Key result
Cervical CTA identifies vertebral artery variations, revealing ~24% have high-riding courses.
Why the study?
Vertebral artery course variations in the atlantoaxial region pose significant risks during posterior C1-C2 fixation, motivating a classification of these variations on CT angiography to assess their anatomic implications for surgical planning.
Cohort (n=511)
No
Preoperative cervical CTA with three-dimensional reconstruction identifies seven distinct vertebral artery course variations in the atlantoaxial region (present in 30% of arteries), helping to minimize iatrogenic vascular injury during posterior C1-C2 fixation.
Answers are grounded in this paper and cite their sources.
Preoperative CTA aids C1-C2 fixation planning; extends anatomic classification while leaving outcome impact open.
BACKGROUND: Vertebral artery (VA) course variations in the atlantoaxial region pose significant risks during posterior C1-C2 fixation. This study aimed to classify these variations on CT angiography (CTA) and assess their anatomic implications for surgical planning. METHODS: A retrospective analysis was conducted on 511 patients (1,022 vertebral arteries) who underwent cervical CTA at Beijing Tongren Hospital between January 2019 and December 2024. Vertebral artery course variations were classified by two independent senior radiologists. Interobserver agreement was assessed using Cohen's kappa coefficient. Associations between variation types and gender/side were analyzed using chi-square tests with adjusted standardized residuals. potential surgical implications were assessed based on anatomical relationships and literature review Results: Seven types were identified: normal type (712 arteries, 70%), high-riding type (243, 24%), posterior arch bridge type (26, 2.5%), protruding type (14, 1.4%), segmental artery type (13, 1.2%), fenestration type (9, 0.9%), and combined type (5, 0.5%). Interobserver agreement was substantial (κ = 0.795). Each type carries distinct anatomic considerations for screw placement, exposure, and surgical approach selection. CONCLUSIONS: Different vertebral artery course variation types carry distinct and predictable potential surgical implications. Detailed preoperative CTA assessment with three-dimensional reconstruction is essential for identifying these variations and minimizing the risk of iatrogenic vertebral artery injury during posterior atlantoaxial surgery.
No takes yet. Share an insight, caveat, or question.
Xi et al. (2026) conducted a cohort in Vertebral artery course variations in the atlantoaxial region (n=511). Cervical CT angiography (CTA) imaging analysis was evaluated on Classification and prevalence of vertebral artery course variations in the atlantoaxial region. Cervical CTA identified seven vertebral artery course types across 1,022 arteries (70% normal, 24% high-riding) with substantial interobserver agreement (κ=0.795).
Synapse has enriched 10 related papers. Consider them for comparative context: