Surgical Treatment of Spondylotic Vertebral Artery Compression

  • E. Pásztor
Part of the Advances and Technical Standards in Neurosurgery book series (NEUROSURGERY, volume 8)


The occurrence of cervical spondylosis increases with increasing age. Cervical spondylosis is demonstrable in 70 to 75 percent of the population over 50 years (Mc Rae 1960, Rosomoff and Rossmann 1966), yet complaints are noted in only half of the cases. In general, the symptoms and signs are not proportional to the severity of the radiological changes. With very mild symptoms sometimes we find astonishingly serious radiological changes and vice versa. The localization of spondylotic changes seems to decide the severity of symptoms. If spondylosis develops in a congenitally narrow vertebral spinal canal symptoms will come earlier and be more severe (Burrows 1963, Crandall and Batzdorf 1966, Waltz 1967). Injury to the spine gives rise to more serious symptoms in the presence of spondylosis (Mayfield 1954, Jennett 1970, Schürmann and Busch 1970, Austin 1972, Brihaye et al. 1977).


Cervical Spine Vertebral Artery Transverse Process Posterior Cerebral Artery Cervical Spondylotic Myelopathy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Aboulker, J., Metzger, J., David, M., Engel, P., Ballivet, J., 1965: Les myélopathies cervicales d’origine rachidienne. Neurochirurgie 11, 87–198.Google Scholar
  2. Austin, G. (ed.), 1972: The spinal cord. 2nd ed. Springfield, Ill.: Ch. C Thomas.Google Scholar
  3. Babin, E., Haller, M., 1973: Correlation between bony radiological signs and dolicho-arterial loops of the cervical vertebral artery. Neuroradiology 7, 15–17.CrossRefGoogle Scholar
  4. Bakay, L., Leslie, E.V., 1965: Surgical treatment of vertebral artery insufficiency caused by cervical spondylosis. J. Neurosurg. 23, 596–602.PubMedCrossRefGoogle Scholar
  5. Barré, 1924: Troubles pyramidaux et arthrite vertébrale chronique. Médecine 5, 358–360.Google Scholar
  6. Bauer, R., Sheehan, S., Meyer, J. S., 1961: Arteriographic study of cerebrovascular disease. II. Cerebral symptoms due to kinking, tortuosity and compression of carotid and vertebral arteries in the neck. Arch. Neurol. 4, 119–131.PubMedGoogle Scholar
  7. Bärtschi-Rochaix, W., 1949: Migraine cervicale. Bern: H. Huber.Google Scholar
  8. Bechinger, D., Kornhuber, H. H., Krott, H. M., 1969: Zur Vertebralis-Basilaris-Insuffizienz. HNO 17, 175–178.Google Scholar
  9. Belart, W., 1946: Die rheumatische Perispondylitis der Halswirbelsäule und das Zervi-kalsyndrom. Schweiz. med. Wschr. 76, 797–801.Google Scholar
  10. Bergquist, E., 1971: Bilateral arteriovenous fistulae. A complication of vertebral angiography by direct percutaneous puncture. Two cases, one with spontaneous closure. Brit. J. Radiol. 44, 519–523.PubMedCrossRefGoogle Scholar
  11. Blaschke, K. E., 1956: Kreis und Kugel, II. Aufl. Berlin: Gruyter.Google Scholar
  12. Boismare, F., Boquet, J., 1973: L’exploration rhéographique de l’insuffisance circulatoire vertébro-basilaire. Intéret des épreuves dynamiques. Nouv. Presse Méd. 2, 1792.PubMedGoogle Scholar
  13. Boucher, M. M., Girard, P. F., Buffard-Gauthier 1967: Insuffisance vertébro-basilaire d’origine traumatique possible. Rev. Oto-Neuro-Ophtalm. 39, 319–398.Google Scholar
