Highlights
- •Unilateral high-riding vertebral artery may cause the nonuniform settlement of lateral mass.
- •Unilateral high-riding vertebral artery is associated with morphological changes of atlantoaxial joint.
- •We first propose the settlement phenomenon of C2 lateral mass and measurement method.
- •Expanding the understanding of effect of high-riding vertebral artery on atlantoaxial joint.
Abstract
Background Context
A high-riding vertebral artery (HRVA) can deviate too medially, too posteriorly, or
too superiorly to allow the safe insertion of screws. However, it is unknown whether
the presence of a HRVA is associated with morphological changes of the atlantoaxial
joint.
Purpose
To investigate the association between HRVA and atlantoaxial joint morphology in patients
with and without HRVA.
Study Design
A retrospective case–control study and finite element (FE) analysis.
Patient Sample
A total of 396 patients with cervical spondylosis underwent multi-slice spiral computed
tomography (MSCT) of cervical spine at our institutions from 2020 to 2022.
Outcome Measures
A series of atlantoaxial joint morphological parameters, including C2 lateral mass
settlement (C2 LMS), C1–2 sagittal joint inclination (C1–2 SI), C1–2 coronal joint
inclination (C1–2 CI), atlanto-dental interval (ADI), lateral atlanto-dental interval
(LADI), and C1–2 relative rotation angle (C1–2 RRA) were measured, and lateral atlantoaxial
joints osteoarthritis (LAJs-OA) was recorded. The stress distribution on the C2 facet
surface under different torques of flexion-extension, lateral bending, and axial rotation
was analyzed by FE models. A 2-Nm moment was applied to all models to determine the
range of motion (ROM).
Methods
A total of 132 consecutive cervical spondylosis patients with unilateral HRVA were
enrolled in the HRVA group, and 264 patients without HRVA matched for age and sex
were enrolled in the normal (NL) group. Atlantoaxial joint morphological parameters
were compared between two sides of C2 lateral mass within HRVA or NL group, and between
HRVA and NL groups. A 48-year-old woman with cervical spondylosis without HRVA was
selected for cervical MSCT. A three-dimensional (3D) FE intact model of the normal
upper cervical spine (C0-C2) was created. We established the HRVA model by simulating
atlantoaxial morphological changes of unilateral HRVA with FE method.
Results
The C2 LMS was significantly smaller on the HRVA side than that on the non-HRVA side
in the HRVA group, but C1–2 SI, C1–2 CI, and LADI on HRVA side were significantly
larger than those on non-HRVA side. There was no significant difference between left
and right sides in the NL group. The difference in C2 LMS (d-C2 LMS) between HRVA
side and non-HRVA side in the HRVA group was larger than that in the NL group (P <
0.05). Meanwhile, the differences in C1–2 SI (d-C1/2 SI), C1–2 CI (d-C1/2 CI), and
LADI (d-LADI) in the HRVA group were significantly larger than those in the NL group.
The C1–2 RRA in the HRVA group was significantly larger than that in the NL group.
Pearson correlations showed that d-C1/2 SI, d-C1/2 CI, and d-LADI were positively
associated with d-C2 LMS (r=0.428, 0.649, 0.498, respectively, p<.05 for all). The
incidence of LAJs-OA in the HRVA group (27.3%) was significantly larger than that
in the NL group (11.7%). Compared with the normal model, the ROM of C1-2 segment declined
in all postures of the HRVA FE model. We found a larger distribution of stress on
the C2 lateral mass surface of the HRVA side under different moment conditions.
Conclusions
We suggest that HRVA affects the integrity of the C2 lateral mass. This change in
patients with unilateral HRVA is associated with the nonuniform settlement of the
lateral mass and an increase in the lateral mass inclination, which may further affect
the degeneration of the atlantoaxial joint because of the stress concentration on
the C2 lateral mass surface.
Keywords
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Article info
Publication history
Published online: March 01, 2023
Accepted:
February 23,
2023
Received in revised form:
February 14,
2023
Received:
November 14,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
FDA device/drug status: Not applicable.
Author disclosures: CT: Nothing to disclose. YHL: Nothing to disclose. QW: Nothing to disclose. QT: Nothing to disclose. FM: Nothing to disclose. CHC: Nothing to disclose. SCX: Nothing to disclose. YBL: Nothing to disclose. TWC: Nothing to disclose. DJZ: Nothing to disclose.
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
