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Unilateral high-riding vertebral artery is associated with asymmetric morphological changes of the atlantoaxial joint: a novel risk factor for atlantoaxial osteoarthritis

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Abstract

Purpose

This study aimed to investigate the association between unilateral high-riding vertebral artery (HRVA) and morphological changes in the atlantoaxial joint (AAJ) and to determine whether unilateral HRVA is a risk factor for atlantoaxial osteoarthritis (AAOA).

Methods

We conducted a retrospective analysis of 2496 patients admitted to our medical center between January 2020 and December 2022 who underwent CT imaging of the cervical spine. Two hundred and seventy-two patients with unilateral HRVA (HRVA group) were identified and a respective 2:1 age- and sex-matched control group without HRVA was built. Morphological parameters, including C2 lateral mass settlement (C2 LMS), C1/2 coronal inclination (C1/2 CI), lateral atlanto-dental interval (LADI), and C1/2 relative rotation angle (C1/2 RRA) were measured. The degree of AAOA was recorded. Risk factors associated with AAOA were identified using univariate and multivariable logistic regression analyses.

Results

The study included 61.4% women, and the overall average age of the study population was 48.7 years. The morphological parameters (C2 LMS, C1/2 CI, and LADI) in AAJ were asymmetric between the HRVA and the non-HRVA sides in the HRVA group (p < 0.001). These differences in parameters (d-C2 LMS, d-C1/2 CI, and d-LADI) between the HRVA and the non-HRVA sides, and C1/2 RRA were significantly larger than those in the control group. Eighty-three of 816 patients (10.2%) with AAOA had larger values of d-C2 LMS, d-C1/2 CI, d-LADI, and C1/2 RRA compared with the patients without AAOA (p < 0.05). The multivariable logistic regression analysis indicated that unilateral HRVA [adjusted odds ratio (OR) = 2.6, 95% CI: 1.1–6.3, p = 0.029], age in the sixth decade or older (adjusted OR = 30.2, 95% CI: 16.1–56.9, p < 0.001), women (adjusted OR = 2.1, 95% CI: 1.0–5.6, P = 0.034) were independent risk factors for AAOA.

Conclusion

Unilateral HRVA was associated with asymmetric morphological changes of nonuniform settlement of C2 lateral mass, lateral slip of atlas, and atlantoaxial rotation displacement. Besides age ≥ 60 years and females, unilateral HRVA is an independent risk factor for AAOA.

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References

  1. Neo M, Sakamoto T, Fujibayashi S, Nakamura T (2005) A safe screw trajectory for atlantoaxial transarticular fixation achieved using an aiming device. Spine (Phila Pa 1976) 30:E236-242. https://doi.org/10.1097/01.brs.0000160998.53282.3f

    Article  PubMed  Google Scholar 

  2. Vaněk P, Bradáč O, de Lacy P, Konopková R, Lacman J, Beneš V (2017) Vertebral artery and osseous anomalies characteristic at the craniocervical junction diagnosed by CT and 3D CT angiography in normal Czech population: analysis of 511 consecutive patients. Neurosurg Rev 40:369–376. https://doi.org/10.1007/s10143-016-0784-x

    Article  PubMed  Google Scholar 

  3. Elgafy H, Pompo F, Vela R, Elsamaloty HM (2014) Ipsilateral arcuate foramen and high-riding vertebral artery: implication on C1–C2 instrumentation. Spine J 14:1351–1365. https://doi.org/10.1016/j.spinee.2014.01.054

    Article  PubMed  Google Scholar 

  4. Wakao N, Takeuchi M, Nishimura M et al (2014) Vertebral artery variations and osseous anomaly at the C1–2 level diagnosed by 3D CT angiography in normal subjects. Neuroradiology 56:843–849. https://doi.org/10.1007/s00234-014-1399-y

    Article  PubMed  Google Scholar 

  5. Klepinowski T, Żyłka N, Pala B, Poncyljusz W, Sagan L (2021) Prevalence of high-riding vertebral arteries and narrow C2 pedicles among Central-European population: a computed tomography-based study. Neurosurg Rev 44:3277–3282. https://doi.org/10.1007/s10143-021-01493-6

    Article  PubMed  PubMed Central  Google Scholar 

  6. Yoshida M, Neo M, Fujibayashi S, Nakamura T (2006) Comparison of the anatomical risk for vertebral artery injury associated with the C2-pedicle screw and atlantoaxial transarticular screw. Spine (Phila Pa 1976) 31:E513–E527. https://doi.org/10.1097/01.brs.0000224516.29747.52

