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"Vertebral artery"

Original Articles

Clinical Study – Epidemiology

Epidemiology and Screening of Traumatic Vertebral Artery Injuries at a Large Scandinavian Level 1 Trauma Center
Paulina Cewe, Victor E. Staartjes, Victor Gabriel El-Hajj, Ihab Ahmad Al-Rikabi, Basel Musmar, Joana M Roy, Dennis Troung, Mats Beckman, Marcus Ohlsson, Pascal Jabbour, Adrian Elmi-Terander, Erik Edström
Neurospine 2025;22(4):905-915.   Published online December 31, 2025
DOI: https://doi.org/10.14245/ns.2551070.535

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Epidemiology and Screening of Traumatic Vertebral Artery Injuries at a Large Scandinavian Level 1 Trauma Center
Neurospine. 2025;22(4):905-915.   Published online December 31, 2025
DOI: https://doi.org/10.14245/ns.2551070.535
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Epidemiology and Screening of Traumatic Vertebral Artery Injuries at a Large Scandinavian Level 1 Trauma Center
Neurospine. 2025;22(4):905-915.   Published online December 31, 2025
DOI: https://doi.org/10.14245/ns.2551070.535
Close
Objective
Traumatic vertebral artery injuries (tVAIs) are uncommon but potentially devastating if missed. While computed tomography angiography (CTA) is routinely used for diagnosis, data on the number needed to image (NNI) remain limited. We hence analyzed tVAI epidemiology and imaging practices at a major Scandinavian level 1 trauma center.
Methods
A retrospective study (2013–2020) was performed based on a single-center trauma registry. Patients were grouped based on CTA imaging protocol used; selective screening (2013–2017) and universal screening (2018–2020). Imaging protocols, treatment strategies, and outcomes were analyzed.
Results
Among 2,843 patients admitted with level 1 trauma and receiving CTA imaging, 62 had a tVAI (2.2%) yielding a NNI of 46 patients to diagnose 1 tVAI. Twenty-five of these patients (40.3%) were found to have a posterior circulation stroke, resulting in an incidence of 0.9%, and a NNI of 114 to diagnose 1 stroke on CTA. NNIs for both tVAI and stroke detection increased with adoption of universal screening (tVAI: 35→65; stroke: 90→149). However, the detection rate of tVAI during the universal screening period was not significantly higher than during the selective screening period (p=0.261).
Conclusion
In our level 1 trauma cohort, the incidence of tVAI was 2.2% and stroke rate 0.9%. The NNI rose with universal screening, yet detection rates did not improve. These findings suggest that selective screening based on risk factors may be more efficient than a universal approach. Further research is needed to balance diagnostic accuracy with resource use in trauma care.

Citations

Citations to this article as recorded by  Crossref logo
  • Optimizing Diagnostic Yield: Evidence Against Universal Computed Tomography Angiography for Traumatic Vertebral Artery Injury Screening – A Commentary on “Epidemiology and Screening of Traumatic Vertebral Artery Injuries at a Large Scandinavian Level 1 Tr
    Jae Taek Hong
    Neurospine.2025; 22(4): 916.     CrossRef
  • From the Editor-in-Chief: Featured Articles in the December 2025 Issue
    Inbo Han
    Neurospine.2025; 22(4): 877.     CrossRef
  • 2,105 View
  • 48 Download
  • 2 Web of Science
  • 2 Crossref
Vertebral Artery Variations at the Craniovertebral Junction in “Sandwich” Atlantoaxial Dislocation Patients
Yinglun Tian, Nanfang Xu, Ming Yan, Jinguo Chen, Kan-Lin Hung, Xiangyu Hou, Shenglin Wang, Weishi Li
Neurospine 2021;18(4):770-777.   Published online December 31, 2021
DOI: https://doi.org/10.14245/ns.2142726.363

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Vertebral Artery Variations at the Craniovertebral Junction in “Sandwich” Atlantoaxial Dislocation Patients
Neurospine. 2021;18(4):770-777.   Published online December 31, 2021
DOI: https://doi.org/10.14245/ns.2142726.363
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Vertebral Artery Variations at the Craniovertebral Junction in “Sandwich” Atlantoaxial Dislocation Patients
Neurospine. 2021;18(4):770-777.   Published online December 31, 2021
DOI: https://doi.org/10.14245/ns.2142726.363
Close
Objective
To summarize the vertebral artery (VA) pattern of 96 “sandwich” atlantoaxial dislocation (AAD) patients and to describe the strategies of reducing the injury of VA during surgery.
Methods
From 2009 to 2020, we retrospectively reviewed the 3-dimensional computed tomography angiography data of 96 AAD patients combined with atlas occipitalization and C2–3 fusion, which were diagnosed as “sandwich” AAD and 96 patients as control group patients who were without atlas occipitalization, C2–3 fusion and any other cervical bone deformity at our institution. The variations of each side of VA were described in 3 different parts (C0–1, C1–2, and C2–3) according to the characteristics of the 3-part pathological structures in “sandwich” subgroup.
Results
One hundred ninety-two sides of VAs in every group of patients were analyzed and every VA was described separately at 3 different level regions. There were different variations in these 3 different regions: 4 variations in the upper fusion region, 5 variations in the sandwiched region, and 6 variations in the lower fusion region in sandwich AAD patients. And the rate of VA deformity in sandwich AAD patients was much higher and more types of VA variations existed.
Conclusion
In “sandwich” AAD patients, deformities of vertebral arteries in craniovertebral junction are more common, and the same VA may have deformities at different levels that severely affect surgical procedures. Therefore, preoperative imaging examination of VA for “sandwich” AAD patients is vital of guiding surgeons to avoid injury of VA during surgery.

