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Medialization of Common Carotid Artery Is Associated with Cervical Kyphosis
Motoya Kobayashi1, Junichi Ohya1, Yuki Onishi1
1Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan.
Introduction:
Reportedly, the medialization of the common carotid artery (MCCA) to be a vascular anomaly with a potential risk of intraoperative carotid artery injury. Nevertheless, among spine surgeons, the presence of MCCA has not been well recognized.
Methods:
We retrospectively reviewed consecutive patients who underwent cervical radiographs and magnetic resonance imaging (MRI) examinations in a single spine center. Using MRI, the MCCA grade was classified into grades 1 to 3 in order of severity. Radiographic measurement included C2-C7 angles as cervical lordosis, cervical sagittal vertical axis (C-SVA), T1 slope (T1S), and T1S-cervical lordosis mismatch. We compared each patient's background and radiographic parameters between patients with each of the three MCCA grades. The continuous variables were compared using the Jonckheere-Terpstra trend test and the proportions were compared using the Cochran-Armitage trend test to investigate the trend of variables in three grades.
Results:
The present study included data from 133 eligible patients (65 males and 68 females) with a mean age of 63.7 (±14.2) years. The details of MCCA grading were as follows: grade 1, n=101; grade 2, n=27; and grade 3, n=5. With an increasing MCCA grade, age (61.9±14.0, 68.2±13.8, and 76.4±9.4 years for grades 1, 2, and 3, respectively, p=0.005) and proportion of female (p<0.001) had an increasing trend, whereas cervical lordosis had a decreasing trend (11.7±13.5°, 7.0±14.5°, and -10.0±19.2° for grades 1, 2, and 3, respectively, p=0.011).
Conclusions:
Several patient backgrounds including the female gender, older age, and kyphotic alignment were determined as MCCA risk factors. Careful preoperative neck vasculature assessment would avoid a catastrophic complication during anterior cervical surgery.
Insights
Medialization of the common carotid artery (MCCA) is a vascular anomaly linked to increased risk during anterior cervical surgery. Female gender, older age, and kyphotic alignment are identified as risk factors for MCCA.
Area of Science:
- Vascular Surgery
- Spine Surgery
- Radiology
Background:
- Medialization of the common carotid artery (MCCA) is a recognized vascular anomaly.
- MCCA presents a potential risk for intraoperative carotid artery injury during anterior cervical spine surgery.
- The prevalence and clinical significance of MCCA are not widely understood by spine surgeons.
Purpose of the Study:
- To investigate the association between patient background and radiographic parameters with the severity of medialization of the common carotid artery (MCCA).
- To identify potential risk factors for MCCA in patients undergoing cervical spine evaluations.
Main Methods:
- Retrospective review of 133 patients who underwent cervical radiography and MRI.
- Classification of MCCA severity into grades 1-3 based on MRI findings.
- Radiographic measurements included cervical lordosis, C-SVA, T1 slope, and T1S-cervical lordosis mismatch. Trend tests were used for statistical analysis.
Main Results:
- Increasing MCCA grade was associated with increasing age (p=0.005) and a higher proportion of females (p<0.001).
- A decreasing trend in cervical lordosis was observed with increasing MCCA grade (p=0.011).
- 101 patients had grade 1, 27 had grade 2, and 5 had grade 3 MCCA.
Conclusions:
- Female gender, older age, and kyphotic cervical alignment are identified as risk factors for MCCA.
- Preoperative assessment of neck vasculature is crucial to prevent serious complications during anterior cervical surgery.
- Awareness of MCCA among spine surgeons is essential for patient safety.
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