title: Tortuous course of the vertebral artery and anterior cervical decompression: a cadaveric and clinical case study.
abstract: METHODS
  Both the cadaveric and clinical examples of anomalous vertebral artery courses are described. The incidence of this anomaly in the general population and recognition, complications, and treatment options for these patients when undergoing anterior cervical decompression are discussed.
  
  
  OBJECTIVE
  Cadaveric study: In this study vertebral artery's course through the cervical spine in the adult population was analyzed. The relation between an abnormal vertebral artery course and surgical landmarks are described. Clinical study: Complications and alternative treatment methods for decompression in patients with the anomaly are described.
  
  
  BACKGROUND
  The incidence of anomalous vertebral artery course is low, but failure to recognize a medially located vertebral artery may result in a life-threatening iatrogenic injury during decompression. Neither the relation between the vertebral arteries and the surgical landmarks nor the guidelines for decompression in the face of a tortuous vertebral artery have been well described.
  
  
  METHODS
  Transverse foramens of the cervical spine were measured in 222 cadaveric spines. The measurements were taken describing the relation between transverse foramens and other surgical landmarks. Three patients with anomalies were identified in clinical practice. The complications and treatment options are identified in these patients.
  
  
  RESULTS
  In the cadaveric specimens, a 2.7% incidence of tortuous vertebral artery course was identified. In these abnormal specimens, the transverse foramen was located an average of 0.14 mm medial to the joint of Luschka. In one patient, the abnormal course of the vertebral artery was recognized after laceration of the artery during a routine corpectomy. Anomalies in the other two patients were recognized before surgery, and the patients underwent modified anterior decompression by combining a discectomy at the anomalous level with a corpectomy at other levels. Vertebral artery ectasia is identifiable on axial magnetic resonance or computed tomographic images.
  
  
  CONCLUSIONS
  Aberrant vertebral artery is rare. Preoperative recognition and appropriate modification of anterior decompression can yield excellent clinical results without risking significant complications.
authors.affiliation: Spine Institute, Department of Orthopedic Surgery, Case Western Reserve University, University Hospitals of Cleveland, Cleveland, Ohio 44106, USA.
authors.forename: L J
authors.initials: LJ
authors.lastname: Curylo
authors.forename: H C
authors.initials: HC
authors.lastname: Mason
authors.forename: H H
authors.initials: HH
authors.lastname: Bohlman
authors.forename: J U
authors.initials: JU
authors.lastname: Yoo
mesh_terms: D002102:Cadaver; D002574:Cervical Vertebrae / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods*; D017586:Diskectomy; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013128:Spinal Osteophytosis / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014711:Vertebral Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000293:injuries