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

• Published in: European spine journal Vol. 33; no. 6; pp. 2322 - 2331
• Main Authors: Tang, Chao, Wen, Xuan, Zhang, Ying, Liao, Ye Hui, Huang, Xian Ming, Tang, Qiang, Qiu, Hao, Yang, Si Zhen, Zhong, De Jun, Chu, Tong Wei
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.06.2024; Springer Nature B.V
• Subjects: Arthritis; Medicine; Medicine & Public Health; Morphology; Neurosurgery; Original Article; Osteoarthritis; Population studies; Regression analysis; Risk factors; Spine (cervical); Surgical Orthopedics; Vertebrae; Atlantoaxial joints; Unilateral high-riding vertebral artery; Osteoarthritis; Morphology; Risk factor
• ISSN: 0940-6719; 1432-0932; 1432-0932
• DOI: 10.1007/s00586-024-08285-8

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.