  14. Brain, W. R., Northfield, D., Wilkinson, M., 1952: The neurological manifestation of cervical spondylosis. Brain 75, 187–225.PubMedCrossRefGoogle Scholar
  15. Bravo, G., Portera, A., Mata, P., 1966: Spondylarthrose cervicale. Neurochirurgie 12, 395–410.PubMedGoogle Scholar
  16. Breig, A., Turnbull, J., Hassler, O., 1966: Effects of mechanical stresses on the spinal cord in cervical spondylosis. J. Neurosurg. 25, 45–56.PubMedCrossRefGoogle Scholar
  17. Brihaye, J., Flament-Durand, J., Retif, J., 1977: Pathology of cervical spinal cord lesions without radiologically demonstrable injury of the cervical spine. International Congress Series No. 433. Neurological Surgery. Amsterdam-Oxford: Excerpta Medica.Google Scholar
  18. Brown, B. S., Tatlow, W. F., 1963: Radiographic studies of the vertebral arteries in cadavers. Effects of position and traction on the head. Radiology 81, 80–88.Google Scholar
  19. Burrows, E. H., 1963: The sagittal diameter of the spinal canal in cervical spondylosis. Clin. Radiol. 14, 77–86.PubMedCrossRefGoogle Scholar
  20. —, Marshall, J., 1965: Angiographic investigation of patients with transient ischaemic attacks. J. Neurol. Neurosurg. Psychiat. 28, 533–539.PubMedCrossRefGoogle Scholar
  21. Chrast, B., Korbicka, J., 1962: Die Beeinflussung der Strömungsverhältnisse in der Arteria vertebralis durch verschiedene Kopf-und Halshaltungen. Dtsch. Z. Nervenheilk. 183, 426–448.CrossRefGoogle Scholar
  22. Clarke, E., Robinson, P. K., 1956: Cervical myelopathy: a complication of cervical spondylosis. Brain 79, 483–510.PubMedCrossRefGoogle Scholar
  23. Collard, M., Colette, J. M., Piraux, A., 1967a: Radiologie study of the pathology of the trunk of the vertebral artery. J. Belge Radiol. 50, 222–228.PubMedGoogle Scholar
  24. Collard, M., Contraux, C., Thiébaut, M. 8., Thiébaut, F., 1967b: Le nystagmus d’origine cervicale. Rev. Neurol. 117, 677–688.PubMedGoogle Scholar
  25. Conolly, E. S., Seymour, R. J., Adams, J. E., 1965: Clinical evaluation of anterior cervical fusion for degenerative cervical disc disease. J. Neurosurg. 23, 431–437.CrossRefGoogle Scholar
  26. Crandall, P. H., Batzdorf, V., 1966: Cervical spondylotic myelopathy. J. Neurosurg. 25, 57–66.PubMedCrossRefGoogle Scholar
  27. Crawford, E. S., De Bakey, M. E., Fields, W. S., 1958: Roentgenographic diagnosis and surgical treatment of basilar artery insufficiency. J. Amer. med. Ass. 168, 509–514.Google Scholar
  28. Dan, N. G., 1976: The management of vertebral artery insufficiency in cervical spondylosis: a modified technique. Austr. N. Z. J. of Surgery 46, 164–165.CrossRefGoogle Scholar
  29. Djindjian, R., Pansini, A., 1962: L’artériographie vertébrale dans les cervicarthroses et les malformations de la charnilère cervico-occipitale. Rev. Neurol. 108, 691–698.Google Scholar
  30. Duncan, W. J., Thom, A. S., Young, A. D., 1970: Mechanics of fluids, II. ed., 725p. New York: American Elsevier Publishing Company.Google Scholar
  31. Ehrlich, F. E., Carey, L., Kitrinos, N. P., 1968: Congenital arteriovenous fistula between the vertebral artery and vertebral vein. Case report. J. Neurosurg. 29, 629–630.PubMedCrossRefGoogle Scholar