    Article  PubMed  Google Scholar 

  7. Yeom JS, Buchowski JM, Kim HJ, Chang BS, Lee CK, Riew KD (2013) Risk of vertebral artery injury: comparison between C1–C2 transarticular and C2 pedicle screws. Spine J 13:775–785. https://doi.org/10.1016/j.spinee.2013.04.005

    Article  PubMed  Google Scholar 

  8. Aota Y, Honda A, Uesugi M et al (2006) Vertebral artery injury in C-1 lateral mass screw fixation. Case illustration. J Neurosurg Spine 5:554. https://doi.org/10.3171/spi.2006.5.6.554

    Article  PubMed  Google Scholar 

  9. Tang C, Liao YH, Wang Q, Tang Q, Ma F, Cai CH, Xu SC, Leng YB, Chu TW, Zhong J (2023) The association between unilateral high-riding vertebral artery and atlantoaxial joint morphology: a multi-slice spiral computed tomography study of 396 patients and a finite element analysis. Spine J 23:1054–1067. https://doi.org/10.1016/j.spinee.2023.02.017

    Article  PubMed  Google Scholar 

  10. Shimizu T, Koda M, Abe T, Shibao Y, Kono M, Eto F, Miura K, Mataki K, Noguchi H, Takahashi H, Funayama T, Yamazaki M (2021) Correlation between osteoarthritis of the atlantoaxial facet joint and a high-riding vertebral artery. BMC Musculoskelet Disord 22:406. https://doi.org/10.1186/s12891-021-04275-9

    Article  PubMed  PubMed Central  Google Scholar 

  11. Lakshmanan P, Jones A, Howes J, Lyons K (2005) CT evaluation of the pattern of odontoid fractures in the elderly–relationship to upper cervical spine osteoarthritis. Eur Spine J 14:78–83. https://doi.org/10.1007/s00586-004-0743-z

    Article  PubMed  Google Scholar 

  12. Betsch MW, Blizzard SR, Shinseki MS, Yoo JU (2015) Prevalence of degenerative changes of the atlanto-axial joints. Spine J 15:275–280. https://doi.org/10.1016/j.spinee.2014.09.011

    Article  PubMed  Google Scholar 

  13. Chandra PS, Goyal N, Chauhan A, Ansari A, Sharma BS, Garg A (2014) The severity of basilar invagination and atlantoaxial dislocation correlates with sagittal joint inclination, coronal joint inclination, and craniocervical tilt: a description of new indexes for the craniovertebral junction. Operative Neurosurgery 10:621–630. https://doi.org/10.1227/NEU.0000000000000470

    Article  Google Scholar 

  14. Miyata M, Neo M, Ito H, Yoshida M, Miyaki K, Fujibayashi S, Nakayama T, Nakamura T (2008) Is rheumatoid arthritis a risk factor for a high-riding vertebral artery? Spine 33:2007–2011. https://doi.org/10.1097/BRS.0b013e31817c6bf7

    Article  PubMed  Google Scholar 

  15. Yamazaki M, Okawa A, Furuya T, Sakuma T, Takahashi H, Kato K, Fujiyoshi T, Mannoji C, Takahashi K, Koda M (2012) Anomalous vertebral arteries in the extra- and intraosseous regions of the craniovertebral junction visualized by 3-dimensional computed tomographic angiography: analysis of 100 consecutive surgical cases and review of the literature. Spine 37:E1389–E1397. https://doi.org/10.1097/BRS.0b013e31826a0c9f

    Article  PubMed  Google Scholar 

  16. Yang H, Liu G, Xia H, Ma X, Wang J (2022) A comprehensive analysis and literature review of vertebral artery variation in craniovertebral junction using three-dimensional computed tomography angiography. Neuroradiology 65:215–223

    Article  PubMed  Google Scholar 

  17. Yamazaki M, Okawa A, Hashimoto M, Aiba A, Someya Y, Koda M (2008) Abnormal course of the vertebral artery at the craniovertebral junction in patients with Down syndrome visualized by three-dimensional CT angiography. Neuroradiology 50:485–490. https://doi.org/10.1007/s00234-008-0368-8

    Article  PubMed  Google Scholar 

  18. Lacy J, Bajaj J, Gillis CC (2023) Atlantoaxial Instability. Treasure Island (FL): StatPearls Publishing. PMID: 30137847, Available via https://pubmed2.ilibs.cn/books/NBK519563

