C1-C2 instability with severe occipital headache in the setting of vertebral artery facet complex erosion. uri icon

Overview

abstract

  • PURPOSE: An exact understanding of patient vertebral artery anatomy is essential to safely place screws at the atlanto-axial level in posterior arthrodesis. We aim to report a case of erosion of the left vertebral artery into the C1-C2 facet complex with resultant rotatory and lateral listhesis presenting with severe occipital headache. This represents a novel etiology for this diagnosis and our report illustrates technical considerations when instrumenting the C1-C2 segment. METHODS: We report a case of severe occipital headache due to C1-C2 instability with resultant left C2 nerve compression in the setting of erosion of the vertebral artery into the C1-C2 facet complex. RESULTS: A 68-year-old woman presented with a 12-month history of progressively debilitating headache and neck pain with atlanto-axial instability. Computed tomography (CT) angiography demonstrated erosion of the left vertebral artery into the left C1-C2 facet complex. In addition, the tortuous vertebral arteries had eroded into the C2 pedicles, eliminating the possibility for posterior pedicle screw placement. The patient underwent posterior arthrodesis of C1-C2 utilizing bilateral lateral mass fixation into C1 and bilateral trans-laminar fixation into C2 with resolution of all preoperative complaints. CONCLUSIONS: This study constitutes the first report of a tortuous vertebral artery causing the partial destruction of a C1-C2 facet complex, as well as instability, with the clinical presentation of severe occipital headache. It hereby presents a novel etiology for both the development of C1-C2 segment instability as well as the development of occipital headache. Careful evaluation of such lesions utilizing CT angiography is important when formulating a surgical plan.

publication date

  • April 25, 2013

Research

keywords

  • Atlanto-Axial Joint
  • Joint Instability
  • Osteolysis
  • Post-Traumatic Headache
  • Vertebral Artery
  • Zygapophyseal Joint

Identity

Scopus Document Identifier

  • 84905399897

Digital Object Identifier (DOI)

  • 10.1007/s00586-013-2792-7

PubMed ID

  • 23616203

Additional Document Info

volume

  • 23 Suppl 2