  32. Elliott, F. A., 1971: Clinical neurology. Philadelphia-London-Toronto: W. B. Saunders Comp.Google Scholar
  33. El-Negamy, E., Sedgwick, E. M., 1979: Delayed cervical somatosensory potentials in cervical spondylosis. J. Neurol. Neurosurg. Psychiat. 42, 238–241.PubMedCrossRefGoogle Scholar
  34. Epstein, B. S., 1969: The spine. A radiological text and atlas, 3rd ed. Philadelphia: Lea and Febiger.Google Scholar
  35. Fang, H. C. H., Palmer, J. J., 1956: Vascular phenomena involving brain stem structures: a clinical and pathological correlation study. Neurology 6, 402–419.PubMedGoogle Scholar
  36. Faris, A. A., Poser, C. M., Agnew, C. H., Youngstrom, K., 1963: Radiologic visualization of neck vessels in man. Neurology 13, 386–396.PubMedGoogle Scholar
  37. Feinstein, B., Langton, J. N. K., Jameson, R. M., Schiller, F., 1954: Experiments on pain referred from deep somatic tissues. J. Bone Jt Surg. 36 A, 981–997.Google Scholar
  38. Frykholm, R., 1951: Lower cervical vertebrae and intervertebral discs. Surgical anatomy and pathology. Acta Chir. Scand. 101, 345–359.PubMedGoogle Scholar
  39. Galera, R., Tovi, D., 1968: Anterior disc excision with interbody fusion in cervical spondylotic myelopathy and rhizopathy. J. Neurosurg. 28, 305–310.PubMedCrossRefGoogle Scholar
  40. Gass, H. H., 1959: Kinks and coils of the cervical carotid artery. Surg. Forum 9, 721–724.Google Scholar
  41. Junghanns, H., 1952: Die funktionelle Röntgenuntersuchung der Halswirbelsäule. Fortschr. Röntgenstr. 76, 591–594.CrossRefGoogle Scholar
  42. Keller, H. M., Meier, W. E., Klumpe, D. A., 1976: Noninvasive angiography for the diagnosis of vertebral artery disease using Doppler ultrasound (Vertebral artery Doppler). Stroke 7, 364–369.PubMedCrossRefGoogle Scholar
  43. Kindt, G. W., Youmans, J. R., 1969: The effect of stricture length on critical arterial stenosis. Surg. Gynec. Obstet. 128, 729–734.PubMedGoogle Scholar
  44. Kovács, Á., 1955: Subluxation and deformation of the cervical apophyseal joints. A contribution to the aetiology of headache. Acta Radiol. 43, 1–16.PubMedGoogle Scholar
  45. —, 1974: Observation of the cervical segment of the spinal canal by an extension device. Acta Radiol. 15, 33–42.Google Scholar
  46. Krayenbühl, H., Yaşargil, M. G., 1957: Die vaskulären Erkrankungen im Gebiet der A. vertebralis und A. basilaris. Stuttgart: G. Thieme.Google Scholar
  47. Kremer, M., 1958: Sitting, standing and walking. Part 1 and 2. Brit. med. J. 2, 63–68 and 121-126.PubMedCrossRefGoogle Scholar
  48. Kunert, W., 1961: Rheographische Messungen im Vertebralis-Stromgebiet. Nervenarzt 32, 34–38.PubMedGoogle Scholar
  49. Labauge, R., Thévenet, A., Crouzet, G., Nivolas, M., 1967: Les insuffisances vertébrobasilaires d’incidence chirurgicale (à propos de 87 malades opérés). Rev. Neurol. 117, 373–389.Google Scholar
  50. Lechner, H., Geyer, N., Lugaresi, E., Martin, F., Lifshitz, K., Markovich S., (eds.), 1969: Rheoencephalography and pletysmographical methods. Amsterdam: Exc. Med. Foundation.Google Scholar
  51. Lee, B. C. P., Kazam, E., Newman, A. D., 1978: Computed tomography of the spine and spinal cord. Radiology 128, 95–102.PubMedGoogle Scholar
