High-riding vertebral artery and its influence on upper cervical spine surgery_West China Medical Journal

Authors：

WU Fan , LI Hong , WAN Shengyu ,  LIN Xu , ZENG Jun , ZHONG Zeli , WU Chao , TAN Lun

Section I, Department of Orthopedics, Zigong Fourth People’s Hospital, Zigong, Sichuan 643000, P. R. China;

Corresponding author：

LIN Xu, Email: med_linxu@163.com

Keywords：

High-riding vertebral artery; Vertebral artery CT angiography; Upper cervical spine fixation

DOI：

10.7507/1002-0179.202007370

Video：

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In the variation of vertebral artery in artery groove, high-riding vertebral artery is the most common. High-riding vertebral artery can affect the choice of internal fixation device for upper cervical spine surgery, and may lead to serious complications such as vertebral artery injury and even death. In recent years, great progress has been made in the concept, incidence, diagnostic techniques, classification and impact on upper cervical spine surgery of high-riding vertebral artery. This review summarizes the above contents in order to improve clinicians’ understanding of high-riding vertebral artery, and provide a reference for timely diagnosis of high-riding vertebral artery, make an appropriate plan for upper cervical cervical spine surgical fixation, and reduce surgical complications.

Citation： WU Fan, LI Hong, WAN Shengyu, LIN Xu, ZENG Jun, ZHONG Zeli, WU Chao, TAN Lun. High-riding vertebral artery and its influence on upper cervical spine surgery. West China Medical Journal, 2020, 35(10): 1248-1251. doi: 10.7507/1002-0179.202007370 Copy

