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Evaluation of tortuous vertebral arteries before cervical spine surgery: illustrative case

BACKGROUND: Cervical spine surgery sometimes necessitates complex ventral/dorsal approaches or osteotomies that place the vertebral artery (VA) at risk of inadvertent injury. Tortuosity of the VA poses increased risk of vessel injury during anterior decompression or placement of posterior instrument...

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Autores principales: Sarmiento, J. Manuel, Cohen, Justin D., Babadjouni, Robin M., Quintero-Consuegra, Miguel D., Gonzalez, Nestor R., Perry, Tiffany G.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Association of Neurological Surgeons 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9245845/
https://www.ncbi.nlm.nih.gov/pubmed/35855017
http://dx.doi.org/10.3171/CASE2198
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author Sarmiento, J. Manuel
Cohen, Justin D.
Babadjouni, Robin M.
Quintero-Consuegra, Miguel D.
Gonzalez, Nestor R.
Perry, Tiffany G.
author_facet Sarmiento, J. Manuel
Cohen, Justin D.
Babadjouni, Robin M.
Quintero-Consuegra, Miguel D.
Gonzalez, Nestor R.
Perry, Tiffany G.
author_sort Sarmiento, J. Manuel
collection PubMed
description BACKGROUND: Cervical spine surgery sometimes necessitates complex ventral/dorsal approaches or osteotomies that place the vertebral artery (VA) at risk of inadvertent injury. Tortuosity of the VA poses increased risk of vessel injury during anterior decompression or placement of posterior instrumentation. OBSERVATIONS: In this report, the authors describe a patient with degenerative cervical spondylotic myelopathy and focal kyphotic deformity requiring corrective surgery via a combined ventral/dorsal approach. Computed tomography (CT) and CT angiography (CTA) of the spine identified a left medially enlarged C4 transverse foramen and tortuous VA V2 segment forming a potentially dangerous medial loop into the vertebral body, respectively. The patient’s presentation and management are described. LESSONS: The course of the VA is variable, and a tortuous VA with significant medial or lateral displacement may be dangerous during ventral and dorsal approaches to the cervical spine. CTA of the cervical spine is warranted in cases in which atlantoaxial fixation is needed or suspicious transverse foramen morphology is identified to understand the course of the VA and identify anatomical variations that would put the VA at risk during cervical spine surgery.
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spelling pubmed-92458452022-07-18 Evaluation of tortuous vertebral arteries before cervical spine surgery: illustrative case Sarmiento, J. Manuel Cohen, Justin D. Babadjouni, Robin M. Quintero-Consuegra, Miguel D. Gonzalez, Nestor R. Perry, Tiffany G. J Neurosurg Case Lessons Case Report BACKGROUND: Cervical spine surgery sometimes necessitates complex ventral/dorsal approaches or osteotomies that place the vertebral artery (VA) at risk of inadvertent injury. Tortuosity of the VA poses increased risk of vessel injury during anterior decompression or placement of posterior instrumentation. OBSERVATIONS: In this report, the authors describe a patient with degenerative cervical spondylotic myelopathy and focal kyphotic deformity requiring corrective surgery via a combined ventral/dorsal approach. Computed tomography (CT) and CT angiography (CTA) of the spine identified a left medially enlarged C4 transverse foramen and tortuous VA V2 segment forming a potentially dangerous medial loop into the vertebral body, respectively. The patient’s presentation and management are described. LESSONS: The course of the VA is variable, and a tortuous VA with significant medial or lateral displacement may be dangerous during ventral and dorsal approaches to the cervical spine. CTA of the cervical spine is warranted in cases in which atlantoaxial fixation is needed or suspicious transverse foramen morphology is identified to understand the course of the VA and identify anatomical variations that would put the VA at risk during cervical spine surgery. American Association of Neurological Surgeons 2021-05-17 /pmc/articles/PMC9245845/ /pubmed/35855017 http://dx.doi.org/10.3171/CASE2198 Text en © 2021 The authors https://creativecommons.org/licenses/by-nc-nd/4.0/CC BY-NC-ND 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) ).
spellingShingle Case Report
Sarmiento, J. Manuel
Cohen, Justin D.
Babadjouni, Robin M.
Quintero-Consuegra, Miguel D.
Gonzalez, Nestor R.
Perry, Tiffany G.
Evaluation of tortuous vertebral arteries before cervical spine surgery: illustrative case
title Evaluation of tortuous vertebral arteries before cervical spine surgery: illustrative case
title_full Evaluation of tortuous vertebral arteries before cervical spine surgery: illustrative case
title_fullStr Evaluation of tortuous vertebral arteries before cervical spine surgery: illustrative case
title_full_unstemmed Evaluation of tortuous vertebral arteries before cervical spine surgery: illustrative case
title_short Evaluation of tortuous vertebral arteries before cervical spine surgery: illustrative case
title_sort evaluation of tortuous vertebral arteries before cervical spine surgery: illustrative case
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9245845/
https://www.ncbi.nlm.nih.gov/pubmed/35855017
http://dx.doi.org/10.3171/CASE2198
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