+ Resolve Article
+ Follow Us
Follow on FacebookFollow on Facebook
Follow on TwitterFollow on Twitter

+ Translate
+ Subscribe to Site Feed
GeoScience Most Shared ContentMost Shared Content

Risk factor analysis and decision-making of surgical strategy for V3 segment anomaly: significance of preoperative CT angiography for posterior C1 instrumentation

, : Risk factor analysis and decision-making of surgical strategy for V3 segment anomaly: significance of preoperative CT angiography for posterior C1 instrumentation. Spine Journal 16(9): 1055-1061

Awareness of vascular anomalies is crucial to avoid iatrogenic injuries during surgical procedure. Although V3 segment anomaly has been well described, the incidence of V3 segment anomaly has been rather variable in the literature, and there are few reports regarding the adequate surgical strategy for each type of V3 segment anomaly. This study aimed to analyze the incidence of V3 segment anomaly and demonstrate the importance of recognizing vertebral artery (VA) anomaly in deciding the surgical strategy for C1 screw placement. A retrospective cohort study was carried out. The sample included 147 patients who underwent C1 posterior instrumentation and preoperative three-dimensional computed tomography angiography (3D CTA). The primary outcome of this study was the incidence of V3 segment anomaly using preoperative CTA, and the secondary outcome was the risk factor analysis of the V3 segment anomaly. There were 147 patients who underwent C1 posterior instrumentation to treat various kinds of upper cervical disease. The 3D CTA of the patients were assessed preoperatively to identify the anomaly of the VA. Each surgical technique of C1 posterior instrumentation was decided upon the shape and the course of the VA around the atlas. During the study period, 11 cases of V3 segment anomaly (7.5%) were found on 3D CTA. Persistent intersegmental artery was found in nine cases and was the most common variant of VA anomaly. Early branch of posterior inferior cerebellar artery was found in three cases. Most of V3 segment anomaly was found unilaterally, but there were two cases with bilateral V3 anomaly. Seven cases (63.6%) were associated with congenital bony abnormality around craniovertebral junction (CVJ), such as occipital assimilation, Klippel-Feil syndrome, and os odontoideum. V3 segment anomaly was significantly common in the cases with bony abnormality (29.2% (7/24) vs. 3.6% (4/123), p<.05). Compared with patient without bony abnormality, the odds ratio was 10.78 (95% CI: 2.88-40.37) for those with congenital bony abnormalities. Rheumatoid arthritis was not a risk factor of V3 segment anomaly (p=.391). The course of the VA is heterogenous, and the V3 segment anomaly of the VA is more common in the cases with congenital bony abnormalities around CVJ. Therefore, preoperative radiological studies should be performed to identify V3 segment variations and reduce the risk of VA injury. To avoid significant morbidities associated with VA, surgical technique of C1 posterior instrumentation should be decided depending upon the V3 segment anomaly. A more optimal entry point and trajectory for C1 fixation can be selected.


PMID: 27140866

DOI: 10.1016/j.spinee.2016.04.019

Other references

Harris, J.; Fallat, L., 2004: Effects of isolated Weber B fibular fractures on the tibiotalar contact area. Fractures of the lateral malleolus can occur without rupture of the deltoid ligament or fracture of the medial malleolus. Controversy exists regarding the necessity of surgery on supination-external rotation stage II ankle fractures. Theoretically...

Hjelm, E.W.gaeus; Lof, A.; Sato, A.; Colmsjo, A.; Lundmark, B.O.e; Norstrom, A., 1994: Dietary and ethanol induced alterations of the toxicokinetics of toluene in humans. This study was undertaken to evaluate the influence of a carbohydrate restricted diet, a subacute ethanol intake, and their combined effect on the kinetics of toluene in humans. Eight healthy male volunteers were exposed by inhalation at four diff...

Anonymous, 2012: Is Kombucha tea safe to drink?. Mayo Clinic Women's Healthsource 15(7): 8-8

McLean, M.R., 2001: When what we know outstrips what we can do. Issues in Ethics 9(2): 6-10

Glasson W.A., 1981: Effect of hydro carbon and nitrogen oxygen mixtures on photochemical smog formation under simulated transport conditions. The effect of urban pollution on downwind areas was studied. Concern was expressed over the appropriate hydrocarbon and NOx control strategy to be used in minimizing the effects of O3 and NO2 on urban population centers and their downwind environs...

Williams J.F. (investigator), 1978: Two-dimensional model of the Piney Point Aquifer. U S

Wojtowicz, M., 1961: Rare cases of external endometriosis. Ginekologia Polska 32: 741-748

Hayase, S.; Kanno, Y.; Watanabe, M.; Takahashi, M.; Kuroda, K.; Miyata, H., 2014: Heteroepitaxial formation of aligned mesostructured silica films with large structural periodicities from mixed surfactant systems. Liquid-crystal phases consisting of cylindrical micelles of amphiphilic block copolymers and silica precursors are epitaxially built up on aligned surface micelles formed by an alkyl-PEO surfactant, Brij56, irrespective of the large difference in...

Kalfa, S., 1928: Elas-tometry of the eye. Zentralbl Ges Ophthalmol Und Grenzgeb: 314

Handing, E.P.; Small, B.J.; Andel, R.; McEvoy, C.L.; Kumar, N., 2017: Can Nutrition or Inflammation Moderate the Age-Cognition Association Among Older Adults?. Previous research has shown that nutrition can influence cognitive abilities in older adults. We examined whether nutritional factors or inflammatory biomarkers moderate the age-cognition association. Analyses included 1,308 participants (age ≥6...