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  • Title: Unusual Case of C2 Subisthmic Vertebral Artery with Atlantoaxial Dislocation: Persistent Second Cervical Intersegmental Artery.
    Author: Sahoo S, Salunke P, Garg R.
    Journal: World Neurosurg; 2018 Jul; 115():154-156. PubMed ID: 29689387.
    Abstract:
    BACKGROUND: The vertebral artery (VA) may have an anomalous course in patients with congenital atlantoaxial dislocation. In such cases, the artery crosses the C1-C2 joint posteriorly. These cases need thorough evaluation of the VA course to avoid its injury during posterior reduction and fusion of C1-C2. We describe for the first time an unusual subisthmic course of VA in a case of congenital irreducible atlantoaxial dislocation (AAD). The surgical implication and possible embryology of such an anomaly have been highlighted. METHODS: A 25-year-male diagnosed with congenital AAD presented with spastic quadriparesis. Radiology showed irreducible AAD with oblique C1-C2 facet joints. The computed tomography angiogram showed the right VA traversing beneath the isthmus of atlas. The joint was opened, drilled, manipulated, and fused with a C1 lateral mass and C2 pedicle screw. RESULTS: The C2 isthmus was defined, and the C2 pedicle screw was inserted to prevent injury to the VA. The patient gradually improved and was doing well at his 6-month follow-up. CONCLUSIONS: The subisthmic variant of the VA may be the result of persistent C2 intersegmental artery. The presence of a subisthmic VA increases the chance of injury while inserting transarticular or C2 pars screw and warrants insertion of direct pedicle screw.
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