedicle, there is sufficient space below the C2 articular surface for screw insertion. When the pedicle is narrow and the C2 pedicle screw is not suitable for placement due to possible injury to the VA, subfacetal screws are a feasible alternative.

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“… 36 59) Before the procedure, surgeons evaluate to the anatomical structures around C1 and C2 via CT and MRI images to determine the correct screw trajectory. Furthermore, CTA or MRA are essential to detect the VA status and accompanying anomalies, such as a high riding VA. 18 40) Other technique, such as the C1 lateral mass with C2 pedicle screw insertion was widely used to decrease the risk of VAI, compared with trans-articular screw. 23) …”

Section: Iatrogenic Vai According To Surgical Approachesmentioning

confidence: 99%

Epidemiology and Management of Iatrogenic Vertebral Artery Injury Associated With Cervical Spine Surgery

2022

Korean J Neurotrauma

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Iatrogenic vertebral artery injury (VAI) caused by surgical interventions involving the cervical spine is an uncommon but catastrophic complication associated with high morbidity or mortality due to ischemic stroke, intra- or extra-dural hemorrhage, and the formation of pseudoaneurysm or arteriovenous fistulae. In cervical spine surgeries, VAI may occur during the peri- or postoperative period. This may be induced by an anterior or posterior surgical approach. Despite advanced imaging techniques and increased anatomical knowledge, VAI during cervical spinal surgery remains a challenge. Techniques for managing VAI include hemostatic tamponade, ligation, microvascular repair or anastomosis, and endovascular management. We need to consider the risk of iatrogenic VAI as a complication in patients undergoing cervical spine surgeries and a better understanding of its mechanism and proper management.

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Transarticular Fixation Following Mobilization of “High-Riding” Vertebral Artery

Cited by 5 publications

References 10 publications

Different C2 screw placement techniques with mobilization of the vertebral artery in high-riding vertebral artery cases: Cadaver dissection

Different C2 screw placement techniques with mobilization of the vertebral artery in high-riding vertebral artery cases: Cadaver dissection

Application of C2 subfacetal screws for the management of atlantoaxial dislocation in patients with Klippel-Feil syndrome characterized by a narrow C2 pedicle and high-riding vertebral artery

Epidemiology and Management of Iatrogenic Vertebral Artery Injury Associated With Cervical Spine Surgery

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