1.	Xu S, Ruan S, Song X, et al. Evaluation of vertebral artery anomaly in basilar invagination and prevention of vascular injury during surgical intervention: CTA features and analysis. Eur Spine J, 2018, 27(6): 1286-1294.
2.	Wang Y, Wang C, Yan M. Clinical outcomes of atlantoaxial dislocation combined with high-riding vertebral artery using C2 translaminar screws. World Neurosurg, 2019, 122: e1511-e1518.
3.	Vaněk P, Bradáč O, de Lacy P, et al. Vertebral artery and osseous anomalies characteristic at the craniocervical junction diagnosed by CT and 3D CT angiography in normal Czech population: analysis of 511 consecutive patients. Neurosurg Rev, 2017, 40(3): 369-376.
4.	Wright NM, Lauryssen C. Vertebral artery injury in C1-2 transarticular screw fixation: results of a survey of the AANS/CNS section on disorders of the spine and peripheral nerves. American Association of Neurological Surgeons/Congress of Neurological Surgeons. J Neurosurg, 1998, 88(4): 634-640.
5.	Madawi AA, Casey AT, Solanki GA, et al. Radiological and anatomical evaluation of the atlantoaxial transarticular screw fixation technique. J Neurosurg, 1997, 86(6): 961-968.
6.	Yeom JS, Buchowski JM, Kim HJ, et al. Risk of vertebral artery injury: comparison between C1-C2 transarticular and C2 pedicle screws. Spine J, 2013, 13(7): 775-785.
7.	Maki S, Koda M, Iijima Y, et al. Medially-shifted rather than high-riding vertebral arteries preclude safe pedicle screw insertion. J Clin Neurosci, 2016, 29: 169-72.
8.	Lau SW, Sun LK, Lai R, et al. Study of the anatomical variations of vertebral artery in C2 vertebra with magnetic resonance imaging and its application in the C1-C2 transarticular screw fixation. Spine (Phila Pa 1976), 2010, 35(11): 1136-1143.
9.	Elgafy H, Potluri T, Goel VK, et al. Biomechanical analysis comparing three C1-C2 transarticular screw salvaging fixation techniques. Spine (Phila Pa 1976), 2010, 35(4): 378-385.
10.	王永庆. 颈2高位椎动脉沟是后路经关节C1C2螺钉固定的禁忌?——椎动脉走行与Magerl术关系的在体研究//中华医学会, 中华医学会骨科学分会. 中华医学会第八届骨科学术会议暨第一届国际COA学术大会论文摘要集. 北京: 中华医学会, 2006: 1.
11.	闫廷飞, 孙璟川, 范丽, 等. 椎动脉扭曲对颈椎横突孔解剖形态影像学改变的影响. 中华医学杂志, 2016, 96(23): 1806-1810.
12.	Neo M, Matsushita M, Iwashita Y, et al. Atlantoaxial transarticular screw fixation for a high-riding vertebral artery. Spine (Phila Pa 1976), 2003, 28(7): 666-670.
13.	Tan LA, Kasliwal MK, Gerard CS, et al. Surgical considerations in posterior C1-2 instrumentation in the presence of vertebral artery anomalies: case illustration and review of literature. Br J Neurosurg, 2019, 33(4): 422-424.
14.	Kothari MK, Dalvie SS, Gupta S, et al. The C2 pedicle width, pars length, and laminar thickness in concurrent ipsilateral ponticulus posticus and high-riding vertebral artery: a radiological computed tomography scan-based study. Asian Spine J, 2019, 13(2): 290-295.
15.	Bloch O, Holly LT, Park J, et al. Effect of frameless stereotaxy on the accuracy of C1-2 transarticular screw placement. J Neurosurg, 2001, 95(1 Suppl): 74-79.
16.	Li T, Yin YH, Qiao GY, et al. Three-dimensional evaluation and classification of the anatomy variations of vertebral artery at the craniovertebral junction in 120 patients of basilar invagination and atlas occipitalization. Oper Neurosurg (Hagerstown), 2019, 17(6): 594-602.
17.	Wakao N, Takeuchi M, Nishimura M, et al. Vertebral artery variations and osseous anomaly at the C1-2 level diagnosed by 3D CT angiography in normal subjects. Neuroradiology, 2014, 56(10): 843-849.
