Transarticular Fixation Following Mobilization of "High-Riding" Vertebral Artery
Transarticular Fixation Following Mobilization of "High-Riding" Vertebral Artery
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DOI：
10.1093/ons/opaa456
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发表时间：
2021-01-19
影响因子：
2.3
通讯作者：
Thomas, Antony
中科院分区：
文献类型：
--
作者：
Goel, Atul;Prasad, Apurva;Thomas, Antony
背景和重要性：文章确定的可行性transarticular螺钉固定后，动员椎动脉的情况下，它是在一个“高骑”location.Clinical介绍：一个42岁的男性患者有4年的历史进行性四肢轻瘫。调查显示严重的颅底凹陷。寰椎有同化现象，C2-3融合。椎动脉高位进入两侧C2椎弓根关节面。在椎动脉弓根后方钻取椎弓根骨，显露椎动脉袢，并在两侧进行游离。椎动脉圆顶前面的C2小面骨现在可用于螺钉插入。C1-2关节面和关节直接成一直线，使得经关节螺钉固定相对简单。骨间隙宽，允许在两侧以经关节方式插入2枚螺钉。患者的临床改善令人满意。22个月后的影像学显示骨融合across faces.CONCLUSION：高骑椎动脉环的松动可以帮助挽救侧块稳定的外科手术。
BACKGROUND AND IMPORTANCE: The article identifies the feasibility of transarticular screw fixation after mobilizing the vertebral artery in cases where it is in a "high-riding" location.CLINICAL PRESENTATION: A 42-yr-old male patient had a 4-yr history of progressive quadriparesis. Investigations revealed severe basilar invagination. There was assimilation of atlas and C2-3 fusion. The vertebral artery was "high-riding" into the pedicle-facet of C2 vertebra on both sides. Vertebral artery loop was exposed and mobilized inferiorly on both sides after careful drilling of pedicular bone on the posterior aspect of the dome of the artery. C2 facetal bone on the anterior face of the vertebral artery dome was now available for screw insertion. The C1-2 facets and the articulation were directly in line, making transarticular screw fixation relatively straightforward. The wide bone space available permitted insertion of 2 screws in a transarticular fashion on both sides. The patient had satisfactory clinical improvement. Imaging after 22 mo showed bone fusion across the facets.CONCLUSION: Mobilization of the high-riding vertebral artery loop can help salvage the surgical procedure of lateral mass stabilization.