{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2023,2,4]],"date-time":"2023-02-04T17:33:24Z","timestamp":1675532004435},"reference-count":16,"publisher":"British Editorial Society of Bone & Joint Surgery","issue":"4","license":[{"start":{"date-parts":[[2014,4,1]],"date-time":"2014-04-01T00:00:00Z","timestamp":1396310400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/online.boneandjoint.org.uk\/TDM"}],"content-domain":{"domain":["online.boneandjoint.org.uk"],"crossmark-restriction":true},"short-container-title":["The Bone &amp; Joint Journal"],"published-print":{"date-parts":[[2014,4]]},"abstract":"<jats:p> We investigated the incidence of anomalies in the vertebral arteries and Circle of Willis with three-dimensional CT angiography in 55 consecutive patients who had undergone an instrumented posterior fusion of the cervical spine. <\/jats:p><jats:p> We recorded any peri-operative and post-operative complications. The frequency of congenital anomalies was 30.9%, abnormal vertebral artery blood flow was 58.2% and vertebral artery dominance 40%. <\/jats:p><jats:p> The posterior communicating artery was occluded on one side in 41.8% of patients and bilaterally in 38.2%. Variations in the vertebral arteries and Circle of Willis were not significantly related to the presence or absence of posterior communicating arteries. Importantly, 18.2% of patients showed characteristic variations in the Circle of Willis with unilateral vertebral artery stenosis or a dominant vertebral artery, indicating that injury may cause lethal complications. One patient had post-operative cerebellar symptoms due to intra-operative injury of the vertebral artery, and one underwent a different surgical procedure because of insufficient collateral circulation. <\/jats:p><jats:p> Pre-operative assessment of the vertebral arteries and Circle of Willis is essential if a posterior spinal fusion with instrumentation is to be carried out safely. <\/jats:p><jats:p> Cite this article: Bone Joint J 2014;96-B:535\u201340. <\/jats:p>","DOI":"10.1302\/0301-620x.96b4.33210","type":"journal-article","created":{"date-parts":[[2014,4,1]],"date-time":"2014-04-01T10:08:50Z","timestamp":1396346930000},"page":"535-540","update-policy":"http:\/\/dx.doi.org\/10.1302\/crossmark-policy","source":"Crossref","is-referenced-by-count":9,"title":["Anomalous vertebral and posterior communicating arteries as a risk factor in instrumentation of the posterior cervical spine"],"prefix":"10.1302","volume":"96-B","author":[{"given":"K.","family":"Nagahama","sequence":"first","affiliation":[{"name":"Hokkaido University Hospital, Department\rof Orthopaedic Surgery, North-15, West-7, Kita-ku, Sapporo, Hokkaido\r060-8638, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H.","family":"Sudo","sequence":"additional","affiliation":[{"name":"Hokkaido University Graduate School of\rMedicine, Department of Advanced Medicine for\rSpine and Spinal Cord Disorders, North-15, West-7, Kita-ku, Sapporo, Hokkaido\r060-8638, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K.","family":"Abumi","sequence":"additional","affiliation":[{"name":"Hokkaido University Graduate School of\rMedicine, North-15, West-7, Kita-ku, Sapporo, Hokkaido\r060-8638, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"Ito","sequence":"additional","affiliation":[{"name":"Hokkaido University Graduate School of\rMedicine, North-15, West-7, Kita-ku, Sapporo, Hokkaido\r060-8638, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"Takahata","sequence":"additional","affiliation":[{"name":"Hokkaido University Hospital, North-15, West-7, Kita-ku, Sapporo, Hokkaido\r060-8638, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Hiratsuka","sequence":"additional","affiliation":[{"name":"Hokkaido University Hospital, North-15, West-7, Kita-ku, Sapporo, Hokkaido\r060-8638, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K.","family":"Kuroki","sequence":"additional","affiliation":[{"name":"Hokkaido University Hospital, North-15, West-7, Kita-ku, Sapporo, Hokkaido\r060-8638, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N.","family":"Iwasaki","sequence":"additional","affiliation":[{"name":"Hokkaido University Graduate School of\rMedicine, North-15, West-7, Kita-ku, Sapporo, Hokkaido\r060-8638, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"42","reference":[{"key":"r1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e318239cf1f"},{"key":"r2","doi-asserted-by":"publisher","DOI":"10.1097\/01.BRS.0000051919.14927.57"},{"key":"r3","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-012-2324-x"},{"key":"r4","doi-asserted-by":"publisher","DOI":"10.1097\/01.brs.0000184306.19870.a8"},{"key":"r5","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e318296e542"},{"key":"r6","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199406023302204"},{"key":"r7","doi-asserted-by":"publisher","DOI":"10.1097\/01.brs.0000176186.64276.d4"},{"key":"r8","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-199804010-00009"},{"key":"r9","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.72B4.2380226"},{"key":"r10","doi-asserted-by":"publisher","DOI":"10.3171\/SPI\/2008\/9\/7\/017"},{"key":"r11","doi-asserted-by":"publisher","DOI":"10.1007\/s00234-011-0849-z"},{"key":"r12","doi-asserted-by":"crossref","first-page":"2495","DOI":"10.2106\/00004623-200512000-00023","volume":"87","author":"Young JP","year":"2005","journal-title":"J Bone Joint Surg [Am]"},{"key":"r13","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbiomech.2006.07.008"},{"key":"r14","unstructured":"Osborne AG. 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