Skip to main content
SpringerLink
Log in

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

  • Original Article
  • Published:
Neurosurgical Review Aims and scope Submit manuscript

Abstract

There are numerous indications for stabilization using instrumentation of the upper cervical spine. This area is comprised of sophisticated anatomy. There is no study describing bony and vascular anomalies of this area in the middle European population. The main aim of this study was to investigate prevalence of any vertebral artery (VA) variations and osseous anomalies in the region of the craniocervical junction in a large sample of Czech patients based on three-dimensional computed tomographic angiography (3D CTA). The VA has a variable course through C2 before it passes above its groove on the posterior arch of C1. The artery can course more medially, more posteriorly or more superiorly, thus limiting the diameter of the bony elements used as landmarks for the safe insertion of metalwork. This is known as a high-riding VA (HRVA). The VA was considered HRVA in this study if the thickness of the C2 isthmus was less than 5 mm and/or the C2 internal height was less than 2 mm and/or the width of the C2 pedicle was less than 4 mm. The prevalence of ponticulus posticus (PP) was also identified. Following the VA variations in the V3 segment of the artery were persistent first intersegmental artery (FIA), fenestration (FEN) of the VA, and the posterior inferior cerebellar artery (PICA) branch originating from the C1/2 part of VA. Records of 511 patients from our institution were analyzed. The mean age of the patients was 63.6 years. One hundred and twenty-three (24.1 %) patients were identified to have HRVA, 30 (6 %) present on both sides. The age of patient over 70 years and female sex were found to be significant risk factors for HRVA presence. The prevalence of a nearby PICA branch was 4 %, FIA was 0.4 %, and FEN was 0.2 %. The presence of PP was identified in 14.3 % of patients. The HRVA and PP are common anomalies in the Czech population, and routine preoperative high-resolution CT evaluation is mandatory to prevent the VA injury when C1–C2 instrumentation is planned. The female sex and age over 70 years were found to be the most important factors for HRVA presence. The FIA and the FEN VA were rare in our study contrary to reports published from Asia, showing as many as a 10 % the VA presence over the starting point for C1 lateral screw. On the basis of the infrequent occurrence of these anomalies, we do not recommend routine CT angiography when upper cervical spine instrumentation in the normal population is planned.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Wright NM, Lauryssen C (1998) 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 88:634–640

    Article  CAS  PubMed  Google Scholar 

  2. Daentzer D (2009) Operative management for atlantoaxial instability in case of bilateral high-riding vertebral artery. Arch Orthop Trauma Surg 129:177–182

    Article  PubMed  Google Scholar 

  3. Young JP, Young PH, Ackermann MJ, Anderson PA, Riew KD (2005) The ponticulus posticus: implications for screw insertion into the first cervical lateral mass. J Bone Joint Surg Am 87:2495–2498

    PubMed  Google Scholar 

  4. Wakao N, Takeuchi M, Nishimura M, Riew KD, Kamiya M, Hirasawa A, Kawanami K, Imagama S, Sato K, Takayasu M (2014) Vertebral artery variations and osseous anomaly at the C1-2 level diagnosed by 3D CT angiography in normal subjects. Neuroradiology 56:843–849

    Article  PubMed  Google Scholar 

  5. Elgafy H, Pompo F, Vela R, Elsamaloty HM (2014) Ipsilateral arcuate foramen and high-riding vertebral artery: implication on C1-C2 instrumentation. Spine J 14:1351–1355

    Article  PubMed  Google Scholar 

  6. Igarashi T, Kikuchi S, Sato K, Kayama S, Otani K (2003) Anatomic study of the axis for surgical planning of transarticular screw fixation. Clin Orthop Relat Res:162–166

  7. Madawi AA, Casey AT, Solanki GA, Tuite G, Veres R, Crockard HA (1997) Radiological and anatomical evaluation of the atlantoaxial transarticular screw fixation technique. J Neurosurg 86:961–968

    Article  CAS  PubMed  Google Scholar 

  8. Uchino A, Saito N, Watadani T, Okada Y, Kozawa E, Nishi N, Mizukoshi W, Inoue K, Nakajima R, Takahashi M (2012) Vertebral artery variations at the C1-2 level diagnosed by magnetic resonance angiography. Neuroradiology 54:19–23

