Document Detail


Image fusion for preoperative evaluation of vertebral artery in a patient with atlantoaxial vertical subluxation and chronic renal failure.
MedLine Citation:
PMID:  19585158     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
For preoperative evaluation of the vertebral artery (VA) at the craniovertebral junction, 3-dimensional (3-D) computed tomography (CT) angiography can simultaneously and precisely depict the location of the VA and the circumferential osseous tissues. However, this procedure has the risk of contrast-induced nephropathy, especially when patients have pre-existing renal impairment. We report the case of a 73-year-old woman with rheumatoid arthritis and concomitant chronic renal failure in whom severe myelopathy developed due to atlantoaxial vertical subluxation and subaxial subluxation. We planned to perform C1 laminectomy and C3-C7 laminoplasty, but to avoid the risk of intraoperative VA injury, we applied a fusion image technique of 3-D magnetic resonance (MR) angiography and co-registered 3-D CT that allowed for virtual assessment preoperatively of the VA courses, instead of 3-D CT angiography. Through the 3-D hybrid MR angiography-CT images, we could predict, in detail, the VA courses and the surrounding bony structures. At surgery, we found that the locations of the VAs were identical to that predicted on the preoperative image fusion analysis. We conclude that our image fusion techniques possess accurate diagnostic value for detecting arterial course, and could be applicable for patients in whom administration of contrast media should be avoided due to specific conditions, such as drug allergy and chronic renal failure.
Authors:
Ryo Kadota; Masashi Yamazaki; Tomonori Endo; Akihiko Okawa; Masao Koda
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Publication Detail:
Type:  Case Reports; Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-07-08
Journal Detail:
Title:  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     Volume:  19 Suppl 2     ISSN:  1432-0932     ISO Abbreviation:  Eur Spine J     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-06-28     Completed Date:  2011-02-16     Revised Date:  2011-08-01    
Medline Journal Info:
Nlm Unique ID:  9301980     Medline TA:  Eur Spine J     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  S96-9     Citation Subset:  IM    
Affiliation:
Spine Section, Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677, Japan.
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MeSH Terms
Descriptor/Qualifier:
Aged
Atlanto-Axial Joint / pathology*,  radiography,  surgery
Diagnostic Imaging / adverse effects,  methods*
Dislocations / pathology*,  radiography,  surgery
Female
Humans
Imaging, Three-Dimensional / methods
Kidney Failure, Chronic / complications*,  surgery
Preoperative Care / methods*
Spinal Fusion / instrumentation,  methods
Treatment Outcome
Vertebral Artery / anatomy & histology,  radiography*,  surgery
Comments/Corrections

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