Vertebral artery anomaly with entry at C4—avoiding a surgical pitfall: a case report

Müller, Mat­thias; Bleeck, Joachim; Ruf, Michael

doi:10.1007/s00586-007-0582-9

Cited by 15 publications

(15 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Localizer images were acquired in three planes to provide a reference for subsequent slice positioning. Images of the full brainstem and cervical spinal cord were acquired using a half-Fourier single-shot fast spin-echo sequence (HASTE) with BOLD contrast [ 14 ]. This method has been shown to provide optimal image quality and BOLD sensitivity in the brainstem and spinal cord [ 1 ].…”

Section: Methodsmentioning

confidence: 99%

Coordinated Human Brainstem and Spinal Cord Networks during the Expectation of Pain Have Elements Unique from Resting-State Effects

et al. 2020

View full text Add to dashboard Cite

Functional magnetic resonance imaging (fMRI) research on the human brainstem (BS) and spinal cord (SC) has identified extensive BS/SC resting-state networks (RSNs) by showing spontaneous coordinated blood oxygenation-level dependent (BOLD) signal fluctuations in the absence of a stimulus. Studies have shown that these networks can be influenced by participants’ level of arousal or attention (e.g., watching a video), and linked network function to autonomic homeostatic regulation. Here we explore how the cognitive state of expecting pain can influence connectivity in these networks. Data from two studies (a predictable pain stimulus study, and a resting-state study) were compared to show the effects of expecting pain on BS/SC networks, and how networks differed from networks associated with the resting-state. In each study, BOLD fMRI data were obtained from the cervical SC and brainstem in healthy participants at 3 tesla using a T2-weighted single-shot fast spin-echo imaging method. Functional connectivity was investigated within the entire 3D volume by means of structural equation modeling (SEM) and analyses of covariance (ANCOVA). Results showed extensive connectivity within/across BS and SC regions during the expectation of pain, and ANCOVA analyses showed that connectivity in specific components of these networks varied with individual pain sensitivity. Comparing these results to RSN fluctuations revealed commonalities in coordination between BS and SC regions, and specific BS–BS connectivity fluctuations unique to the expectation of pain. Based on the regions involved, these results provide evidence of brainstem regulation specific to the expectation of pain.

show abstract

Section: Methodsmentioning

confidence: 99%

Coordinated Human Brainstem and Spinal Cord Networks during the Expectation of Pain Have Elements Unique from Resting-State Effects

et al. 2020

View full text Add to dashboard Cite

show abstract

“…instrumentation of the spine is considered. 4,7,11,28,29 Besides irregular pathways of the VA, different entry points of the VA into the TF were seen. In cases in which the entry point differs from C-6, this was usually a bilateral finding.…”

Section: Irregularities and Entry Point Of The Vamentioning

confidence: 99%

The vertebral artery and the cervical pedicle: morphometric analysis of a critical neighborhood