  52. Leslie, E. V., Alker, G. J., Bakay, L., 1966: Three positional pancervical angiography. Acta Radiol. 5, 328–336.Google Scholar
  53. Liéou, Y. C., 1928: Syndrome sympathique et arthrite chronique de la colonne vertébrale cervicale. Strasbourg: Schüler-Mink.Google Scholar
  54. Luschka, H., 1858: Die Halbgelenke des menschlichen Körpers. Berlin.Google Scholar
  55. Mayfield, F. H., 1954: Cervical spine trauma: neurosurgical aspects. Clin. Neurosurg. 2, 83–100.PubMedGoogle Scholar
  56. Markham, J. W., 1969: Spontaneous arteriovenous fistula of the vertebral artery and vein. J. Neurosurg. 31, 220–223.PubMedCrossRefGoogle Scholar
  57. McRae, D. L., 1960: The significance of abnormalities of the cervical spine. Amer. J. Roentgenol. 84, 3–25.Google Scholar
  58. Meyer, J. S., Leiderman, H., Denny-Brown, D., 1956: Electroencephalographic study of insufficiency of the basilar and carotid arteries in man. Neurology 6, 455–477.PubMedGoogle Scholar
  59. —, Sheehan, S., Bauer, R. B., 1960: An arteriographic study of cerebrovascular disease in man: I. Stenosis and occlusion of the vertebral-basilar arterial system. Arch. Neurol. 2, 21–45.Google Scholar
  60. Nagashima, C. 1970: Surgical treatment of vertebral artery insufficiency caused by cervical spondylosis. J. Neurosurg. 32, 512–521.PubMedCrossRefGoogle Scholar
  61. —, Iwasaki, T.. Kawanuma, S., et al. 1977: Traumatic arteriovenous fistula of the vertebral artery with spinal cord symptoms. J. Neurosurg. 46, 681–687.PubMedCrossRefGoogle Scholar
  62. Nornes, H., Hørven, I., Tønjum, A. M., 1971: Simultaneous recording of corneal indentation pulse and internal carotid blood flow. Acta Neurol. Scand. 47, 291–306.PubMedCrossRefGoogle Scholar
  63. Northfield, D. W. C., 1955: Diagnosis and treatment of myelopathy due to cervical spondylosis. Brit. med. J. 2, 1474–1477.PubMedCrossRefGoogle Scholar
  64. Nugent, G. R., 1959: Clinicopathologic correlations in cervical spondylosis. Neurology 9, 273–281.PubMedGoogle Scholar
  65. Pallis, C., Jones, A. M., Spillane, J. D., 1954: Cervical spondylosis: incidence and implications. Brain 77, 274–289.PubMedCrossRefGoogle Scholar
  66. Payne, E. E., Spillane, J. D., 1957: The cervical spine. An anatomopathological study of 70 specimens with particular reference to the problem of cervical spondylosis. Brain 80, 571–596.PubMedCrossRefGoogle Scholar
  67. Pásztor, E., 1978: Decompression of vertebral artery in cases of cervical spondylosis. Surg. Neurol. 9, 371–377.PubMedGoogle Scholar
  68. Pfalz, C. R., Richter, H. R., 1956: Photoelektrische Nystagmusregistrierung. Practica oto-rhino-laryngologica 18, 253–271.Google Scholar
  69. Planiol, Th., Pourcelot, L., 1974: Doppler effect study of carotid circulation. In: Ultrasonics in Medicine. Proceedings of the Second World Congress, 1973 (Vlieger, M., White, D. N., McCready, V. R., eds.), pp. 104–111. New York: American Elsevier Publ. Comp.Google Scholar
  70. Popovicin, L., Asgian, B., 1968: Clinical and electroencephalographical contributions to the interpretation of Barré-Liéou syndrome (in Hungarian). Orv. Szemle (Tirgu Mures) 14, 122–125.Google Scholar