18.	Song GS, Theodore N, Dickman CA, et al. Unilateral posterior atlantoaxial transarticular screw fixation. J Neurosurg, 1997, 87(6): 851-855.
19.	黄学良, 朱双芳, 林雨聪, 等. 三维重建CT血管造影在C1-2水平椎动脉变异诊断中的价值. 中国脊柱脊髓杂志, 2018, 28(4): 315-319.
20.	吴益奇, 黄春辉, 卢海川, 等. 福建闽西地区颈寰椎同侧弓状孔和椎动脉高跨的发生率及其临床意义. 中外医疗, 2017, 36(17): 87-89.
21.	Chen TY, Lin KL, Ho HH. Morphologic characteristics of atlantoaxial complex in rheumatoid arthritis and surgical consideration among Chinese. Spine (Phila Pa 1976), 2004, 29(9): 1000-1004.
22.	Moon BJ, Choi KH, Shin DA, et al. Anatomical variations of vertebral artery and C2 isthmus in atlanto-axial fusion: consecutive surgical 100 cases. J Clin Neurosci, 2018, 53: 147-152.
23.	杨会峰, 郭明明, 谢雁春, 等. 术前椎动脉CT血管造影检查在上颈椎手术置钉中的应用. 局解手术学杂志, 2017, 26(9): 675-678.
24.	张健, 林旭, 万盛钰, 等. CT血管造影枢椎椎弓根矢状面术前评估方法的临床应用. 华西医学, 2018, 33(9): 1110-1113.
25.	Lee SH, Park DH, Kim SD, et al. Analysis of 3-dimensional course of the intra-axial vertebral artery for C2 pedicle screw trajectory: a computed tomographic study. Spine (Phila Pa 1976), 2014, 39(17): E1010-E1014.
26.	王建华, 尹庆水, 夏虹, 等. 枢椎椎动脉孔解剖分型与椎弓根置钉关系的研究. 中国脊柱脊髓杂志, 2006, 16(9): 677-680.
27.	Lee JH, Jahng TA, Chung CK. C1-2 transarticular screw fixation in high-riding vertebral artery: suggestion of new trajectory. J Spinal Disord Tech, 2007, 20(7): 499-504.
28.	Sanelli PC, Tong S, Gonzalez RG, et al. Normal variation of vertebral artery on CT angiography and its implications for diagnosis of acquired pathology. J Comput Assist Tomogr, 2002, 26(3): 462-470.
29.	武兴国, 黄健, 蒋煜青, 等. 椎动脉的解剖研究及在上颈椎椎弓根置钉中的应用. 中国骨伤, 2014(9): 772-774.
30.	胡勇, 马维虎, 徐荣明, 等. 组合枢椎椎板螺钉固定技术治疗颈椎损伤的临床研究. 中华创伤杂志, 2009, 25(3): 218-222.
31.	Cassinelli EH, Lee M, Skalak A, et al. Anatomic considerations for the placement of C2 laminar screws. Spine (Phila Pa 1976), 2006, 31(24): 2767-2771.
32.	Hoh DJ, Liu CY, Wang MY. A radiographic computed tomography-based study to determine the ideal entry point, trajectory, and length for safe fixation using C-2 pars interarticularis screws. J Neurosurg Spine, 2010, 12(6): 602-612.
33.	Su BW, Shimer AL, Chinthakunta S, et al. Comparison of fatigue strength of C2 pedicle screws, C2 pars screws, and a hybrid construct in C1-C2 fixation. Spine (Phila Pa 1976), 2014, 39(1): E12-E19.
34.	刘观燚, 徐荣明, 马维虎, 等. 枢椎棘突螺钉与椎弓根螺钉的解剖学比较. 中国骨伤, 2011, 24(8): 659-661.
35.	陈安民, 田伟. 骨科学. 北京: 人民卫生出版社, 2014: 11.
36.	Wong TS, Abdul Rashid ML, Hasan MS, et al. C1-C2 fusion with absence of C1 posterior arch and presence of C2 high-riding vertebral artery: is it possible?. J Orthop Surg (Hong Kong), 2019, 27(2): 2309499019840763.
37.	Wu AM, Wang XY, Zhou F, et al. Percutaneous atlantoaxial anterior transarticular screw fixation combined with mini-open posterior C1/2 wire fusion for patients with a high-riding vertebral artery. J Spinal Cord Med, 2016, 39(2): 234-239.
38.	Lonjon N, Chan-Seng E, Costalat V, et al. Robot-assisted spine surgery: feasibility study through a prospective case-matched analysis. Eur Spine J, 2016, 25(3): 947-955.
39.	田伟, 王晋超, 刘亚军, 等. 上颈椎手术方式回顾及应用机器人辅助上颈椎手术的体会. 中国医疗器械信息, 2017, 23(7): 9-13.
40.	吴超, 邓佳燕, 谭伦, 等. 逐级扩大型3D打印导板系统辅助寰枢椎椎弓根植钉准确性分析及临床应用. 中国修复重建外科杂志, 2019, 33(2): 212-218.
41.	王华栋, 何达, 刘波, 等. 术中即时三维导航辅助寰枢椎经关节螺钉固定治疗寰枢椎不稳定. 中华骨科杂志, 2019, 39(21): 1311-1319.