Citations

Citations to this article as recorded by  Crossref logo
  • Three-dimensional time-of-flight magnetic resonance angiography as a safe preoperative guide for vertebral arteries in craniovertebral junction anomalies: A cross-sectional study
    Nivedita Sharma, Rahul Dev, Pankaj Kandwal, Rajnish Kumar Arora, Preetham Patavardhan, Kunal Nigam, Sonal Saran
    Journal of Craniovertebral Junction and Spine.2026; 17(2): 158.     CrossRef
  • Bilateral High-Riding Persistent First Cervical Intersegmental Arteries in a Case of Klippel-Feil Syndrome: The Technique of Vertebral Artery Mobilization for C1-C2 Reduction and Fusion for Atlanto-Axial Dislocation and Basilar Invagination: 2-Dimensional
    Ashutosh Kumar, Arun Kumar Srivastava, Pawan Kumar Verma, Kamlesh Singh Bhaisora, Anant Mehrotra, Awdhesh Kumar Jaiswal, Sanjay Behari
    Operative Neurosurgery.2025; 28(5): 724.     CrossRef
  • Morphometric analysis of the C1-2 zygapophysial joint in atlantoaxial dislocation patients with sandwich fusion of the craniovertebral junction
    Cheng Zhang, Jinguo Chen, Yinglun Tian, Shilin Xue, Guodong Gao, Qiyue Gao, Zhihang Gan, Nanfang Xu, Shenglin Wang
    Neurosurgical Review.2025;[Epub]     CrossRef
  • Influence of variations of craniovertebral junction anatomy on safe C1 lateral mass and C2 pedicle screw insertion: a cadaveric and radiologic study
    Derya Karatas, Ahmet Dagtekin, Saygi Uygur, Irmak Tekeli Barut, Engin Kara, Kaan Esen, Emel Avci, Mustafa Kemal Baskaya
    Surgical and Radiologic Anatomy.2025;[Epub]     CrossRef
  • Commentary: Bilateral High-Riding Persistent First Cervical Intersegmental Arteries in a Case of Klippel-Feil Syndrome: The Technique of Vertebral Artery Mobilization for C1-C2 Reduction and Fusion for Atlantoaxial Dislocation and Basilar Invagination: 2-
    Xin Zhou, Huasheng Jiang, Qing Chen, Jianming Liang, Li Nie, Kai Xu, Shuizhen Chen, Haiyang Qing, Wenchao Yang
    Operative Neurosurgery.2025; 29(2): 319.     CrossRef
  • Letter: The Rocker Technique for Atlantoaxial Dislocation With or Without Basilar Invagination: A Prospective Observational Study
    Xin Zhou
    Operative Neurosurgery.2025; 29(2): 321.     CrossRef
  • Modified classification system of high-riding vertebral artery for the C2 screw placement strategy: a large-scale, cross-sectional study
    Yuwang Du, Keyun He, Kelin Li, Zhaojie Qin, Xiaofeng Li, Lihao Tan, Tao Kang, Hongyu Qin, Hua Jiang
    Scientific Reports.2025;[Epub]     CrossRef
  • Role of Patient-Specific 3D-Printed Models for Complex Pediatric Craniocervical Junction Surgery: Case Description and Systematic Literature Review
    David S. K. Mak, Yu Tung Lo, Mark B. W. Tan, Dinesh S. Kumar, Sharon Y. Y. Low
    Surgical Techniques Development.2025; 15(1): 1.     CrossRef
  • Imaging and classifications of atlantoaxial dislocation: a narrative review
    Guangzhou Li, Hao Zhang, Qing Wang
    EFORT Open Reviews.2025; 10(7): 551.     CrossRef
  • A screw algorithm for congenital C2-3 fusion with high-riding vertebral arteries: feasibilities and clinical outcomes of five different fixation techniques
    Qiang Jian, Zhe Hou, Xingang Zhao, Yinqian Wang, Cong Liang, Tao Fan
    Neurosurgical Review.2024;[Epub]     CrossRef
  • Whole‐Exome Sequencing Analysis Identifies Risk Genes in Atlantoaxial Dislocation Patients with Sandwich Fusion
    Guodong Gao, Yinglun Tian, Kan-Lin Hung, Dongwei Fan, Nanfang Xu, Shenglin Wang, George P. Patrinos
    Human Mutation.2024;[Epub]     CrossRef
  • Clinical and Surgical Characteristics of Patients with Atlantoaxial Dislocation in the Setting of Sandwich Fusion
    Nanfang Xu, Yinglun Tian, Lihao Yue, Ming Yan, Kan-lin Hung, Xiangyu Hou, Weishi Li, Shenglin Wang
    Journal of Bone and Joint Surgery.2023; 105(10): 771.     CrossRef
  • Overstrain on the longitudinal band of the cruciform ligament during flexion in the setting of sandwich deformity at the craniovertebral junction: a finite element analysis
    Xiangyu Hou, Yinglun Tian, Nanfang Xu, Hui Li, Ming Yan, Shenglin Wang, Weishi Li
    The Spine Journal.2023; 23(11): 1721.     CrossRef
  • Characteristics and evaluation of C1 posterior arch variation for transpedicular screw placement between patients with and without basilar invagination
    Lu-Ping Zhou, Chen-Hao Zhao, Zhi-Gang Zhang, Jin Shang, Hua-Qing Zhang, Fang Ma, Chong-Yu Jia, Ren-Jie Zhang, Cai-Liang Shen
    European Spine Journal.2023; 32(10): 3547.     CrossRef
  • Anterior Transarticular Crossing Screw Fixation for Atlantoaxial Joint Instability: A Biomechanical Study
    Hang Xiao, Zhiping Huang, Panjie Xu, Junyu Lin, Qingan Zhu, Wei Ji
    Neurospine.2023; 20(3): 940.     CrossRef
  • Application of C2 subfacetal screws for the management of atlantoaxial dislocation in patients with Klippel-Feil syndrome characterized by a narrow C2 pedicle and high-riding vertebral artery
    Zhe Hou, Qiang Jian, Wayne Fan, Xingang Zhao, Yinqian Wang, Tao Fan
    Journal of Orthopaedic Surgery and Research.2022;[Epub]     CrossRef
  • 16,984 View
  • 363 Download
  • 17 Web of Science
  • 16 Crossref

Case Report

Endovascular Management of Iatrogenic Vertebral Artery Transection During Anterior Cervical Spine Surgery: A Case Report
Rasmiranjan Padhi, Sathish Kandasamy, Balasenthil Kumaran, Pranesh Madakasira Bheemarao, Senthil Kumaran
Neurospine 2021;18(1):245-249.   Published online March 31, 2021
DOI: https://doi.org/10.14245/ns.2040478.239

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Endovascular Management of Iatrogenic Vertebral Artery Transection During Anterior Cervical Spine Surgery: A Case Report
Neurospine. 2021;18(1):245-249.   Published online March 31, 2021
DOI: https://doi.org/10.14245/ns.2040478.239
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Endovascular Management of Iatrogenic Vertebral Artery Transection During Anterior Cervical Spine Surgery: A Case Report
Neurospine. 2021;18(1):245-249.   Published online March 31, 2021
DOI: https://doi.org/10.14245/ns.2040478.239
Close
Anterior surgical approaches to the cervical spinal pathology have become a frequently used technique. Anterior cervical spine surgeries are generally considered to be safe with low incidence of neurological complications. Vertebral artery (VA) injuries are infrequent during an anterior cervical spine approach but can be devastating. A retrospective review of these injuries documents an incidence of 0.3%–0.5%. However, there is no established strategy or guidelines for managing iatrogenic VA injuries. We describe a case of iatrogenic VA injury at C5 vertebral level during an anterior cervical approach for C5 cervical osteoblastoma; successful managed by endovascular coiling using detachable coils achieving complete occlusion. The patient had a good clinical outcome, with no symptoms of vertebrobasilar insufficiency at 2-year follow-up. There is a paradigm shift in the management of the VA injury after introduction of the interventional angiography. Endovascular embolization is a safe and effective treatment option, which offers certain advantages over open surgery such as minimal invasion, lower risk of neurological injury, lower morbidity, and recurrence rates.

