Morphologic Changes in the Vertebral Artery Subsequent to Cervical Spine Degeneration and Aging: Analyses by Computed
Takashi Ohnishi1, Kota Suda2, Miki Komatsu2
1Department of Orthopedic Surgery, Hokkaido Spinal Cord Injury Center, Bibai, Hokkaido, Japan; Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan.
Insights
Cervical spine degeneration and aging correlate with vertebral artery (VA) changes, increasing the risk of VA injury during surgery. Osteophytes are key factors in VA deviation and stenosis, particularly at C3/C4.
Area of Science:
- Orthopedic Surgery
- Vascular Anatomy
- Radiology
Background:
- Cervical spine degeneration and aging are common conditions.
- Vertebral artery (VA) injury is a potential complication of cervical spine surgery.
- Understanding VA morphologic changes is crucial for surgical safety.
Purpose of the Study:
- To identify morphologic changes in the VA related to cervical spine degeneration and aging.
- To investigate risk factors for iatrogenic VA injury or occlusion.
Main Methods:
- Retrospective analysis of 88 patients (176 VAs) using imaging (radiographs, CT, CT angiography).
- Grading of cervical spine degeneration using the Kellgren and Lawrence (KL) score.
- Measurement of VA tortuosity and diameter; statistical analysis of correlations and explanatory variables.
Main Results:
- Significant positive correlations found between KL score/age and VA tortuosity width.
- Facet joint osteophytes were the main cause of medial VA deviation.
- VA stenosis highest at C3/C4 (24.5%), primarily due to uncovertebral joint osteophytes (52.0%).
Conclusions:
- Age and cervical spine degeneration significantly alter VA morphology.
- Osteophyte formation is a primary risk factor for VA deviation and stenosis.
- Findings aid surgical planning to prevent VA injury during cervical spine procedures.
Objective:
To identify the morphologic changes in the vertebral artery (VA) subsequent to cervical spine degeneration and aging and to investigate the risk factors for iatrogenic VA injury or occlusion.
Methods:
Eighty-eight consecutive patients (176 bilateral VAs) were retrospectively analyzed using radiographs, computed tomography, and computed tomography angiography images. The Kellgren and Lawrence (KL) score and its modified subscores were used to grade the severity of degenerative changes in the cervical spine. VA tortuosity widths and diameters were measured between the C2 and C6 transverse foramens. The outcome measures were statistically analyzed for difference, correlation, and explanatory variable. The level with a high prevalence of VA stenosis was also evaluated.
Results:
There were significant positive correlations between the KL score and VA tortuosity width, and between age and VA tortuosity width. Osteophyte formation in the facet joint was the predominant explanatory variable for medial deviation of the VA. Significant positive correlations were evident between the dominant VA diameter and KL score or age. VA stenosis occurred at C3/C4 (24.5%) with the highest prevalence and it was caused by uncovertebral joint osteophytes (52.0%) with the highest incidence.
Conclusions:
The present study provides important evidence for decisions of surgical strategy and for avoiding catastrophic VA injury or occlusion in cervical spine surgeries.
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