1. Xu S, Ruan S, Song X, et al. Evaluation of vertebral artery anomaly in basilar invagination and prevention of vascular injury during surgical intervention: CTA features and analysis. Eur Spine J, 2018, 27(6): 1286-1294.
2. Wang Y, Wang C, Yan M. Clinical outcomes of atlantoaxial dislocation combined with high-riding vertebral artery using C2 translaminar screws. World Neurosurg, 2019, 122: e1511-e1518.
3. Vaněk P, Bradáč O, de Lacy P, et al. Vertebral artery and osseous anomalies characteristic at the craniocervical junction diagnosed by CT and 3D CT angiography in normal Czech population: analysis of 511 consecutive patients. Neurosurg Rev, 2017, 40(3): 369-376.
4. Wright NM, Lauryssen C. Vertebral artery injury in C1-2 transarticular screw fixation: results of a survey of the AANS/CNS section on disorders of the spine and peripheral nerves. American Association of Neurological Surgeons/Congress of Neurological Surgeons. J Neurosurg, 1998, 88(4): 634-640.
5. Madawi AA, Casey AT, Solanki GA, et al. Radiological and anatomical evaluation of the atlantoaxial transarticular screw fixation technique. J Neurosurg, 1997, 86(6): 961-968.
6. Yeom JS, Buchowski JM, Kim HJ, et al. Risk of vertebral artery injury: comparison between C1-C2 transarticular and C2 pedicle screws. Spine J, 2013, 13(7): 775-785.
7. Maki S, Koda M, Iijima Y, et al. Medially-shifted rather than high-riding vertebral arteries preclude safe pedicle screw insertion. J Clin Neurosci, 2016, 29: 169-72.
8. Lau SW, Sun LK, Lai R, et al. Study of the anatomical variations of vertebral artery in C2 vertebra with magnetic resonance imaging and its application in the C1-C2 transarticular screw fixation. Spine (Phila Pa 1976), 2010, 35(11): 1136-1143.
9. Elgafy H, Potluri T, Goel VK, et al. Biomechanical analysis comparing three C1-C2 transarticular screw salvaging fixation techniques. Spine (Phila Pa 1976), 2010, 35(4): 378-385.
10. 王永庆. 颈2高位椎动脉沟是后路经关节C1C2螺钉固定的禁忌?——椎动脉走行与Magerl术关系的在体研究//中华医学会, 中华医学会骨科学分会. 中华医学会第八届骨科学术会议暨第一届国际COA学术大会论文摘要集. 北京: 中华医学会, 2006: 1.
11. 闫廷飞, 孙璟川, 范丽, 等. 椎动脉扭曲对颈椎横突孔解剖形态影像学改变的影响. 中华医学杂志, 2016, 96(23): 1806-1810.
12. Neo M, Matsushita M, Iwashita Y, et al. Atlantoaxial transarticular screw fixation for a high-riding vertebral artery. Spine (Phila Pa 1976), 2003, 28(7): 666-670.
13. Tan LA, Kasliwal MK, Gerard CS, et al. Surgical considerations in posterior C1-2 instrumentation in the presence of vertebral artery anomalies: case illustration and review of literature. Br J Neurosurg, 2019, 33(4): 422-424.
14. Kothari MK, Dalvie SS, Gupta S, et al. The C2 pedicle width, pars length, and laminar thickness in concurrent ipsilateral ponticulus posticus and high-riding vertebral artery: a radiological computed tomography scan-based study. Asian Spine J, 2019, 13(2): 290-295.
15. Bloch O, Holly LT, Park J, et al. Effect of frameless stereotaxy on the accuracy of C1-2 transarticular screw placement. J Neurosurg, 2001, 95(1 Suppl): 74-79.
16. Li T, Yin YH, Qiao GY, et al. Three-dimensional evaluation and classification of the anatomy variations of vertebral artery at the craniovertebral junction in 120 patients of basilar invagination and atlas occipitalization. Oper Neurosurg (Hagerstown), 2019, 17(6): 594-602.
17. Wakao N, Takeuchi M, Nishimura M, et al. Vertebral artery variations and osseous anomaly at the C1-2 level diagnosed by 3D CT angiography in normal subjects. Neuroradiology, 2014, 56(10): 843-849.