Citations

Citations to this article as recorded by  Crossref logo
  • Vertebral Artery Injury in Cervical Spine Surgery: Anatomy, Risk Factors, and Modern Management Strategies
    Nicolas Kelhofer, Rahul Ramanathan, Varun Gopal, Christopher Gonzalez, Chinemerem Nwosu, Ryan Zuckerbraun, Michael Shannon, Richard A. Wawrose, Michael J. Spitnale, Yisheng Cao, Joon Y. Lee
    Montefiore Einstein Journal of Musculoskeletal Medicine and Surgery.2025;[Epub]     CrossRef
  • Complication Following Chemoport Insertion – Role of Endovascular Intervention
    Rasmiranjan Padhi, Sreenath Sethumadhavan
    Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques.2024; 51(6): 882.     CrossRef
  • VertebralArtery Injury with Anterior Cervical Spine Operations: A Systematic Review of Risk Factors, Clinical Outcomes, and Management Strategies
    Umaru Barrie, Donald Detchou, Raghuram Reddy, Jonathan Tao, Mahmoud Elguindy, Claudia Reimer, Kristen Hall, Desmond A. Brown, Salah G. Aoun, Carlos A. Bagley
    World Neurosurgery.2023; 173: 226.     CrossRef
  • Multiple Myeloma Treatment Challenges: A Case Report of Vertebral Artery Pseudoaneurysm Complicating Occipitocervical Arthrodesis and a Review of the Literature
    Gervith Reyes Soto, Carlos Salvador Ovalle Torres, Jorge Perez Terrazas , Kaori Honda Partida , Andreina Rosario Rosario , Alvaro Campero, Matias Baldoncini, Manuel de Jesus Encarnacion Ramirez, Nicola Montemurro
    Cureus.2023;[Epub]     CrossRef
  • Iatrogenic Vascular Injury Associated with Cervical Spine Surgery: A Systematic Literature Review
    Mehmet Turgut, Ali Akhaddar, Ahmet T. Turgut, Walter A. Hall
    World Neurosurgery.2022; 159: 83.     CrossRef
  • Epidemiology and Management of Iatrogenic Vertebral Artery Injury Associated With Cervical Spine Surgery
    Ho Jun Yi
    Korean Journal of Neurotrauma.2022; 18(1): 34.     CrossRef
  • Horner’s Syndrome and Vertebral Artery Occlusion Concomitant With Brachial Plexus Injury in a Patient With Anterior Approach Cervical Disc Herniation Surgery
    Seniz Akcay, Ali Murat Koc, Neslihan Eskut, Asli Koskderelioglu
    Cureus.2021;[Epub]     CrossRef
  • 12,088 View
  • 210 Download
  • 5 Web of Science
  • 7 Crossref

Review Article

Subaxial Cervical Spine Injuries: WFNS Spine Committee Recommendations
Salman Sharif, Muhammad Yassar Jazaib Ali, Ibet Marie Y. Sih, Jutty Parthiban, Óscar L. Alves
Neurospine 2020;17(4):737-758.   Published online December 31, 2020
DOI: https://doi.org/10.14245/ns.2040368.184

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Subaxial Cervical Spine Injuries: WFNS Spine Committee Recommendations
Neurospine. 2020;17(4):737-758.   Published online December 31, 2020
DOI: https://doi.org/10.14245/ns.2040368.184
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Subaxial Cervical Spine Injuries: WFNS Spine Committee Recommendations
Neurospine. 2020;17(4):737-758.   Published online December 31, 2020
DOI: https://doi.org/10.14245/ns.2040368.184
Close
To formulate specific guidelines for the recommendation of subaxial cervical spine injuries concerning classification, management, posttraumatic locked facets and vertebral artery injury. Computerized literature was searched on PubMed and google scholar database from 2009 to 2020. For classification, keywords “Sub Axial Cervical Spine Classification,” resulting in 22 articles related to subaxial cervical spine injury classification system (SLICS) system and 11 articles related to AO (Arbeitsgemeinschaft für Osteosynthesefragen, German for “Association for the Study of Internal Fixation”) Spine system. The literature search yielded 210 and 78 articles on “management of subaxial cervical spine injuries” and the role of “SLICS” and “AO Spine” respectively. Keywords “management of traumatic facet locks” were searched and closed reduction, traction, approaches and techniques were studied. “Vertebral artery injury and cervical fracture” exhibited 2,328 references from the last 15 years. The objective was to identify the appropriate diagnostic tests and optimal treatment. Up-to-date information was reviewed, and statements were produced to reach a consensus in 2 separate consensus meetings of World Federation of Neurosurgical Societies (WFNS) Spine Committee. The statements were voted and reached a positive or negative consensus using Delphi method. Based on the most relevant literature, panelists in Moscow consensus meeting conducted in May 2019 drafted the statements, and after a preliminary voting session, the consensus was identified on various statements. Another meeting was conducted at Peshawar in November 2019, where in addition to previous statements, few other statements were discussed and voted. Specific recommendations were then formulated guiding classification, management, locked facets and vertebral artery injuries. This review summarizes the WFNS Spine Committee recommendations on subaxial cervical spine injuries.

