Surgical Treatment of Vertebral Artery Insufficiency Caused by Cervical Spondylosis

C ERVICAL spondylosis accompanied by arthritic bony spurs that compress the vertebral artery is not uncommon in older people, ~,21,23,2~ and is often most severe during rotation and hyperextension of the neck. The most common site of formation of these osteophytes is on the uncinate portion of the vertebrae, which in embryonic stages is the junction of the centrum and lateral masses, called the neurocentral, uncovertebral, or Luschka's joint. There is disagreement on whether this is a true joint or not. 3,m1,18 It has been suggested that compression and displacement of one or both vertebral arteries may interfere with circulation in the vertebrobasilar arterial system. To date, few attempts have been made to correct this condition by surgical measures. The surgical procedure presented here evolved from observations of cadavers with displaced vertebral arteries due to severe osteophytes on the uncinate portion of the vertebrae. The ease with which those lateral osteophytes could be exposed and removed through the anterior approach with excision of the longus colli muscle led us to develop a simple method of removing the hypertrophied uncovertebral joint (uncectomy) without making a burr hole or performing an interbody fusion as described by Bakay and Leslie? Even after the spurs and fibrocartilaginous masses had been removed, the verterbral artery was still kinked due to marked perivascular fibrosis; a crease remained in the adventitia, with evidence of chronic irritation of the vertebral nerve. I therefore advocate excision of the fibrosis including the adventitia and periarterial vertebral nerve, following unroofing of the transverse fora-