    Article  PubMed  Google Scholar 

  9. Yamazaki M, Okawa A, Furuya T, Sakuma T, Takahashi H, Kato K, Fujiyoshi T, Mannoji C, Takahashi K, Koda M (2012) Anomalous vertebral arteries in the extra- and intraosseous regions of the craniovertebral junction visualized by 3-dimensional computed tomographic angiography: analysis of 100 consecutive surgical cases and review of the literature. Spine (Phila Pa 1976) 37:E1389–E1397

    Article  Google Scholar 

  10. Chung SS, Lee CS, Chung HW, Kang CS (2006) CT analysis of the axis for transarticular screw fixation of rheumatoid atlantoaxial instability. Skelet Radiol 35:679–683

    Article  Google Scholar 

  11. Tokuda K, Miyasaka K, Abe H, Abe S, Takei H, Sugimoto S, Tsuru M (1985) Anomalous atlantoaxial portions of vertebral and posterior inferior cerebellar arteries. Neuroradiology 27:410–413

    Article  CAS  PubMed  Google Scholar 

  12. Goel A, Gupta S (1999) Vertebral artery injury with transarticular screws. J Neurosurg 90:376–377

    CAS  PubMed  Google Scholar 

  13. Gluf WM, Schmidt MH, Apfelbaum RI (2005) Atlantoaxial transarticular screw fixation: a review of surgical indications, fusion rate, complications, and lessons learned in 191 adult patients. J Neurosurg Spine 2:155–163

    Article  PubMed  Google Scholar 

  14. Harms J, Melcher RP (2001) Posterior C1-C2 fusion with polyaxial screw and rod fixation. Spine (Phila Pa 1976) 26:2467–2471

    Article  CAS  Google Scholar 

  15. Magerl F, Seeman PS (1986) Stable posterior fusion of the atlas and axis by transarticular screw fixation. In: Kehr P, Weidner A (eds) Cervical spine I. Springer-Verlag, New York, pp. 322–327

    Google Scholar 

  16. Yoshida M, Neo M, Fujibayashi S, Nakamura T (2006) Comparison of the anatomical risk for vertebral artery injury associated with the C2-pedicle screw and atlantoaxial transarticular screw. Spine (Phila Pa 1976) 31:E513–E517

    Article  Google Scholar 

  17. Wright NM (2005) Translaminar rigid screw fixation of the axis. Technical note. J Neurosurg Spine 3:409–414

    Article  PubMed  Google Scholar 

  18. Miyata M, Neo M, Ito H, Yoshida M, Miyaki K, Fujibayashi S, Nakayama T, Nakamura T (2008) Is rheumatoid arthritis a risk factor for a high-riding vertebral artery? Spine (Phila Pa 1976) 33:2007–2011

    Article  Google Scholar 

  19. Kim KH, Park KW, Manh TH, Yeom JS, Chang BS, Lee CK (2007) Prevalence and morphologic features of ponticulus posticus in Koreans: analysis of 312 radiographs and 225 three-dimensional CT scans. Asian Spine J 1:27–31

    Article  PubMed  PubMed Central  Google Scholar 

  20. O'Donnell CM, Child ZA, Nguyen Q, Anderson PA, Lee MJ (2014) Vertebral artery anomalies at the craniovertebral junction in the US population. Spine (Phila Pa 1976) 39:E1053–E1057

    Article  Google Scholar 

  21. Macdonell RA, Kalnins RM, Donnan GA (1987) Cerebellar infarction: natural history, prognosis, and pathology. Stroke 18:849–855

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery and Neurooncology, First Medical Faculty, Military University Hospital and Charles University, U Vojenské Nemocnice 1200, 169 02, Prague 6, Czech Republic

    P. Vaněk, Ondřej Bradáč & V. Beneš

  2. Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield, UK

    P. de Lacy

  3. Department of Anatomy and Biomechanics, Faculty of Physical education and Sport, Charles University, Prague, Czech Republic

    R. Konopková

  4. Department of Neuroradiology, Military University Hospital, Prague, Czech Republic

    J. Lacman

Authors
  1. P. Vaněk
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ondřej Bradáč
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. de Lacy
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R. Konopková
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. Lacman
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. V. Beneš
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ondřej Bradáč.

Ethics declarations

This research was approved by the Ethical committee of Military University Hospital in Prague under project number NT 13627. Research was carried out in compliance with the Helsinki declaration.

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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 40, 369–376 (2017). https://doi.org/10.1007/s10143-016-0784-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10143-016-0784-x

Keywords

Search

Navigation