Citations

Citations to this article as recorded by  Crossref logo
  • Surgical Adverse Events After Anterior Stabilization of Subaxial Cervical Spine Injuries: A Nationwide Registry Study
    Philipp Raisch, Ursula Trinler, Sven Y. Vetter, Paul A. Grützner, Matthias K. Jung
    Global Spine Journal.2026; 16(6): 2683.     CrossRef
  • Mortality After Operatively Treated Cervical Spine Fractures – A National FinSpine Register Study
    Nils Danner, Nikolai Klimko, Henri Salo, Ville Leinonen, Jukka Huttunen
    Global Spine Journal.2026; 16(7): 3560.     CrossRef
  • Awake closed manual reduction of cervical spine dislocation as an emergency bridge to surgery: a case report
    Fangzheng Lin, Ji Qi, Jing Li, Jianglin Wu, Yu Hou, Minshan Feng, Yongjin Li, Shudong Chen, Dingkun Lin
    Frontiers in Medicine.2026;[Epub]     CrossRef
  • Association of concomitant subaxial cervical spine injury with imaging-based spinal cord injury and impaired consciousness in upper cervical spine trauma
    David Timaran-Montenegro, Mario Enrique Mahecha, Santiago Aristizabal-Ortiz, Andres Felipe Rodriguez, Rocco Hlis, Kamand Khalaj, Elham Tavakkol, Andres Mejia, Juan Camilo Ricardo, Roy Riascos
    Neuroradiology.2026;[Epub]     CrossRef
  • Subaxial cervical spine fractures with facet joint dislocation: Surgical management, technique, and results in a retrospective series of 36 patients
    Angelo Rusconi, Stefano Peron, Delia Cannizzaro, Alberto Campione, Roberto Stefini
    Journal of Craniovertebral Junction and Spine.2026; 17(3): 279.     CrossRef
  • Anaesthesia for cervical spine surgery. Part 2: emergency surgery
    J. Summers, A. Ghosh, T. Lawrence
    BJA Education.2026; 26(7): 295.     CrossRef
  • Unilateral biportal endoscopic cervical laminectomy with bilateral foraminotomy for cervical myeloradiculopathy: clinical and radiological outcomes at 1 year
    JinWoo Jung, Sang-Woo Lee, Donghyun Kim, Young San Ko, Dae-Chul Cho, Sang-Kyu Son, Man-Kyu Park
    Neurosurgical Review.2026;[Epub]     CrossRef
  • Traumatic Spinal Cord Injury: A Contemporary Review of Classification, Evaluation, and Acute Management
    John Carlos McDearman, John Attelah, Ali Nourbakhsh
    Journal of Clinical Medicine.2026; 15(16): 6175.     CrossRef
  • Time to Surgery for Subaxial Cervical Fractures: A Multicenter Study
    Guisela Quinteros, Guillermo Ricciardi, Ignacio Cirillo, Edgar Marquez García, Juan P. Cabrera, Charles A. Carazzo, Ratko Yurac, Alfredo Guiroy
    World Neurosurgery.2025; 193: 796.     CrossRef
  • Delayed Presentation of a Cervical Spine Fracture: A Case Report
    Ahmed Mahmood, Moustafa Abouelkheir
    Cureus.2025;[Epub]     CrossRef
  • BOOTStrap-SCI: Beyond One option of treatment for spinal trauma and spinal cord injury: Consensus-based stratified protocols for pre-hospital care and emergency room (part I)
    Nicolò Marchesini, Andreas K. Demetriades, Oscar Alves, Riya Mandar Dange, Harold Mauricio Choco, Edinson Dussan Lozada, Dumar Javier Figueredo Sanabria, Angélica Gamboa, Luz Llined Mendoza Victoria, Enoc Noscue Montealegre, Jonathan A. Pardo Carranza, Jo
    Brain and Spine.2025; 5: 104251.     CrossRef
  • Concept for direct reduction of large-sized cervical tear-drop fractures through a single anterior approach with follow up of five cases
    Samuel Haupt, Sabrina Weber, Christoph Zindel, Ivan Broger, Veit Schoenborn
    Archives of Orthopaedic and Trauma Surgery.2025;[Epub]     CrossRef
  • Optimization of surgical fixation in cervical spine fractures using advanced imaging techniques: a systematic review of functional and neurological outcomes
    Jesús Jiménez-Sánchez, Diego Alberto García Cortés, Ninoska Andrea Fuentes Sánchez, Juan Pablo Lasso Bravo, Juan Carlos Arce Vivas, Norman Baldelmir Olmedo Raza, Ayrthon Ezequiel Olmedo Salvador, Sebastián Barragán Barreto
    International Journal of Research in Orthopaedics.2025;[Epub]     CrossRef
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    Candyce Hamel, Nishard Abdeen, Barb Avard, Samuel Campbell, Noel Corser, Noah Ditkofsky, Ferco Berger, Nicolas Murray
    Canadian Association of Radiologists Journal.2024; 75(2): 279.     CrossRef
  • Secondary Dislocations in Type B and C Injuries of the Subaxial Cervical Spine: Risk Factors and Treatment
    Philipp Raisch, Jan Pflästerer, Michael Kreinest, Sven Y. Vetter, Paul A. Grützner, Matthias K. Jung
    Journal of Clinical Medicine.2024; 13(3): 700.     CrossRef
  • Outcome and complications of operatively treated subaxial cervical spine injuries: A population-based retrospective cohort study
    Joel Alve, Jukka Huttunen, Ville Leinonen, Henna-Kaisa Jyrkkänen, Nils Danner
    World Neurosurgery: X.2024; 22: 100283.     CrossRef
  • Predictors of failure after primary anterior cervical discectomy and fusion for subaxial traumatic spine injuries
    Aman Singh, Victor Gabriel El-Hajj, Alexander Fletcher-Sandersjöö, Nabeel Aziz, Abdul Karim Ghaith, Charles Tatter, Simon Blixt, Gunnar Nilsson, Mohamad Bydon, Paul Gerdhem, Erik Edström, Adrian Elmi-Terander
    European Spine Journal.2024; 33(6): 2332.     CrossRef
  • Immobilization protocols for the treatment of cervical spine fracture: a scoping review
    Akhilesh Bhushan, Alexa Beland, Chantelle Poelstra, Jessica Butterfield, Marina Angel, Tiffany Cheung, Emma Plater, Daipayan Guha, Markian Pahuta, Luciana G. Macedo
    The Spine Journal.2024; 24(9): 1571.     CrossRef
  • El ABC de las fracturas cervicales en región subaxial de origen traumático
    Luis Mario Hinojosa Martínez, José Rafael Calderón Varela, Edgar Joaquín Cardeña Morales, Andrés Villalvazo Barón
    Cirugía de Columna.2024; 2(2): 97.     CrossRef
  • Trauma to the lower cervical spine (sub-axial or C3–C7) in adults
    Himanshu Shekhar, Andreas K. Demetriades
    Orthopaedics and Trauma.2024; 38(5): 289.     CrossRef
  • A New Risk Prediction Model for the Assessment of Myocardial Injury in Elderly Patients Undergoing Non-Elective Surgery
    Vedat Cicek, Mert Babaoglu, Faysal Saylik, Samet Yavuz, Ahmet Furkan Mazlum, Mahmut Salih Genc, Hatice Altinisik, Mustafa Oguz, Berke Cenktug Korucu, Mert Ilker Hayiroglu, Tufan Cinar, Ulas Bagci
    Journal of Cardiovascular Development and Disease.2024; 12(1): 6.     CrossRef
  • Clinical and radiological outcomes of one-level cervical corpectomy with an expandable cage for three-column uncomplicated subaxial type «B» injures: a multicenter retrospective study
    Vadim A. Byvaltsev, Andrei A. Kalinin, Evgenii G. Belykh, Marat A. Aliyev, Bair B. Sanzhin, Alexander V. Kukharev, Yermek K. Dyussembekov, Valerii V. Shepelev, K. Daniel Riew
    European Spine Journal.2023; 32(5): 1644.     CrossRef
  • Navigating treatment options for sacral spine lymphoma
    Ali Msheik, Firas Saad, Wajih A. Saad, Zeinab Al Mokdad, Charif Tarhini, Mohamad Bayram
    International Journal of Surgery Case Reports.2023;[Epub]     CrossRef
  • Tratamiento quirúrgico del trauma subaxial cervical. Reporte de tres casos clínicos y revisión de la literatura
    Fabián Ramírez Hernández, Ricardo Erik Robles Ortiz, Alejandro Fabián Rodríguez Messina, Alberto Hernández Cora, Olivia María Rascón Sosa
    Ortho-tips.2023; 19(3): 166.     CrossRef
  • Post-operative Use of Cervical Orthoses for Subaxial Cervical Spine Injuries – a Survey-based Analysis at German Spine Care Centres
    Philipp Raisch, Matthias K. Jung, Sven Y. Vetter, Paul A. Grützner, Michael Kreinest
    Zeitschrift für Orthopädie und Unfallchirurgie.2022; 160(06): 637.     CrossRef
  • Epidemiology of traumatic cervical spinal fractures in a general Norwegian population
    Nils Christian Utheim, Eirik Helseth, Mona Stroem, Paal Rydning, Magnus Mejlænder-Evjensvold, Thomas Glott, Christina Teisner Hoestmaelingen, Mads Aarhus, Paal Andre Roenning, Hege Linnerud
    Injury Epidemiology.2022;[Epub]     CrossRef
  • Sub-axial cervical dislocation
    Amit Shukla, Suyash Singh
    Journal of Spinal Surgery.2022; 9(2): 75.     CrossRef
  • Results Of Anterior Fixation for Subaxial Cervical Injuries in A Tertiary Care Centre
    Shiraz Ahmed Ghouri, Farrukh Zulfiqar, Muhammad Asim Khan Rehmani, Ramesh Kumar, Muhammad Faaiq Ali, Qazi Muhammad Zeeshan
    Pakistan BioMedical Journal.2022; : 133.     CrossRef
  • Update on Upper Cervical Injury Classifications
    Alexander R. Vaccaro, Brian A. Karamian, Hannah A. Levy, Jose A. Canseco, Shanmuganathan Rajasekaran, Lorin M. Benneker, F. Cumhur Oner, Frank Kandziora, Klaus J. Schnake, Christopher K. Kepler, Gregory D. Schroeder
    Clinical Spine Surgery.2022; 35(6): 249.     CrossRef
  • Cervical spine Flexion-Distraction fracture in a Brazilian Jiu-Jitsu athlete: A case report and literature review
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  • 27,335 View
  • 1,172 Download
  • 26 Web of Science
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Original Article

