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Prevalence of Vertebral artery anomaly in upper cervical and its surgical implications: a systematic review

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Abstract

Background

The presence vertebral artery (VA) abnormalities in the upper cervical may be a potential cause of catastrophic complication in the posterior approach of the upper cervical spine surgery. The aim of this study was to demonstrate the real incidence of the V3 segment anomaly in patients who need upper cervical surgery, and tried to find out the risk factors of V3 segment anomaly to evaluate the necessary of computed tomographic angiography (CTA) for upper cervical surgery.

Method

This systematic review was conducted following the preferred reporting items for systematic reviews and meta-Analyses (PRISMA). Retrospective studies and reports of case series involving human subjects with data on anomalies of vertebral artery in upper cervical spine were included. Data on the prevalence of persistent first intersegmental artery (PIA), fenestration of the VA (FA), posterior inferior cerebellar artery (PICA) were extracted.

Results

A total of 16 articles involving 5927 subjects met the inclusion criteria. The total incidence of V3 segment anomaly in the patients with bony abnormalities was 25.9% (74/286): PIA was 17.5%, FA was 6.6% and PICA was 1.8%. The total incidence of V3 segment anomaly in the patients without bony abnormalities was 2.7% (152/5671): PIA was 1.76%, FA was 0.4% and PICA was 0.5%. The total incidence of V3 segment anomaly in Asian population without bony abnormalities was 5.8%, while in European and American population was 0.8 and 0.6%, respectively.

Conclusion

Patients with bone abnormalities are high risk factor for VA abnormalities, CTA is of paramount importance to evaluate the variant VA anatomy. However, regarding to the low incidence of V3 variation in normal population, we do not recommend preoperative CT angiography as mandatory part of preoperative.

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Funding

This work received funding by Startup Fund for scientific research, Fujian Medical University, Grant number:2016098.

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Author notes

  1. Ting Zheng revised manuscript and drew the Fig.3.

Authors and Affiliations

  1. Shengli Clinical Medical College of Fujian Medical University, Fu Zhou, China

    Xi Lin, Yang Xu, Ting Zheng, Fei-Yue Lin & Xiao-Ming Yin

  2. Department of Orthopedics, FuJian Provincial Hospital, DongJie Road 134, Fu Zhou, 350001, People’s Republic of China

    Xi Lin, Yang Xu, Fei-Yue Lin & Xiao-Ming Yin

  3. Department of Anesthesiology, FuJian Provincial Hospital, DongJie Road 134, Fu Zhou, 350001, People’s Republic of China

    Ting Zheng

  4. Penglai People’s Hospital, Yan Tai, 265600, People’s Republic of China

    Hou-Jun Zhu

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Contributions

XY: direct the whole review; XL: write the manuscript and extract the statistics; H-JZ, F-YL and X-MY primary screen the articles.

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Correspondence to Yang Xu or Ting Zheng.

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Lin, X., Zhu, HJ., Xu, Y. et al. Prevalence of Vertebral artery anomaly in upper cervical and its surgical implications: a systematic review. Eur Spine J 30, 3607–3613 (2021). https://doi.org/10.1007/s00586-021-07015-8

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