Posterior C1-C2 fixation for atlantoaxial instability due to a dysplastic C1 arch, complicated by an accidental vertebral artery injury managed with intravascular intervention and salvage contralateral unilateral fusion.

IF 0.4 Q4 SURGERY
Journal of Surgical Case Reports Pub Date : 2025-05-05 eCollection Date: 2025-05-01 DOI:10.1093/jscr/rjaf267
Armand Dominik Škapin, Peter Brumat, Juš Kšela, Miha Vodičar
{"title":"Posterior C1-C2 fixation for atlantoaxial instability due to a dysplastic C1 arch, complicated by an accidental vertebral artery injury managed with intravascular intervention and salvage contralateral unilateral fusion.","authors":"Armand Dominik Škapin, Peter Brumat, Juš Kšela, Miha Vodičar","doi":"10.1093/jscr/rjaf267","DOIUrl":null,"url":null,"abstract":"<p><p>Posterior fixation with fusion is recommended in symptomatic congenital anomalies of the upper cervical spine. Altered vertebral anatomy in such cases increases the likelihood of intraoperative complications, where injury to the vertebral artery (VA) may result in cerebellar and dorsolateral medulla oblongata ischemia. Prompt and appropriate intervention is paramount if complications arise. We present a patient with a dysplastic C1 arch, leading to atlantodental arthrosis and anterior C1 subluxation with resultant compressive myelopathy of the spinal cord. During elective surgery, a VA injury occurred, which was managed with intravascular intervention and salvage contralateral posterior unilateral C1-C2 fusion. Postoperatively, the patient developed partial Wallenberg syndrome. Imaging revealed two ischemic changes in the cerebellar hemisphere. One year after surgery, the patient showed substantial improvement following comprehensive rehabilitation, able to ambulate without support and maintain a significant level of independence in everyday activities.</p>","PeriodicalId":47321,"journal":{"name":"Journal of Surgical Case Reports","volume":"2025 5","pages":"rjaf267"},"PeriodicalIF":0.4000,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052242/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Surgical Case Reports","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1093/jscr/rjaf267","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/5/1 0:00:00","PubModel":"eCollection","JCR":"Q4","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0

Abstract

Posterior fixation with fusion is recommended in symptomatic congenital anomalies of the upper cervical spine. Altered vertebral anatomy in such cases increases the likelihood of intraoperative complications, where injury to the vertebral artery (VA) may result in cerebellar and dorsolateral medulla oblongata ischemia. Prompt and appropriate intervention is paramount if complications arise. We present a patient with a dysplastic C1 arch, leading to atlantodental arthrosis and anterior C1 subluxation with resultant compressive myelopathy of the spinal cord. During elective surgery, a VA injury occurred, which was managed with intravascular intervention and salvage contralateral posterior unilateral C1-C2 fusion. Postoperatively, the patient developed partial Wallenberg syndrome. Imaging revealed two ischemic changes in the cerebellar hemisphere. One year after surgery, the patient showed substantial improvement following comprehensive rehabilitation, able to ambulate without support and maintain a significant level of independence in everyday activities.

后路C1- c2固定治疗因C1弓发育不良导致的寰枢椎不稳定,并发意外椎动脉损伤,采用血管内介入治疗和对侧单侧抢救融合。
对于有症状的先天性上颈椎畸形,推荐后路内固定融合。在这种情况下,椎体解剖结构的改变增加了术中并发症的可能性,其中椎动脉(VA)的损伤可能导致小脑和延髓背外侧缺血。如果出现并发症,及时和适当的干预是至关重要的。我们报告了一位C1弓发育不良的患者,导致寰齿关节和前C1半脱位,并导致脊髓压缩性脊髓病。在择期手术中,发生了VA损伤,通过血管内介入治疗和挽救对侧后侧单侧C1-C2融合。术后,患者出现部分瓦伦堡综合征。影像学显示小脑半球有两处缺血性改变。手术一年后,患者在全面康复后表现出明显的改善,能够在没有支持的情况下行走,并在日常活动中保持显著的独立性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
CiteScore
0.70
自引率
0.00%
发文量
559
审稿时长
11 weeks
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信