APCSS special Topic-Craniovertebral Junction Surgery

Basilar Invagination and Atlantoaxial Dislocation: Reduction, Deformity Correction and Realignment Using the DCER (Distraction, Compression, Extension, and Reduction) Technique With Customized Instrumentation and Implants
P. Sarat Chandra, Jitin Bajaj, Pankaj Kumar Singh, Kanwaljeet Garg, Deepak Agarwal
Neurospine 2019;16(2):231-250.   Published online June 30, 2019
DOI: https://doi.org/10.14245/ns.1938194.097

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Basilar Invagination and Atlantoaxial Dislocation: Reduction, Deformity Correction and Realignment Using the DCER (Distraction, Compression, Extension, and Reduction) Technique With Customized Instrumentation and Implants
Neurospine. 2019;16(2):231-250.   Published online June 30, 2019
DOI: https://doi.org/10.14245/ns.1938194.097
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Basilar Invagination and Atlantoaxial Dislocation: Reduction, Deformity Correction and Realignment Using the DCER (Distraction, Compression, Extension, and Reduction) Technique With Customized Instrumentation and Implants
Neurospine. 2019;16(2):231-250.   Published online June 30, 2019
DOI: https://doi.org/10.14245/ns.1938194.097
Close
Objective
The technique of distraction, compression, extension, and reduction (DCER) is effective to reduce, realign, and relieve cranio-spinal compression through posterior only approach.
Methods
Study included all patients with atlantoaxial dislocation and basilar invagination (BI) with occipitalized C1 arch. Study techniques included Nurick grading, computed tomography scan to study atlanto-dental interval, BI, hyper-lordosis, and neck tilt. Sagittal inclination (SI), coronal inclination (CI), cranio-cervical tilt, presence of pseudo-joints, and anomalous vertebral artery were also noted. Patients underwent DCER with/without joint remodeling or extra-articular distraction (EAD) based on the SI being <100°, 100°–160°, or >160° respectively. In cases with pseudo-joints, joint remodeling was performed in type I and EAD in type II. Customized ‘bullet shaped’ PSC spacers (n=124) and prototype of the universal craniovertebral junction reducer (UCVJR, n=36) were useful.
Results
A total of 148 patients with average age 27.25±17.43 years, ranging from 3 to 71 years (87 males) were operated. Nurick’s grading improved from 3.14±1.872 to 1.22±1.17 (p<0.0001). Fifty-two percent of total joints (n=154/296 joints) were either type I (19%)/type II (33%) pseudo-j oints. All traditional indices such as Chamberlein line, McRae line, atlanto-dental interval, and Ranawat line improved (pConclusion
Occipito-C2 pseudo-joints are important in determining the severity of BI. Asymmetrical pseudo-joint causes coronal/neck tilt. Type of pseudo-joint can strategize by DCER. Customized instruments and implants make technique safe, effective and easier.

Citations

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Technical Note

APCSS special Topic-Craniovertebral Junction Surgery

Anterior Retropharyngeal Cage Distraction and Fixation for Basilar Invagination: “The Wedge Technique”
Sushil Patkar
Neurospine 2019;16(2):286-292.   Published online June 30, 2019
DOI: https://doi.org/10.14245/ns.1938172.086

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Anterior Retropharyngeal Cage Distraction and Fixation for Basilar Invagination: “The Wedge Technique”
Neurospine. 2019;16(2):286-292.   Published online June 30, 2019
DOI: https://doi.org/10.14245/ns.1938172.086
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Anterior Retropharyngeal Cage Distraction and Fixation for Basilar Invagination: “The Wedge Technique”
Neurospine. 2019;16(2):286-292.   Published online June 30, 2019
DOI: https://doi.org/10.14245/ns.1938172.086
Close
Objective
Surgery is indicated for basilar invagination (BI) in symptomatic patients. In many patients, symptoms and signs occur due to an upward-migrated and malaligned odontoid with fixed or mobile atlantoaxial instability. Posterior distraction and fixation of the atlantoaxial joints has evolved to become the standard of care, but has some inherent morbidity. In this study, we propose that the unilateral anterior submandibular retropharyngeal approach with customized wedge-shaped titanium cages inserted into both atlantoaxial joints and anterior atlantoaxial fixation with a plate screw construct is a safer and easier option in many cases of BI.
Methods
From February 2014 to February 2019, 52 patients (age range, 15–78 years; 40 males and 12 females) with symptomatic BI with atlantoaxial dislocation and minimal sagittal facetal inclination and only mild Chiari malformation without syringomyelia were offered anterior submandibular retropharyngeal atlantoaxial distraction and fixation surgery.
Results
Neurological improvement occurred in 80% of patients, while the neurological status of 20% remained unchanged. No patients worsened, and no major complications or mortality was observed.
Conclusion
In properly selected cases of symptomatic BI, anterior wedge cage distraction with anterior atlantoaxial fixation is a safe and simple option.

