Anatomical variations of vertebral artery and C2 isthmus in atlanto-axial fusion: Consecutive surgical 100 cases

Bong Ju Moon, Kyung Ho Choi, Dong Ah Shin, Seong Yi, Keung Nyun Kim, Do Heum Yoon, Yoon Ha

Research output: Contribution to journalArticlepeer-review

17 Citations (Scopus)


VA anomalies in extra- and intraosseous regions of the craniovertebral junction (CVJ) is considered very carefully during the posterior screw fixation for the atlantoaxial instability (AAI). This study aims to compare the incidence and variations of VA anomalies, isthmus and pedicle size of C2 in 100 patients with AAI due to congenital skeletal anomaly (CSA) and acquired disease by using three-dimensional CT angiograms (3D CTA) before surgery. The CSA group contained 48 patients and the acquired disease group consisted of 52. In the CSA group, Os odontoideum was the major cause with 43 patients. The causes of acquired disease were RA in 16 patients and OA in 36 patients. Five patients had the anomalous VA in only CSA group; fenestration 2 patients and persistent first intersegmental (PFIS) artery 3 patients. Between CSA and acquired disease groups, no significant differences were found in the isthmus height, internal height, and pedicle width of C2 except the right internal height that is bigger in CSA group. The high-riding VA (isthmus height <4 mm or internal height <2 mm) had no significant difference between CSA group (27.1%) and acquired disease group (34.6%). However, in acquired disease group, patients with rheumatoid arthritis had smaller left internal height (4.21 ± 1.63 vs. 5.51 ± 1.83 mm) and pedicle width (4.11 ± 1.05 vs. 5.05 ± 1.66 mm) of C2 than those of patients with degenerative osteoarthritis. Therefore, in the case of atlantoaxial fusion, we should contemplate VA anomaly and the high-riding VA, especially in patients with CSA and RA.

Original languageEnglish
Pages (from-to)147-152
Number of pages6
JournalJournal of Clinical Neuroscience
Publication statusPublished - 2018 Jul

Bibliographical note

Publisher Copyright:
© 2018 Elsevier Ltd

All Science Journal Classification (ASJC) codes

  • Surgery
  • Neurology
  • Clinical Neurology
  • Physiology (medical)


Dive into the research topics of 'Anatomical variations of vertebral artery and C2 isthmus in atlanto-axial fusion: Consecutive surgical 100 cases'. Together they form a unique fingerprint.

Cite this