  71. Asgian, B. —, Piros, F., 1969: Clinical, biochemical, radiological, and electroencephalographical correlation in vertebrobasilar circulatory insufficiency in cervical arthrosis (in Hungarian). Orvosi Szemle (Tirgu Mures) 15, 39–46.Google Scholar
  72. Pratezi, F., Deidda, C., Caramelli, L., Dabizzi, R. P., 1969: Original method of selective rheography of the carotid and the vertebral arteries. In: Rheoencephalography and pletismographical methods (Lechner, H. et al., ed.). Amsterdam: Exc. Med. Foundation.Google Scholar
  73. Rosomoff, H. L., Rossmann, F., 1966: Treatment of cervical spondylosis by anterior cervical discectomy and fusion. Arch. Neurol. 14, 392–398.PubMedGoogle Scholar
  74. Roth, G., Baumgartner, J., De Morsier, G., 1964: Syndrome bulbaire rétro-olivaire et artériosclérose sténosante ostiale des deux artlères vertébrales. Neurochirurgie 10, 251–263.PubMedGoogle Scholar
  75. Ryan, G. M. S., Cope, S., 1955: Cervical vertigo. Lancet 2, 1355–1358.CrossRefGoogle Scholar
  76. Schlüter, J., 1921: Apparat zur Bestimmung des elektrischen Widerstandes im Gehirn. Zbl. f. Chirurgie 48, 1827–1832.Google Scholar
  77. Schneider, R. C., Schlemm, G. W., 1961: Vertebral artery insufficiency in acute and chronic spinal trauma. J. Neurosurg. 18, 349–360.Google Scholar
  78. Schürmann, K., Busch, G., 1970: Die Behandlung der cervicalen Luxationsfrakturen durch die ventrale Fusion. Chirurg 41, 225–228.PubMedGoogle Scholar
  79. Sheehan, S., Bauer, R. B., Meyer, J. S., 1960: Vertebral artery compression in cervical spondylosis, arteriographic demonstration during life of vertebral artery insufficiency due to rotation and extension of the neck. Neurology 10, 968–986.Google Scholar
  80. Simeone, F., Goldberg, H. I., 1968: Thrombosis of vertebral artery from hyperextension injury of the neck. J. Neurosurg. 29, 540–543.CrossRefGoogle Scholar
  81. Smidt, E. V., 1967: Narusenija mozgovogo krovoobrascsenija ih hirurgicseszkoe lecsenije. Moszkva: Medicina.Google Scholar
  82. Smith, D. R., Vanderark, G. D., Kempe, L. G., 1971: Cervical spondylosis causing vertebrobasilar insufficiency: a surgical treatment. J. Neurol. Neurosurg. Psychiat. 34, 388–392.PubMedCrossRefGoogle Scholar
  83. Smith, R. A., Estridge, M. N., 1962: Neurologic complications of head and neck manipulations. J.A.M.A. 182, 528–531.PubMedGoogle Scholar
  84. Stein, B. M., McCormick, W. F., Rodriguez, J. N., Taveras, J. M., 1962: Postmortem angiography of cerebral vascular system. Arch. Neurology 7, 545–558.Google Scholar
  85. Stoops, W. L., King, R. B., 1962: Neural complications of cervical spondylosis. Their response to laminectomy and foramenectomy. J. Neurosurg. 19, 986–999.PubMedCrossRefGoogle Scholar
  86. Stopford, J. S. B., 1960: Arteries of pons and medulla oblongata. J. Anat. 50, 131–164.Google Scholar
  87. Sullivan, H. G., Harbison, J. W., Vines, F. S., Becker, D., 1975: Embolic posterior cerebral artery occlusion secondary to spondylotic vertebral artery compression. J. Neurosurg. 43, 618–622.PubMedCrossRefGoogle Scholar
  88. Symon, L., Lavender, P., 1967: The surgical treatment of cervical spondylotic myelopathy. Neurology 17, 117–126.PubMedGoogle Scholar
  89. —, 1971: Surgical treatment. In: Cervical spondylosis (Wilkinson, M., ed.). Philadelphia-Toronto: W. B. Saunders Co.Google Scholar
