Posterior Decompression and Arthrodesis in Congenital Atlantoaxial Subluxation and Associated Complex Vertebral Artery Anomaly: A Case Report

Introduction: The overall incidence of vertebral artery (VA) variations is 2–3%, but among patients with congenital anomalies at the cranio-vertebral junction, it is 20%. Knowing these anomalies is important, if failed to recognize can lead to VA injury during surgery and subsequent cerebrovascular accidents. Case Report: A 14-year-old boy presenting with progressive weakness of bilateral upper limb and lower limb was diagnosed as case of supra-axial cervical myelopathy due to congenital atlantoaxial subluxation with fenestration of VA and high-riding VA. The patient underwent posterior decompression and fusion using C1 lateral mass and C2 laminar screw rod construct. Conclusion: A thorough evaluation of the anatomy of the craniovertebral joint is required in congenital pathologies, and a patient-specific treatment approach should be used. Surgical management can effectively alleviate symptoms and prevent complications, but careful consideration must be given to the risks and benefits of different surgical techniques.