  19. Izzo R, Ambrosanio G, Cigliano A (2007) Biomechanics of the Spine III. The cranio—cervical junction. Neuroradiol J 30:165–174

    Google Scholar 

  20. Zapletal J, de Valois JC (1997) Radiologic prevalence of advanced lateral C1–C2 osteoarthritis. Spine 22:2511–2513. https://doi.org/10.1097/00007632-199711010-00009

    Article  CAS  PubMed  Google Scholar 

  21. Kobayashi T, Miyakoshi N, Konno N, Abe E, Ishikawa Y, Shimada Y (2014) Acute neck pain caused by arthritis of the lateral atlantoaxial joint. Spine J 14:1909–1913. https://doi.org/10.1016/j.spinee.2013.10.054

    Article  PubMed  Google Scholar 

  22. Yin M, Ding X, Liu S, Ma J, Mo W (2022) Research progress of atlantoaxial osteoarthritis: a narrative literature review. World Neurosurg 160:e573–e578. https://doi.org/10.1016/j.wneu.2022.01.081

    Article  PubMed  Google Scholar 

  23. Badve SA, Bhojraj S, Nene A (2010) Occipito-atlanto-axial osteoarthritis: a cross sectional clinico-radiological prevalence study in high risk and general population. Spine (Phila Pa 1976) 35:434–438

    Article  PubMed  Google Scholar 

  24. Suga Y, Shigematsu H, Tanaka M, Okuda A, Kawasaki S, Yamamoto Y, Ikejiri M, Asai H, Fukushima H, Tanaka Y (2022) Factors associated with the increased risk of atlantoaxial osteoarthritis: a retrospective study. Eur Spine J 31:3418–3425. https://doi.org/10.1007/s00586-022-07414-5

    Article  PubMed  Google Scholar 

  25. Tomasz K, Bartomiej P, Jagoda C (2020) Prevalence of high-riding vertebral artery: a meta-analysis of the anatomical variant affecting choice of craniocervical fusion method and its outcome. World Neurosurg 143:e474–e481

    Article  Google Scholar 

  26. Tomasz K, Jagoda C, Leszek S (2020) Risk of the high-riding variant of vertebral arteries at C2 is increased over twofold in rheumatoid arthritis: a meta-analysis. Neurosurgical Rev 44:2041–2046

    Google Scholar 

  27. Hellwig FL, Tong J, Hussell JG (2016) Hip joint degeneration due to cam impingement: a finite element analysis. Comput Methods Biomech Biomed Engin 19:41–48

    Article  CAS  PubMed  Google Scholar 

  28. Turley SM, Thambyah A, Riggs CM (2014) Microstructural changes in cartilage and bone related to repetitive overloading in an equine athlete model. J Anat 224:647–658

    Article  PubMed  PubMed Central  Google Scholar 

  29. Fang L, Ye Y, Tan X (2021) Overloading stress-induced progressive degeneration and self-repair in condylar cartilage. Ann NY Acad Sci 1503:72–87

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We thank LetPub (www.letpub.com) for its linguistic assistance during the preparation of this manuscript.

Funding

This work was supported by the Sichuan Science and Technology Program (24NSFSC2177) and key projects for technological innovation and application development in Chongqing (CSTB2022TIAD-KPX0192).

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Author notes

  1. Chao Tang and Xuan Wen have contributed equally to this work as co-first author.

Authors and Affiliations

  1. Department of Orthopedics, The Second Affiliated Hospital (Xinqiao Hospital) of Army Medical University, No. 83, Xinqiao Main Street, Chongqing, China

    Chao Tang, Xuan Wen, Ying Zhang, Xian Ming Huang, Hao Qiu, Si Zhen Yang & Tong Wei Chu

  2. Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Luzhou, China

    Chao Tang, Ye Hui Liao, Qiang Tang & De Jun Zhong

Authors
  1. Chao Tang
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Corresponding authors

Correspondence to De Jun Zhong or Tong Wei Chu.

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The authors have no relevant financial or non-financial interests to disclose.

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Medical Ethics Committee of the Second Affiliated Hospital of Army Medical University, People Liberation Army (IRB No. 2023-YD070-01).

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Tang, C., Wen, X., Zhang, Y. et al. Unilateral high-riding vertebral artery is associated with asymmetric morphological changes of the atlantoaxial joint: a novel risk factor for atlantoaxial osteoarthritis. Eur Spine J (2024). https://doi.org/10.1007/s00586-024-08285-8

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