Bilateral persistent intersegmental artery in a patient with posterior atlantoaxial subluxation after subaxial cervical laminoplasty

International Journal of Surgery Case Reports, 2023 · DOI: https://doi.org/10.1016/j.ijscr.2022.107796 · Published: January 1, 2023

Surgery Orthopedics Research Methodology & Design

Simple Explanation

This case report discusses a rare vascular condition called bilateral persistent first intersegmental artery (PFIA) in an 85-year-old woman who also had posterior subluxation of the atlantoaxial joint. Due to the presence of PFIA and other factors, the patient underwent posterior occipito-thoracic fixation, a surgical procedure to stabilize the upper spine, without posterior arch resection. The patient's neurological symptoms improved after surgery, and the report emphasizes the importance of pre-operative imaging to detect such vascular anomalies to avoid iatrogenic vertebral artery injury (IVAI).

Study Duration

Not specified

Participants

One 85-year-old woman

Evidence Level

Level 4, Case Report

Key Findings

1
The patient had bilateral PFIA, a rare vascular anomaly, along with left-sided high-riding vertebral artery (HRVA).
2
Posterior occipito-thoracic fixation, avoiding posterior arch resection, was successfully performed to stabilize the spine.
3
Post-operative neurological symptoms improved, and imaging confirmed adequate spinal cord decompression.

Research Summary

This case report describes the successful management of an 85-year-old woman with posterior atlantoaxial subluxation and bilateral persistent first intersegmental artery (PFIA). The patient underwent posterior occipito-thoracic fixation to avoid the high risk of vertebral artery injury associated with posterior arch resection and lateral mass screw insertion, given the presence of PFIA and bony fragility. Postoperatively, the patient's neurological symptoms improved, and imaging confirmed adequate spinal cord decompression, highlighting the importance of careful preoperative planning and imaging in cases with anomalous vertebral artery anatomy.

Practical Implications

Preoperative Planning

Careful preoperative evaluation with 3D-CT angiography is crucial to identify vertebral artery anomalies like PFIA to avoid iatrogenic injury during surgery.

Surgical Technique Selection

Surgical techniques should be tailored to avoid high-risk maneuvers, such as posterior arch resection or lateral mass screw insertion, when vertebral artery anomalies are present.

Alternative Fixation Strategies

Occipitothoracic fixation can be a viable alternative in cases with PFIA and bony fragility, providing spinal stabilization while minimizing the risk of vertebral artery injury.

Study Limitations

1
This is a single case report, limiting the generalizability of the findings.
2
Long-term follow-up data beyond one year is not provided.
3
The specific criteria for selecting occipitothoracic fixation over other surgical options are not fully elaborated.

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