Unilateral high-riding vertebral artery is associated with asymmetric morphological changes of the atlantoaxial joint: a novel risk factor for atlantoaxial osteoarthritis

Chao Tang; Xuan Wen; Ying Zhang; Ye Hui Liao; Xian Ming Huang; Qiang Tang; Hao Qiu; Si Zhen Yang; De Jun Zhong; Tong Wei Chu

doi:10.1007/s00586-024-08285-8

Unilateral high-riding vertebral artery is associated with asymmetric morphological changes of the atlantoaxial joint: a novel risk factor for atlantoaxial osteoarthritis

Eur Spine J. 2024 Apr 27. doi: 10.1007/s00586-024-08285-8. Online ahead of print.

Authors

Chao Tang^#^{1

2}, Xuan Wen^#¹, Ying Zhang¹, Ye Hui Liao², Xian Ming Huang¹, Qiang Tang², Hao Qiu¹, Si Zhen Yang¹, De Jun Zhong³, Tong Wei Chu⁴

Affiliations

¹ Department of Orthopedics, The Second Affiliated Hospital (Xinqiao Hospital) of Army Medical University, No. 83, Xinqiao Main Street, Chongqing, China.
² Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Luzhou, China.
³ Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Luzhou, China. zdj_spine802@swmu.edu.cn.
⁴ Department of Orthopedics, The Second Affiliated Hospital (Xinqiao Hospital) of Army Medical University, No. 83, Xinqiao Main Street, Chongqing, China. chtw@sina.com.

^# Contributed equally.

PMID: 38676728
DOI: 10.1007/s00586-024-08285-8

Abstract

Purpose: This study aimed to investigate the association between unilateral high-riding vertebral artery (HRVA) and morphological changes in the atlantoaxial joint (AAJ) and to determine whether unilateral HRVA is a risk factor for atlantoaxial osteoarthritis (AAOA).

Methods: We conducted a retrospective analysis of 2496 patients admitted to our medical center between January 2020 and December 2022 who underwent CT imaging of the cervical spine. Two hundred and seventy-two patients with unilateral HRVA (HRVA group) were identified and a respective 2:1 age- and sex-matched control group without HRVA was built. Morphological parameters, including C2 lateral mass settlement (C2 LMS), C1/2 coronal inclination (C1/2 CI), lateral atlanto-dental interval (LADI), and C1/2 relative rotation angle (C1/2 RRA) were measured. The degree of AAOA was recorded. Risk factors associated with AAOA were identified using univariate and multivariable logistic regression analyses.

Results: The study included 61.4% women, and the overall average age of the study population was 48.7 years. The morphological parameters (C2 LMS, C1/2 CI, and LADI) in AAJ were asymmetric between the HRVA and the non-HRVA sides in the HRVA group (p < 0.001). These differences in parameters (d-C2 LMS, d-C1/2 CI, and d-LADI) between the HRVA and the non-HRVA sides, and C1/2 RRA were significantly larger than those in the control group. Eighty-three of 816 patients (10.2%) with AAOA had larger values of d-C2 LMS, d-C1/2 CI, d-LADI, and C1/2 RRA compared with the patients without AAOA (p < 0.05). The multivariable logistic regression analysis indicated that unilateral HRVA [adjusted odds ratio (OR) = 2.6, 95% CI: 1.1-6.3, p = 0.029], age in the sixth decade or older (adjusted OR = 30.2, 95% CI: 16.1-56.9, p < 0.001), women (adjusted OR = 2.1, 95% CI: 1.0-5.6, P = 0.034) were independent risk factors for AAOA.

Conclusion: Unilateral HRVA was associated with asymmetric morphological changes of nonuniform settlement of C2 lateral mass, lateral slip of atlas, and atlantoaxial rotation displacement. Besides age ≥ 60 years and females, unilateral HRVA is an independent risk factor for AAOA.

Keywords: Atlantoaxial joints; Morphology; Osteoarthritis; Risk factor; Unilateral high-riding vertebral artery.

Abstract

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