TORTUOSITY OF THE VERTEBRAL ARTERY IN PATIENTS WITH CERVICAL SPONDYLOTIC MYELOPATHY - RISK FACTOR FOR THE VERTEBRAL ARTERY INJURY DURING ANTERIOR CERVICAL DECOMPRESSION

Study Design. The case report presented herein shows tortuosity of the vertebral artery in a patient with cervical myelopathy. This case led the authors to evaluate 22 other patients who also had undergone ante rior cervical fusion. They were studied before operation by either mag netic resonance imaging angiography or selective vertebral angiography . Objectives. To analyze the radiographs, computed tomography, magneti c resonance imaging, and angiography findings to detect any tortuosity of the vertebral artery in patients with cervical myelopathy to show the risk factors of vertebral artery injury during anterior decompress ion. Summary of Background Data. Complications of vertebral artery lac eration during cervical anterior decompression are rare, so this injur y and abnormality in the course: of vertebral artery in patients with cervical myelopathy receive little attention. Methods. The tortuosity of the vertebral artery was assessed by angiography, magnetic resonanc e imaging, and computed tomography. Results. Mild vertebral artery tor tuosity was observed In 10 patients and loop formation in three associ ated with cervical spondylotic changes. Conclusions. This study sugges ts that vertebral artery loop formation is developed associated with c ervical spondylotic changes. During the anterior decompression of cerv ical spondylotic myelopathy or radiculopathy, the looped vertebral art ery could be injured by an excessive wide rejection of the bone or dis c material. In the case of vertebral artery migration, the looped vert ebral artery can even be injured by routine procedures.