  90. Taitz, C., Nathan, H., Arensburg, B., 1978: Anatomical observations of the foramina transversaria. J. Neurol. Neurosurg. Psychiat. 41, 170–176.PubMedCrossRefGoogle Scholar
  91. Taylor, A. R., 1964: Vascular factors m the myelopathy associated with cervical spondylosis. Neurology 14, 62–68.PubMedGoogle Scholar
  92. Tepe, H. J., 1956: Die Häufigkeit osteochondrotischer Röntgenbefunde der Halswirbelsäule bei 400 symptomfreien Erwachsenen. Fortschr. Röntgenstr. 85, 659–663.CrossRefGoogle Scholar
  93. Tissington-Tatlow, W. F., Banner, H. G., 1957: Syndrome of vertebral artery compression. Neurology 7, 331–340.PubMedGoogle Scholar
  94. Toole, J. F., Tucker, S. H., 1960: Influence of head position upon cerebral circulation. Studies on blood flow in cadavers. Arch. Neurol. 2, 616–623.PubMedGoogle Scholar
  95. Toussaint, J. P., Fabeck, P., Brihaye, J., Crahay, S., 1966: Le syndrome cervical traumatique. Acta Orthopaedica Belgica 32, 119–153.Google Scholar
  96. Töndury, G., 1974: Embryonale und postnatale Entwicklung der Wirbelsäule. In: Handbuch der medizinischen Radiologie, Vol. VI/1 (Diethelm, L., Herausg.). Berlin-Heidelberg-New-York: Springer.Google Scholar
  97. Trobe, J. D., Lorber, M. L., Schlezinger, N. S., 1973: Isolated homonymous hemianopsia. A review of 104 cases. Arch. Ophthalmol. 89, 377–381.PubMedGoogle Scholar
  98. Unterharnscheidt, F., 1956: Syncopal cervical vertebral artery syndrome. Nervenarzt 27, 481–486.PubMedGoogle Scholar
  99. Varga, J., 1974: Handbook of hydraulic and pneumatic machines (in Hungarian). Budapest: Müszaki Könyvkiadó.Google Scholar
  100. Verbiest, H., 1970: La chirurgie antérieure et latérale du rachis cervical. Neurochirurgie 16, Suppl. 2.Google Scholar
  101. —, 1978: From anterior to lateral operations on the cervical spine. Neurosurg. Rev. 1, 47–67.CrossRefGoogle Scholar
  102. —, Pazy Geuze, H. D., 1966: Anterolateral surgery for cervical spondylosis in cases of myelopathy or nerve-root compression. J. Neurosurg. 25, 611–622.PubMedCrossRefGoogle Scholar
  103. Virtamo, P., Kivalo, E., 1957: Impressions of the vertebral artery by deformation of the unco-vertebral joints. Postmortem angiographic studies. Acta Radiol. 48, 410–412.CrossRefGoogle Scholar
  104. Vlajic, I., Distelmaier, P., 1978: Traumen der Halswirbelsäule und Kompression der Vertebralarterien. Neurochirurgia 21, 122–127.PubMedGoogle Scholar
  105. Walsh, F. B., Hoyt, W. F., 1969: Clinical Neuro-Ophthalmology, Vol. 3, 3rd ed. Baltimore, Md.: Williams and Wilkins Co.Google Scholar
  106. Waltz, T. A., 1967: Physical factors in the production of the myelopathy of cervical spondylosis. Brain 90, 395–404.PubMedCrossRefGoogle Scholar
  107. Wilkinson, M., 1960: The morbid anatomy of cervical spondylosis and myelopathy. Brain 83, 589–617.PubMedCrossRefGoogle Scholar
  108. Zimmerman, H. M., Kumar, A. J., Gadoth, N., Hodges III, F. J., 1978: Traumatic vertebrobasilar occlusive disease in childhood. Neurology 28, 185–188.PubMedGoogle Scholar

Copyright information

© Springer-Verlag/Wien 1981

Authors and Affiliations

  • E. Pásztor
    • 1
  1. 1.National Institute of NeurosurgeryBudapestHungary

Personalised recommendations