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A rare anomaly of the course of the vertebral artery
The Spine Journal 11 (2011) 681–682
A rare anomaly of the course of the vertebral artery A 15-year-old female patient presented with persistent neck pain and headaches after an incident of posterior head trauma. She underwent magnetic resonance imaging to rule out cervical spine injury and was found to have an anomalous left vertebral artery in the cervical spine. We do not believe that this aberrant artery was a cause of her symptoms but report this case as an incidental finding to make interventionalists aware of this anomaly (Figs. 1–3). The anomaly of the vertebral artery was detected where the artery entered the cervical central spinal canal. Instead of the entire artery entering the cervical central canal cephalad to the posterior arch of C1, a component of the artery entered the central canal caudad to the posterior arch of C1 and compressed the left C2 dorsal root ganglion. The remainder of the artery entered the central canal cephalad to the posterior arch of C1. Once in the central canal, the caudad component of the artery joined the cephalad component of the artery to form a single artery before entering the foramen magnum.
Fig. 1. T2-axial magnetic resonance image demonstrates the component of the left vertebral artery (solid arrow) entering the central spinal canal caudad to the C1 posterior arch and compressing the left C2 dorsal root ganglion (dashed arrow). 1529-9430/$ - see front matter Ó 2011 Elsevier Inc. All rights reserved. doi:10.1016/j.spinee.2011.05.006
Fig. 2. Slightly cephalad to Fig. 1, T2-axial magnetic resonance image demonstrates the component of the left vertebral artery (solid arrow) that entered the central canal caudad to the C1 posterior arch now located in the central spinal canal.
The presence of the aberrant artery adjacent to, and even impinging, the C2 dorsal root ganglion is very rare and could potentially lead to vascular injury during a C2
Fig. 3. Cephalad to the C1 posterior arch, T2-axial magnetic resonance image demonstrates the component of the left vertebral artery that entered the central spinal canal cephalad to the C1 posterior arch and joining the component of the left vertebral artery that entered the central canal caudad to the C1 posterior arch. The normal right vertebral artery is also demonstrated entering the central spinal canal.
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J.D. Back et al. / The Spine Journal 11 (2011) 681–682
nerve root injection. The presence of arterial anomalies increases the risks associated with cervical interventions and surgeries [1]. It is therefore important to identify such abnormalities before attempting to perform any cervical procedure.
Reference
Richard J. Herzog, MD Department of Radiology and Imaging Hospital for Special Surgery 535 East 70th St, New York, NY 10021, USA Gregory E. Lutz, MD Department of Physiatry, Hospital for Special Surgery 523 East 72nd St, 2nd Floor, New York NY 10021, USA
[1] Eskander MS, Drew JM, Aubin ME, et al. Vertebral artery anatomy: a review of two hundred fifty magnetic resonance imaging scans. Spine 2010;35:2035–40.
Joshua D. Back, BA Department of Physiatry, Hospital for Special Surgery 523 East 72nd St, 2nd Floor, New York, NY 10021, USA
FDA device/drug status: not applicable. Author disclosures: JDB: Nothing to disclose. RJH: Consulting: Medtronic (D). GEL: Nothing to disclose. The disclosure key can be found on the Table of Contents and at www. TheSpineJournalOnline.com.
A rare anomaly of the course of the vertebral artery A 15-year-old female patient presented with persistent neck pain and headaches after an incident of posterior head trauma. She underwent magnetic resonance imaging to rule out cervical spine injury and was found to have an anomalous left vertebral artery in the cervical spine. We do not believe that this aberrant artery was a cause of her symptoms but report this case as an incidental finding to make interventionalists aware of this anomaly (Figs. 1–3). The anomaly of the vertebral artery was detected where the artery entered the cervical central spinal canal. Instead of the entire artery entering the cervical central canal cephalad to the posterior arch of C1, a component of the artery entered the central canal caudad to the posterior arch of C1 and compressed the left C2 dorsal root ganglion. The remainder of the artery entered the central canal cephalad to the posterior arch of C1. Once in the central canal, the caudad component of the artery joined the cephalad component of the artery to form a single artery before entering the foramen magnum.
Fig. 1. T2-axial magnetic resonance image demonstrates the component of the left vertebral artery (solid arrow) entering the central spinal canal caudad to the C1 posterior arch and compressing the left C2 dorsal root ganglion (dashed arrow). 1529-9430/$ - see front matter Ó 2011 Elsevier Inc. All rights reserved. doi:10.1016/j.spinee.2011.05.006
Fig. 2. Slightly cephalad to Fig. 1, T2-axial magnetic resonance image demonstrates the component of the left vertebral artery (solid arrow) that entered the central canal caudad to the C1 posterior arch now located in the central spinal canal.
The presence of the aberrant artery adjacent to, and even impinging, the C2 dorsal root ganglion is very rare and could potentially lead to vascular injury during a C2
Fig. 3. Cephalad to the C1 posterior arch, T2-axial magnetic resonance image demonstrates the component of the left vertebral artery that entered the central spinal canal cephalad to the C1 posterior arch and joining the component of the left vertebral artery that entered the central canal caudad to the C1 posterior arch. The normal right vertebral artery is also demonstrated entering the central spinal canal.
682
J.D. Back et al. / The Spine Journal 11 (2011) 681–682
nerve root injection. The presence of arterial anomalies increases the risks associated with cervical interventions and surgeries [1]. It is therefore important to identify such abnormalities before attempting to perform any cervical procedure.
Reference
Richard J. Herzog, MD Department of Radiology and Imaging Hospital for Special Surgery 535 East 70th St, New York, NY 10021, USA Gregory E. Lutz, MD Department of Physiatry, Hospital for Special Surgery 523 East 72nd St, 2nd Floor, New York NY 10021, USA
[1] Eskander MS, Drew JM, Aubin ME, et al. Vertebral artery anatomy: a review of two hundred fifty magnetic resonance imaging scans. Spine 2010;35:2035–40.
Joshua D. Back, BA Department of Physiatry, Hospital for Special Surgery 523 East 72nd St, 2nd Floor, New York, NY 10021, USA
FDA device/drug status: not applicable. Author disclosures: JDB: Nothing to disclose. RJH: Consulting: Medtronic (D). GEL: Nothing to disclose. The disclosure key can be found on the Table of Contents and at www. TheSpineJournalOnline.com.