C1-2 Instability associated with Duplicated Vertebral Artery: A Case Report / 대한척추외과학회지

A vertebral artery injury is one of the most critical complications of atlantoaxial fixation. Abnormal courses or congenital anomalies of the vertebral artery increase its risk. The authors report a case of a patient who had an atlantoaxial subluxation associated with severe spinal cord compression and a duplicated vertebral artery. The atlantoaxial subluxation, which was not reduced satisfactorily by an intraoperative head position change or direct manipulation of the atlas and axis, precluded a transarticular screw fixation. The lack of free space around the spinal cord precluded a sublaminar wiring. The duplicated vertebral artery made it difficult to insert C1 lateral mass screws and C2 pedicle screws with Harms' technique.