J Korean Soc Spine Surg.  2006 Sep;13(3):205-209. 10.4184/jkss.2006.13.3.205.

C1-2 Instability associated with Duplicated Vertebral Artery: A Case Report

• Park SK
• Yeom JS
• Shim DM
• Park KW
• Chang BS
• Lee CK

• KMID: 2209643
• DOI: http://doi.org/10.4184/jkss.2006.13.3.205

Abstract

A vertebral artery injury is one of the most critical complications of atlantoaxial fixation. Abnormal courses or congenital anomalies of the vertebral artery increase its risk. The authors report a case of a patient who had an atlantoaxial subluxation associated with severe spinal cord compression and a duplicated vertebral artery. The atlantoaxial subluxation, which was not reduced satisfactorily by an intraoperative head position change or direct manipulation of the atlas and axis, precluded a transarticular screw fixation. The lack of free space around the spinal cord precluded a sublaminar wiring. The duplicated vertebral artery made it difficult to insert C1 lateral mass screws and C2 pedicle screws with Harms' technique.

Keyword

Duplicated vertebral artery; Atlantoaxial instability; Atlantoaxial fixation

MeSH Terms

Axis, Cervical Vertebra
Head
Humans
Spinal Cord
Spinal Cord Compression
Vertebral Artery*

Figure

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  Fig. 1. Preoperative lateral radiographs of the cervical spine in flexion (A) and extension (B) show irreducible atlantoaxial subluxation and os odontoideum. A T2-weighted sagittal magnetic resonance image (C) demonstrates severe compression of the spinal cord. A high signal area in the compressed spinal cord is observed (arrow).

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  Fig. 2. CT-angiography images show duplication of the right vertebral artery. The diameter of the normal branch (arrows) is smaller than that of the aberrant branch (arrowheads).

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  Fig. 3. Postoperative radiographs and a CT scan image are shown. On the open mouth anteroposterior view (A), vascular clips (arrowheads) used for ligation of the aberrant branch of the duplicated vertebral artery are seen on the right side. On the lateral view (B), reduction of the atlantoaxial subluxation was incomplete. However, a CT scan image (C) shows satisfactory widening of the spinal canal.

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