The Vertebral Artery Cave at C2: Anatomic Study with Application to C2 Pedicle Screw Placement

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• 作者：R. Shane Tubbs¹ ; Andre Granger¹ ; Christian Fisahn¹ ; ³ ; ^{christian.fisahn@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Marios Loukas² ; Marc Moisi³ ; Joe Iwanaga³ ; David Paulson³ ; Shiveindra Jeyamohan³ ; Jens R. Chapman³ ; Rod J. Oskouian³
• 关键词：Anatomy ; Axis ; Complications ; Spine ; Surgery
• 刊名：World Neurosurgery
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：94
• 期：Complete
• 页码：368-374
• 全文大小：1673 K

文摘

Knowledge of the course of the vertebral artery during instrumentation is of paramount importance. It has been shown that erosion of the C2 pedicle and body can occur due to pulsations of the adjacent vertebral artery. This often results in a “cave” for this segment of the artery. The descriptions of this anatomy are limited. The current study was performed with the hope that these data will be of use to spine surgeons during C2 instrumentation.

Methods

In 40 human adult C2 bone specimens, the position of the vertebral artery in relation to the undersurface of the superior articular facet, pedicle, and C2 body was observed. A classification system was used to better describe these relationships. Pedicle screws were then placed into selected examples of each type.

Results

We found type 0 specimens, with no cave, on 8 sides (10%). Types I, II, and III caves with minimal, moderate, and significant encroachment of the pedicle were observed on 40%, 35%, and 27.5% sides, respectively. Type IV caves with erosion into the lateral C2 body and undersurface of the superior articular facet were observed on 12.5% of sides. Although larger caves were found on left sides, this did not reach statistical significance. Pedicle screw placement for types III and IV were most likely to enter the vertebral artery cave (P < 0.05).

Conclusions

Additional osteologic data regarding the course of the vertebral artery while within C2 may decrease morbidity during surgery in this region.