Bilateral Subaxial Rotational Vertebral Artery Occlusion in a Setting of a Prior Cervical Construct.
BACKGROUND
Rotational vertebral artery occlusion, or bow hunter's syndrome, most commonly affects the C1-2 level because of its importance in regulating rotational movement.


METHODS
A 50-year-old man with increasing neck pain and severe symptoms of vertebrobasilar insufficiency with bidirectional head rotation had undergone several prior subaxial cervical spine operations. Dynamic cerebral angiography demonstrated complete occlusion of the left vertebral artery during head rotation to the right and complete occlusion of the right vertebral artery during head rotation to the left. Occlusions occurred at the level of and rostral to his prior construct, with immediate recurrence of debilitating vertigo and near syncope. Successful radiographic and clinical resolution of symptoms was achieved by posterior instrumentation and fusion from C2, connecting to his prior hardware.


CONCLUSIONS
A brief literature review and treatment options are discussed for this unusual presentation of a rare clinical entity.
Department of Neurosurgery, Medstar Georgetown University Hospital, Washington, DC, USA.
Daniel R
DR
Felbaum
Department of Neurosurgery, Medstar Georgetown University Hospital, Washington, DC, USA.
Joshua E
JE
Ryan
Department of Neurology, Medstar Georgetown University Hospital, Washington, DC, USA.
Andrew B
AB
Stemer
Department of Neurosurgery, Medstar Georgetown University Hospital, Washington, DC, USA. Electronic address: aanaizi@gmail.com.
Amjad N
AN
Anaizi
D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012399:Rotation / Q000009:adverse effects; D014715:Vertebrobasilar Insufficiency / Q000000981:diagnostic imaging* / Q000601:surgery*
Adjacent segment disease; Bow hunter's syndrome; Cervical spine fusion; Rotational vertebral artery occlusion