Tomasino

Parikh

Koller

et al. 2010

SPI

View full text Add to dashboard Cite

OBJECT The purpose of this retrospective study was to quantify the anatomical relationship between the vertebral artery (VA), the cervical pedicle, and its surrounding structures, including the incidence of irregularities. Additionally, data delineating a "safe zone," and these data's application during instrumentation with transpedicular cervical screw fixation were considered. The anatomical proximity of the VA to the cervical pedicle prevents spine surgeons from preferring cervical pedicle screws (CPSs) over lateral mass screws at levels C3-6. Accurate placement of CPSs is often difficult to determine, because this definition can vary between 1 and 4 mm of lateral "noncritical" and "critical" pedicle breaches. No previous study in a western population has investigated the VA's proximity to the cervical pedicle, its percentage of occupancy in the transverse foramen (TF), and the incidence of irregular VA pathways. METHODS One hundred twenty-seven consecutive patients who underwent CT angiography of the neck were enrolled in this study. The measurements included the following: medial pedicle border to VA; lateral pedicle border to VA; pedicle diameter (PD); sagittal diameter of the VA; coronal diameter of the VA; sagittal diameter of the TF; and coronal diameter of the TF. The cross-sections of the VA and the TF were measured to determine the occupation ratio of the VA. In addition, a safe zone was defined based on all lateral pedicle border to VA measurements in which the VA was within the TF. The level of entry of the VA into the TF as well as irregularities of the VA and the cervical pedicles were recorded. RESULTS Vertebral artery dominance on the left side was seen in 69.3% of cases. The mean PD increased from 4.9 to 6.5 mm (from C-3 to C-7, respectively). Statistically significantly bigger PDs were seen in males. The mean PD at C-2 was 5.6 mm. Entry of the VA at C-6 was seen in approximately 80% of cases. The TF occupation ratio of the VA was found to be the greatest in C-4 and C-7 (37.1 and 74.2%, respectively). The safe zone increased from C-2 to C-6 (1.1 to 1.7 mm, respectively), but was only 0.65 mm at C-7. In 23.6% of cases, an irregular pathway of the VA or irregular anatomy of a cervical pedicle was seen, with the highest incidence of irregularities found at C-2. CONCLUSIONS Computed tomography angiography is a valuable tool that can help determine the relationships between cervical pedicles and the VA as well as irregular VA pathways. Pedicle diameter, safe zone, and occupational ratio of the VA in the foramen determine the risk associated with instrumentation and should be assessed individually. Based on the authors' measurements, C-4 and C-7 can be considered critical levels for CPS placement. Because of this and the high incidence of irregular VA pathways and different entry points, it may be helpful to review neck CT angiography studies before considering posterior instrumentation procedures in the cervical spine.

show abstract

“…Abnormal levels of entrances of the VA into the C3, C4, C5 and C7 vertebrae and medial loops of the VA, with and without bony erosion were typical abnormalities at the V2 segment1,3,12,13,15). The incidence of an abnormal entrance of the VA was reported in 5-7% of cases13).…”

Section: Discussionmentioning

confidence: 94%

“…Therefore, authors have emphasized that preoperative MRI or CT scans should be conducted to avoid inadvertent tearing during an anterior or lateral approach to the cervical spine3,10). Abnormal levels of entrances of the VA into the C3, C4, C5 and C7 vertebrae and medial loops of the VA, with and without bony erosion were typical abnormalities at the V2 segment1,3,12,13,15). The incidence of an abnormal entrance of the VA was reported in 5-7% of cases13).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Medial Loop of V2 Segment of Vertebral Artery Causing Compression of Proximal Cervical Root

Park

Yang

Lee

2012

J Korean Neurosurg Soc

View full text Add to dashboard Cite

ObjectiveIt is rare that the medial loop in the V2 segment of the vertebral artery (VA) causes compression of the proximal cervical root of the spinal cord without leading to bony erosion and an enlarged foramen. We evaluated the clinical significance and incidence of the medial loop in the V2 segment of the VA.MethodsWe reviewed the records from 1000 consecutive patients who had undergone magnetic resonance imaging evaluation of the cervical spine between January 2005 and January 2008. The inclusion criteria were that over a third of the axial aspect of the VA located in the intervertebral foramen was inside the line between the most ventral points of the bilateral lateral mass, and that the ipsilateral proximal root deviated dorsally because of the medial loop of the VA. We excluded cases of bone erosion, a widened foramen at the medial loop of the VA, any bony abnormalities, tumors displacing VA, or vertebral fractures. The medical records were reviewed retrospectively to search for factors of clinical significance.ResultsIn six patients (0.6%), the VA formed a medial loop that caused compression of the proximal cervical root. One of these patients had the cervical radiculopathy that developed after minor trauma but the others did not present with cervical radiculopathy related to the medial loop of the VA.ConclusionThe medial loop of the VA might have a direct effect on cervical radiculopathy. Therefore, this feature should be of critical consideration in preoperative planning and during surgery.

show abstract

Vertebral artery anomaly with entry at C4—avoiding a surgical pitfall: a case report

Cited by 15 publications

References 13 publications

Coordinated Human Brainstem and Spinal Cord Networks during the Expectation of Pain Have Elements Unique from Resting-State Effects

Coordinated Human Brainstem and Spinal Cord Networks during the Expectation of Pain Have Elements Unique from Resting-State Effects

The vertebral artery and the cervical pedicle: morphometric analysis of a critical neighborhood

Medial Loop of V2 Segment of Vertebral Artery Causing Compression of Proximal Cervical Root

Contact Info

Product

Resources

About