Rotational occlusion of the vertebral artery caused by transverse process hyperrotation and unilateral apophyseal joint subluxation. Case report

Journal of Neurosurgery
T KawaguchiN Tamaki

Abstract

The authors describe transverse process hyperrotation and unilateral apophyseal joint subluxation as a novel mechanism of rotational vertebral artery (VA) occlusion. The patient, a 56-year-old man, complained of episodic bilateral blindness when rotating his head more than 90 degrees to the right. Plain cervical x-ray films showed spondylotic osteophytes of the right C4-5 uncovertebral portion. Dynamic angiography revealed right VA occlusion at C4-5 and left VA occlusion at C1-2 with head rotation to the right. It was demonstrated on three-dimensional images constructed from computerized tomography scans that C-4 transverse process hyperrotation compressed the right VA against the apex of the C-5 subluxating superior articular process via the inner surface of the transverse process anterior root (processus costarius) rather than the osteophytes. It is also proposed that the true site of occlusion is different from that observed in angiographic studies.

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Citations

Feb 1, 2011·European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society·Kazuhiro YoshimuraToshiki Yoshimine
Apr 20, 2000·Journal of Manipulative and Physiological Therapeutics·C D NelsonD Redwood
Aug 7, 2003·Journal of Manipulative and Physiological Therapeutics·Jeanette A Mitchell
Jan 21, 2014·Journal of Neurosurgery. Spine·Mina G SafainSteven W Hwang
Jan 24, 2014·Clinical Anatomy : Official Journal of the American Association of Clinical Anatomists & the British Association of Clinical Anatomists·Jeffrey Hartman
Apr 2, 2015·Neurosurgical Focus·Gregory F Jost, Andrew T Dailey
Nov 1, 2016·Interventional Neuroradiology : Journal of Peritherapeutic Neuroradiology, Surgical Procedures and Related Neurosciences·Tony LuOrlando M Diaz
Apr 30, 2017·World Neurosurgery·Ben A StricklandFrank L Acosta
May 23, 2013·Stroke; a Journal of Cerebral Circulation·Kwang-Dong ChoiJae-Il Kim
Feb 16, 2006·Neurosurgery·Michaël BruneauBernard George
Dec 25, 2004·Neurosurgery·Marcelo D VilelaDavid W Newell
Nov 26, 2021·The Journal of Manual & Manipulative Therapy·Brian T Swanson, Douglas Creighton

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