Tortuous course of the vertebral artery and anterior cervical decompression - A cadaveric and clinical case study

Study Design. Both the cadaveric and clinical examples of anomalous vertebr al artery courses are described. the incidence of this anomaly in the gener al population and recognition,complications, and treatment options for thes e patients when undergoing anterior cervical decompression are discussed. Objectives. Cadaveric study: In this study vertebral artery's course throug h the cervical spine in the adult population was analyzed. The relation bet ween an abnormal vertebral artery course and surgical landmarks are :descri bed. Clinical study: Complications and alternative treatment methods for de compression in patients with the anomaly are described. Summary of Background Data. The incidence of anomalous vertebral artery cou rse is low, but failure to recognize a medially located vertebral artery ma y result in a life-threatening iatrogenic injury during decompression. Neit her the relation between the vertebral arteries and the surgical landmarks nor the guidelines for decompression in the face of a tortuous vertebral ar tery have been well described. Methods, Transverse foramens of the cervical spine were measured in 222 cad averic spines. The measurements were taken describing the relation between transverse foramens and other surgical landmarks. Three patients with anoma lies were identified in clinical practice. The complications and treatment options are identified in these patients. Results. In the cadaveric specime ns, a 2.7% incidence of tortuous vertebral artery course was identified. In these abnormal specimens, the transverse foramen was located an average of 0.14 mm medial to the joint of Luschka. In one patient, the abnormal cours e of the vertebral artery was recognized after laceration of the artery dur ing a routine corpectomy. Anomalies in the other two patients were recogniz ed before surgery, and the patients underwent modified anterior decompressi on by combining a discectomy at the anomalous level with a corpectomy at ot her levels. Vertebral,artery ectasia is identifiable on axial magnetic reso nance or computed tomographic images. Conclusions. Aberrant vertebral artery is rare. Preoperative recognition an d appropriate modification of anterior decompression can yield excellent cl inical results without risking significant complications.