18. Song GS, Theodore N, Dickman CA, et al. Unilateral posterior atlantoaxial transarticular screw fixation. J Neurosurg, 1997, 87(6): 851-855.
19. 黄学良, 朱双芳, 林雨聪, 等. 三维重建CT血管造影在C1-2水平椎动脉变异诊断中的价值. 中国脊柱脊髓杂志, 2018, 28(4): 315-319.
20. 吴益奇, 黄春辉, 卢海川, 等. 福建闽西地区颈寰椎同侧弓状孔和椎动脉高跨的发生率及其临床意义. 中外医疗, 2017, 36(17): 87-89.
21. Chen TY, Lin KL, Ho HH. Morphologic characteristics of atlantoaxial complex in rheumatoid arthritis and surgical consideration among Chinese. Spine (Phila Pa 1976), 2004, 29(9): 1000-1004.
22. Moon BJ, Choi KH, Shin DA, et al. Anatomical variations of vertebral artery and C2 isthmus in atlanto-axial fusion: consecutive surgical 100 cases. J Clin Neurosci, 2018, 53: 147-152.
23. 杨会峰, 郭明明, 谢雁春, 等. 术前椎动脉CT血管造影检查在上颈椎手术置钉中的应用. 局解手术学杂志, 2017, 26(9): 675-678.
24. 张健, 林旭, 万盛钰, 等. CT血管造影枢椎椎弓根矢状面术前评估方法的临床应用. 华西医学, 2018, 33(9): 1110-1113.
25. Lee SH, Park DH, Kim SD, et al. Analysis of 3-dimensional course of the intra-axial vertebral artery for C2 pedicle screw trajectory: a computed tomographic study. Spine (Phila Pa 1976), 2014, 39(17): E1010-E1014.
26. 王建华, 尹庆水, 夏虹, 等. 枢椎椎动脉孔解剖分型与椎弓根置钉关系的研究. 中国脊柱脊髓杂志, 2006, 16(9): 677-680.
27. Lee JH, Jahng TA, Chung CK. C1-2 transarticular screw fixation in high-riding vertebral artery: suggestion of new trajectory. J Spinal Disord Tech, 2007, 20(7): 499-504.
28. Sanelli PC, Tong S, Gonzalez RG, et al. Normal variation of vertebral artery on CT angiography and its implications for diagnosis of acquired pathology. J Comput Assist Tomogr, 2002, 26(3): 462-470.
29. 武兴国, 黄健, 蒋煜青, 等. 椎动脉的解剖研究及在上颈椎椎弓根置钉中的应用. 中国骨伤, 2014(9): 772-774.
30. 胡勇, 马维虎, 徐荣明, 等. 组合枢椎椎板螺钉固定技术治疗颈椎损伤的临床研究. 中华创伤杂志, 2009, 25(3): 218-222.
31. Cassinelli EH, Lee M, Skalak A, et al. Anatomic considerations for the placement of C2 laminar screws. Spine (Phila Pa 1976), 2006, 31(24): 2767-2771.
32. Hoh DJ, Liu CY, Wang MY. A radiographic computed tomography-based study to determine the ideal entry point, trajectory, and length for safe fixation using C-2 pars interarticularis screws. J Neurosurg Spine, 2010, 12(6): 602-612.
33. Su BW, Shimer AL, Chinthakunta S, et al. Comparison of fatigue strength of C2 pedicle screws, C2 pars screws, and a hybrid construct in C1-C2 fixation. Spine (Phila Pa 1976), 2014, 39(1): E12-E19.
34. 刘观燚, 徐荣明, 马维虎, 等. 枢椎棘突螺钉与椎弓根螺钉的解剖学比较. 中国骨伤, 2011, 24(8): 659-661.
35. 陈安民, 田伟. 骨科学. 北京: 人民卫生出版社, 2014: 11.
36. Wong TS, Abdul Rashid ML, Hasan MS, et al. C1-C2 fusion with absence of C1 posterior arch and presence of C2 high-riding vertebral artery: is it possible?. J Orthop Surg (Hong Kong), 2019, 27(2): 2309499019840763.
37. Wu AM, Wang XY, Zhou F, et al. Percutaneous atlantoaxial anterior transarticular screw fixation combined with mini-open posterior C1/2 wire fusion for patients with a high-riding vertebral artery. J Spinal Cord Med, 2016, 39(2): 234-239.
38. Lonjon N, Chan-Seng E, Costalat V, et al. Robot-assisted spine surgery: feasibility study through a prospective case-matched analysis. Eur Spine J, 2016, 25(3): 947-955.
39. 田伟, 王晋超, 刘亚军, 等. 上颈椎手术方式回顾及应用机器人辅助上颈椎手术的体会. 中国医疗器械信息, 2017, 23(7): 9-13.
40. 吴超, 邓佳燕, 谭伦, 等. 逐级扩大型3D打印导板系统辅助寰枢椎椎弓根植钉准确性分析及临床应用. 中国修复重建外科杂志, 2019, 33(2): 212-218.
41. 王华栋, 何达, 刘波, 等. 术中即时三维导航辅助寰枢椎经关节螺钉固定治疗寰枢椎不稳定. 中华骨科杂志, 2019, 39(21): 1311-1319.

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