Citations

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  • C2 Vertebra: An Enigma for Young Spine/Neurosurgeons
    Mayank Garg, Raghavendra K. Sharma, Vikas Janu, Mohit Agrawal, Ashutosh Jha, Pushpinder Khera, Deepak K. Jha
    Journal of Neurological Surgery Part B: Skull Base.2025; 86(01): 092.     CrossRef
  • Surgical Treatment of Basilar Invagination
    Ricardo V. Botelho, Oscar L. Alves, Geraldo Sá Carneiro, Zan Chen, Onur Yaman, Jutty Parthiban, Massimiliano Visocchi, Jörg Klekamp, Atul Goel, Mehmet Zileli
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    Hongfeng Meng, Zong Xin, Boyan Zhang, Maoyang Qi, Yueqi Du, Wanru Duan, Zan Chen
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    Qiang Jian, Xingang Zhao, Zhe Hou, Yinqian Wang, Tao Fan
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    Sushil Patkar
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    Sushil Patkar
    Neurosurgical Focus: Video.2020; 3(1): V11.     CrossRef
  • Editorial: Are there any indications of transoral odontoidectomy today?
    P. Sarat Chandra
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  • 215 Download
  • 6 Web of Science
  • 7 Crossref

Original Articles

Anatomical Relationship of the Vertebral Artery With the Lateral Recess: Clinical Importance for Posterior Cervical Foraminotomy
Sung Woon Oh, Ravindra Singh, Nitin Maruti Adsul, Jung Hoon Noh, Jun Hwan Park, Hyeun-Sung Kim, Il-Tae Jang, Seong Hoon Oh
Neurospine 2019;16(1):34-40.   Published online March 31, 2019
DOI: https://doi.org/10.14245/ns.1836304.152

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Anatomical Relationship of the Vertebral Artery With the Lateral Recess: Clinical Importance for Posterior Cervical Foraminotomy
Neurospine. 2019;16(1):34-40.   Published online March 31, 2019
DOI: https://doi.org/10.14245/ns.1836304.152
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Anatomical Relationship of the Vertebral Artery With the Lateral Recess: Clinical Importance for Posterior Cervical Foraminotomy
Neurospine. 2019;16(1):34-40.   Published online March 31, 2019
DOI: https://doi.org/10.14245/ns.1836304.152
Close
Objective
Vertebral artery injuries during posterior cervical foraminotomy are rare, but can be fatal. Therefore, we investigated the anatomical correlation between the lateral recess and the vertebral artery.
Methods
On axial cuts of cervical magnetic resonance imaging from 108 patients, we measured the distance between the vertebral arteries and the medial border of the facet joints. The anatomical vertebro-facet distance (AVFD), surgical vertebro-facet distance (SVFD), and vertebro-facet angle (VFA) were measured.
Results
The mean AVFD values on the right side at the C3–4, C4–5, C5–6, and C6–7 levels showed statistically significant differences. On the right side, the mean SVFD values were equivalent to the AVFD values. The mean values of the VFA on the right side at all levels showed statistically significant differences. For all measurements, the greatest differences were seen between the C5–6 and C6–7 levels, and higher levels were associated with smaller distances from the lateral recess. The mean values of the AVFD on the right and left sides showed statistically significant differences at all levels, and the distances on the left were smaller than those on the right.
Conclusion
The vertebral artery is closer to the lateral recess at higher cervical levels than at lower cervical levels. The largest distances were found at the C5–6 and C6–7 levels, and the left vertebral arteries were closer to the lateral recess than the right vertebral arteries.

Citations

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  • Complications in Full-Endoscopic Posterior Cervical Surgery: A Review of the Literature and Preventive Strategies
    Vit Kotheeranurak, Pramod V. Lokhande, Thanadol Tangdamrongtham, Teerachat Tassanasoomboon, Khanathip Jitpakdee, Weerasak Singhatanadgige, Worawat Limthongkul, Wicharn Yingsakmongkol, Yanting Liu, Jin-Sung Kim, Surachat Jaroenwareekul
    Global Spine Journal.2025; 15(7): 3379.     CrossRef
  • Single-Incision Posterior Endoscopic Cervical Foraminotomy for 2-Level Cervical Radiculopathy
    Florian Wanivenhaus, Christoph Johannes Laux, Sohrab Gollogly, Jin-Sung Kim, Mazda Farshad
    Journal of Minimally Invasive Spine Surgery and Technique.2025; 10(2): 289.     CrossRef
  • Minimally Invasive Microscopic C5-6 Foraminotomy and Discectomy: Operative Nuances
    Het Shah, Manoj Phalak
    Neurology India.2024; 72(5): 976.     CrossRef
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    Chien-Wei Liao, Kuo-Tai Chen, Kai-Sheng Chang, Li-wei Sun, Chun Tseng, Chien-Min Chen
    Journal of Minimally Invasive Spine Surgery and Technique.2023; 8(Suppl 1): S9.     CrossRef
  • Cervical kinematic change after posterior full-endoscopic cervical foraminotomy for disc herniation or foraminal stenosis
    Seungyoon Paik, Yunhee Choi, Chun Kee Chung, Young Il Won, Sung Bae Park, Seung Heon Yang, Chang-Hyun Lee, John Min Rhee, Kyoung-Tae Kim, Chi Heon Kim, Thamer Hamdan
    PLOS ONE.2023; 18(2): e0281926.     CrossRef
  • Fully-Endoscopic Posterior Cervical 2-Level Foraminotomy With Total Pediculectomy for Adjacent-Level Foraminal Stenosis in Severe Degenerative Spondylolisthesis: A Technical Note With 1-Year Follow-up
    Hyeun-Sung Kim, Harshavardhan Dilip Raorane, Jin Woo An, Yeon Jin Yi, Il Tae Jang
    Journal of Minimally Invasive Spine Surgery and Technique.2023; 8(Suppl 1): S92.     CrossRef
  • Overview and Prevention of Complications During Full-Endoscopic Cervical Spine Surgery
    Young-Rak Kim, Jun-Hoe Kim, Tae-Hwan Park, Hangeul Park, Sum Kim, Chang-Hyun Lee, Kyoung-Tae Kim, Chun Kee Chung, Chi Heon Kim
    Journal of Minimally Invasive Spine Surgery and Technique.2023; 8(2): 153.     CrossRef
  • 11,864 View
  • 428 Download
  • 7 Web of Science
  • 7 Crossref
Biomechanical and Anatomical Validity of the Short Posterior Arch Screw
Jun Mizutani, Nozomu Inoue, Yoshihisa Otsuka, Aiharu Furuya, Alejandro A. Espinoza Orias, Takanobu Otsuka
Neurospine 2019;16(2):347-353.   Published online October 14, 2018
DOI: https://doi.org/10.14245/ns.1836156.078

