Modified posterior atlantoaxial screw-rod fixation in a case of persistent first intersegmental artery. Case report and literature review.
OBJECTIVE
This case reports atlantoaxial stabilization in case of V3 segment anomaly.


METHODS
We report the case of a patient who was victim of a complex C2 fracture requiring atlantoaxial stabilization whereas the initial cervical 3D CT angiography showed a persistent first intersegmental artery consisting in a V3 segment of the vertebral artery penetrating dura-mater in the spinal canal below the C1 posterior arch without passing through the C1 foramen transversarium.


RESULTS
This rare vascular anomaly described in 2 to 5% of the patients led us to modify the screw entrance over the C1 posterior arch in order to obtain a satisfactory stabilization and to limit the risk of vertebral artery injury.
Service de neurochirurgie, hôpital Maison-Blanche, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims, France. jduntze@chu-reims.fr
J
J
Duntze
G
G
Pech-gourg
T
T
Adetchessi
G
G
Armaganian
P
P
Rakotozanany
S
S
Fuentes
D000058:Accidental Falls; D000061:Accidents, Home; D000368:Aged; D000792:Angiography / Q000379:methods; D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging / Q000601:surgery; D001368:Axis, Cervical Vertebra / Q000293:injuries* / Q000601:surgery; D001863:Bone Screws; D004388:Dura Mater / Q000098:blood supply; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D016268:Internal Fixators; D007431:Intraoperative Complications / Q000517:prevention & control; D008297:Male; D019547:Neck Pain / Q000209:etiology; D016103:Spinal Fractures / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D014057:Tomography, X-Ray Computed; D014711:Vertebral Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging