A case of bow hunter's syndrome and a systematic literature review / 中华骨科杂志

ABSTRACT

Objective:A clinical case of rotational vertebral artery occlusion (bow hunter's syndrome, BHS) caused by left C 1 osteophyte was reported, and the epidemiological characteristics, diagnosis and treatment methods, and clinical outcomes of BHS were further analyzed. Methods:The clinical data, diagnostic methods, treatment options, and clinical outcomes of the above-mentioned BHS patient are described. The literature from 1978 to 2021 was retrieved, the BHS patients involved were taken as the research objects, and the data of onset age, gender, etiology, site of onset, diagnosis method, treatment method, and clinical outcomes of each selected patient were collected. The data were subdivided through systematic analysis.Results:A patient with rotational compression of the left vertebral artery associated with the left osteophyte of the atlas was presented. 3D-CT showed that the vertebral artery was compressed by the left osteophyte of the atlas. Dynamic digital subtraction angiography (dDSA) showed mild stenosis of the distal V2 segment of the left vertebral artery. When his head turned to the left, the distal V2 segment of the left vertebral artery was compressed and the blood flow was interrupted. After his head was in a neutral position, the blood flow was restored. Because the symptoms could not be relieved after conservative treatment, posterior C 1 osteophyte resection was used to decompress the vertebral artery, and the symptoms disappeared after the operation, and the short-term follow-up results were good. All of the 87 articles and 126 patients have been studied. The median age was 55.0 years (IQR 43.5, 65.0 years) and the peak age of onset was 51 to 60 years old. The gender difference has been uncovered and the sex ratio was 1.9∶1 (male∶female). Among the 126 patients, 65 patients had vertebral artery occlusion or stenosis located in the C 1-C 2 segment; 66 patients involved the left vertebral artery, 45 patients involved the right vertebral artery, and 15 patients involved bilateral vertebral arteries. DSA was used to confirm BHS in 114 of 126 patients. The follow-up time was 0.25-114 months, with an average of 16.6 months. Thirty-six patients were treated conservatively, and 12 patients had residual symptoms; 33 patients underwent fusion surgery, and all patients' symptoms were relieved after surgery; 54 patients underwent simple decompression surgery, and 4 patients had residual symptoms after surgery; 4 patients received endovascular surgery, and their symptoms were relieved after surgery. Conclusion:Patients with BHS are rare clinically, often involving C 1-C 2 and the left vertebral artery is more likely to be involved. The peak age of onset was 51 to 60 years old. DSA is the gold standard for the diagnosis of BHS. For BHS caused by abnormal bone structure, intervertebral disc herniation, joint instability, etc., decompressive surgery of the vertebral artery or C 1-C 2 segment fusion is the most common treatment modality.