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Biomechanical and Anatomical Validity of the Short Posterior Arch Screw
Neurospine. 2019;16(2):347-353.   Published online October 14, 2018
DOI: https://doi.org/10.14245/ns.1836156.078
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Biomechanical and Anatomical Validity of the Short Posterior Arch Screw
Neurospine. 2019;16(2):347-353.   Published online October 14, 2018
DOI: https://doi.org/10.14245/ns.1836156.078
Close
Objective
This study was conducted to clarify the validity of the short posterior arch screw (S-PAS). The S-PAS is inserted only in the pedicle-analogue portion of the posterior arch. The S-PAS screw length is almost half that conventional C1 lateral mass screws inserted via the posterior arch (via-PAS). S-PAS reduces the risk of vertebral artery injury (VAI) because it never reaches the transverse foramen. Although the biomechanical validity of various C1 lateral mass screws (C1LMS) analyzed in young specimens have been published, that of unicortically inserted C1LMS such as the unicortical Harms screw, S-PAS, and via-PAS for elderly patients is concerning because of the high prevalence of osteoporosis in the elderly.
Methods
Nine fresh frozen cadavers (average age at death, 72.1 years) were used for pullout testing. The bone mineral density of each specimen was evaluated using quantitative computed tomography.
Results
The pullout strength of via-PAS (1,048.5 N) was significantly greater than that of the unicortical Harms screw (257.9 N) (p<0.05). The pullout strength of S-PAS was 720.3 N, which was also significantly greater than that of the unicortical Harms screw (p<0.05).
Conclusion
The via-PAS and S-PAS are valid surgical options, even in elderly patients. Along with sufficient biomechanical strength, the S-PAS screw prevents VAI.

Citations

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  • Surgical strategies for treatment of secondary cervical subaxial spine kyphotic deformities (review)
    D. V. Biragov, D. A. Gulyaev, D. S. Godanyuk
    Russian Neurosurgical Journal named after Professor A. L. Polenov.2024; 16(2): 174.     CrossRef
  • Vertebral artery injury during anterior cervical spine surgery (review)
    D. V. Biragov, D. A. Gulyaev, D. S. Godanyuk, Yu. Yu. Polyakov, R. M. Sharifov, T. S. Aldatov, K. V. Zhdanovich
    Russian Neurosurgical Journal named after Professor A. L. Polenov.2024; 16(3): 133.     CrossRef
  • A Review of Strategies to Improve Biomechanical Fixation in the Cervical Spine
    Colby Oitment, Patrick Thornley, Frank Koziarz, Thorsten Jentzsch, Kunal Bhanot
    Global Spine Journal.2022; 12(7): 1596.     CrossRef
  • Safety and efficacy of Wharton's jelly-derived mesenchymal stem cells with teriparatide for osteoporotic vertebral fractures: A phase I/IIa study
    JeongHyun Shim, Kyoung-Tae Kim, Kwang Gi Kim, Un-Yong Choi, Jae Won Kyung, Seil Sohn, Sang Heon Lim, Hyemin Choi, Tae-Keun Ahn, Hye Jeong Choi, Dong-Eun Shin, Inbo Han
    Stem Cells Translational Medicine.2021; 10(4): 554.     CrossRef
  • Clinical Efficacy and Safety of C1 Lateral Mass Screws versus C1 Pedicle Screws in the Treatment of Atlantoaxial Instability: A Meta-Analysis
    小龙 郑
    Advances in Clinical Medicine.2021; 11(09): 4010.     CrossRef
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    International Journal of Molecular Sciences.2020; 21(12): 4274.     CrossRef
  • 10,664 View
  • 185 Download
  • 3 Web of Science
  • 6 Crossref

Case Reports

Delayed Vertebral Artery Dissection after Posterior Cervical Fusion with Traumatic Cervical Instability: A Case Report
Chang Hyun Oh, Gyu Yeul Ji, Seung Hwan Yoon, Dongkeun Hyun, Eun Young Kim, Hyeonseon Park, A Reum Jang
Korean J Spine 2015;12(2):79-83.   Published online June 30, 2015
DOI: https://doi.org/10.14245/kjs.2015.12.2.79

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Delayed Vertebral Artery Dissection after Posterior Cervical Fusion with Traumatic Cervical Instability: A Case Report
Korean J Spine. 2015;12(2):79-83.   Published online June 30, 2015
DOI: https://doi.org/10.14245/kjs.2015.12.2.79
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Delayed Vertebral Artery Dissection after Posterior Cervical Fusion with Traumatic Cervical Instability: A Case Report
Korean J Spine. 2015;12(2):79-83.   Published online June 30, 2015
DOI: https://doi.org/10.14245/kjs.2015.12.2.79
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Vascular injury presented immediately after the penetration, but delayed onset of vascular symptom caused by an embolism or vessel dissection after cervical fusion or traumatic event is extremely rare. We present a case of a 56-year-old woman who underwent an operation for cervical fusion for type II Odontoid process fracture. She presented symptoms of seizure with hemiparesis in 6 days after the operation. Multifocal acute infarction due to an embolism from the left VA (V3 segment) dissection was observed without a definite screw breach the transverse foramen. We hereby reported the instructive case report of delayed onset of vertebral artery dissection after posterior cervical fusion with type II odontoid process fracture patient. When a cervical operation performed in the cervical trauma patient, even if no apparent VA injury occurs before and during the operation, the surgeon must take caution not to risk cerebral infarction because of the delayed VA dissection.

Citations

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  • Iatrogenic Vascular Injury Associated with Cervical Spine Surgery: A Systematic Literature Review
    Mehmet Turgut, Ali Akhaddar, Ahmet T. Turgut, Walter A. Hall
    World Neurosurgery.2022; 159: 83.     CrossRef
  • Vascular complications in spine surgery
    Daniel B.C. Reid, Shyam A. Patel, Alan H. Daniels, Jeffrey A. Rihn
    Seminars in Spine Surgery.2019; 31(4): 100756.     CrossRef
  • Impact of Perioperative Neurologic Deficits on Clinical Outcomes After Posterior Cervical Fusion
    Sanjana Dayananda, Amol Mehta, Nitin Agarwal, Enyinna L. Nwachuku, David K. Hamilton, Parthasarathy D. Thirumala
    World Neurosurgery.2018; 119: e250.     CrossRef
  • 12,121 View
  • 102 Download
  • 3 Crossref
Cervicogenic Vertigo Treated by C1 Transverse Foramen Decompression : A Case Report
Junhee Park, Chulkyu Lee, Namkyu You, Sanghyun Kim, Kihong Cho
Korean J Spine 2014;11(3):209-211.   Published online September 30, 2014
DOI: https://doi.org/10.14245/kjs.2014.11.3.209

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Cervicogenic Vertigo Treated by C1 Transverse Foramen Decompression : A Case Report
Korean J Spine. 2014;11(3):209-211.   Published online September 30, 2014
DOI: https://doi.org/10.14245/kjs.2014.11.3.209
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Cervicogenic Vertigo Treated by C1 Transverse Foramen Decompression : A Case Report
Korean J Spine. 2014;11(3):209-211.   Published online September 30, 2014
DOI: https://doi.org/10.14245/kjs.2014.11.3.209
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Cervicogenic vertigo was known as Bow hunter's syndrome. Occlusion of vertebral artery causes vertebrobasilar insufficiency and we reported cervicogenic vertigo case which was treated by simple decompression of transverse foramen of C1. The patient was 48 years old female who had left side dominant vertebral artery and vertigo was provoked when she rotated her head to right side. Angiography showed complete obliteration of blood flow of left vertebral artery when her head was rotated to right side. The operation was decompression of left vertebral artery at C1 level. Posterior wall of transverse foramen was resected and vertebral artery was exposed and decompressed. After surgery, vertigo of the patient was disappeared, and angiography showed patent left vertebral artery when her head was rotated to right side. Vertigo caused by compression of cervical vertebral artery could be treated by decompression without fusion or instrumentation, especially in C1 transverse foramen.

Citations

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  • Audiología y Mareo de Origen Cervical
    Eider Fernando Otero-Velasco, Erika Geraldine Muñoz-Moreno, Leidy Johana Gomez-Calvache
    Areté.2019; 19(2): 49.     CrossRef
  • Congenital Bilateral C2 Transverse Foramina Stenosis Causing Adult-Onset Vertebrobasilar Insufficiency and Posterior Circulation Stroke
    Ajeet Gordhan, Catherine Lockhart
    Case Reports in Neurology.2017; 9(2): 137.     CrossRef
  • Letter to the Editor: Bow hunter’s syndrome: surgery or conservative therapy?
    Zhe Yu, Shengyuan Yu, Ruozhuo Liu
    Neurosurgical Focus.2015; 39(5): E6.     CrossRef
  • 11,424 View
  • 120 Download
  • 3 Crossref
Vertebral Artery Dissect Injury with Brown-Séquard Syndrome by a Neural Foramen Penetrated Electric Screw Driver Bit : A Case Report
Chang Hyun Oh, Min Soo Kim, Sung Hyun Noh, Dong Ah Shin, Gyu Yeul Ji
Korean J Spine 2013;10(4):258-260.   Published online December 31, 2013
DOI: https://doi.org/10.14245/kjs.2013.10.4.258

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Vertebral Artery Dissect Injury with Brown-Séquard Syndrome by a Neural Foramen Penetrated Electric Screw Driver Bit : A Case Report
Korean J Spine. 2013;10(4):258-260.   Published online December 31, 2013
DOI: https://doi.org/10.14245/kjs.2013.10.4.258
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Vertebral Artery Dissect Injury with Brown-Séquard Syndrome by a Neural Foramen Penetrated Electric Screw Driver Bit : A Case Report
Korean J Spine. 2013;10(4):258-260.   Published online December 31, 2013
DOI: https://doi.org/10.14245/kjs.2013.10.4.258
Close

There are few reports in the literature of complete obstruction of the vertebral artery (VA) due to an electric screw driver bit penetration through the neural foramen into the spinal canal with Brown-Séquard syndrome (BSS). A 25-year-old man was admitted to the emergency department with a penetrated neck injury by an electric screw driver bit after a struggle. The patient presented the clinical features of BSS. Computed tomography scan revealed that the electric screw driver bit penetrated through the right neural foramen at the level of C3-4, and it caused an injury to the right half of the spinal cord. Emergent angiography revealed VA dissection, which was managed by immediate coil embolization at both proximal and distal ends of the injury site. After occlusion of the VA, the electric screw driver bit was extracted under general anesthesia. Bleeding was minimal and controlled without difficulties. No postoperative complications, such as wound dehiscence, CSF leakage, or infection, were noted. Endovascular approaches for occlusion of vertebral artery lesions are safe and effective methods of treatment.

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  • Penetrating Vertebral Artery Injuries: A Literature Review and Proposed Treatment Algorithm
    Keaton Piper, Maximilian Rabil, David Ciesla, Sivero Agazzi, Zeguang Ren, Maxim Mokin, Waldo R. Guerrero
    World Neurosurgery.2021; 148: e518.     CrossRef
  • A systematic review of penetrating extracranial vertebral artery injuries
    Juan A. Asensio, Parinaz J. Dabestani, Florian A. Wenzl, Stephanie S. Miljkovic, John J. Kessler, Carlos A. Fernandez, Tyson Becker, David Cornell, Margaret Siu, Charles Voigt, Devendra K. Agrawal
    Journal of Vascular Surgery.2020; 71(6): 2161.     CrossRef
  • Management of non-missile penetrating spinal injury
    David J. Wallace, Christopher Sy, Geoffrey Peitz, Ramesh Grandhi
    Neurosurgical Review.2019; 42(4): 791.     CrossRef
  • 9,652 View
  • 52 Download
  • 3 Crossref
O-arm(R) Imaging System Coupled with Navigation Guided Posterior Atlantoaxial Screw Fixation in the Patient with Ponticulus Posticus, an Anatomical Variation of Atlas.
Sang Mok Kim, Kyeong Sik Ryu, Hong Jae Lee, Chun Kun Park
Korean J Spine 2010;7(4):265-267.

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O-arm(R) Imaging System Coupled with Navigation Guided Posterior Atlantoaxial Screw Fixation in the Patient with Ponticulus Posticus, an Anatomical Variation of Atlas.
Korean J Spine. 2010;7(4):265-267.
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O-arm(R) Imaging System Coupled with Navigation Guided Posterior Atlantoaxial Screw Fixation in the Patient with Ponticulus Posticus, an Anatomical Variation of Atlas.
Korean J Spine. 2010;7(4):265-267.
Close
Ponticulus posticus is an abnormal bony bridge of posterior arch of atlas. The resulting foramen contains the vertebral artery and has clinical significance in lateral mass screw insertion into the first cervical vertebra. The authors report an atlantoaxial subluxation case showing a ponticulus posticus, which was surgically treated with posterior atlantoaxial screw fixation under the guidance of O-arm(R) imaging system coupled with navigation.
  • 3,327 View
  • 24 Download
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