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Due to an abnormally appearing left vertebral artery (VA) on CT angiography, the patient underwent conventional angiography, which revealed a complex AVF stemming from the left VA at the level of C-2 with dilated posterior cervical veins and a large venous varix. Given the radiographic evidence of bone remodeling and the chronicity of the AVF, it is believed that the C-2 vertebra was weakened over time by the pulsatile and compressive force of the vascular malformation eventually leading to fracture with minimal stress. Coil embolization of the AVF was performed followed by surgical fixation of C-1 to C-4. This case highlights the importance of investigating an underlying disease process in patients who present with significant spinal fractures in the absence of trauma.<\/jats:p>","DOI":"10.3171\/2016.8.spine16351","type":"journal-article","created":{"date-parts":[[2016,12,2]],"date-time":"2016-12-02T15:02:45Z","timestamp":1480690965000},"page":"341-345","source":"Crossref","is-referenced-by-count":4,"title":["C-2 arteriovenous fistula presenting as a pathologic hangman's fracture: case report"],"prefix":"10.3171","volume":"26","author":[{"given":"Rajeev D.","family":"Sen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carolina Gesteira","family":"Benjamin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Howard A.","family":"Riina","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Donato","family":"Pacione","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-spine16351","series-title":"Radiology","doi-asserted-by":"publisher","first-page":"537","DOI":"10.1148\/96.3.537","article-title":"Cervical pedicle erosion and rootlet compression caused by a tortuous vertebral artery","volume":"96","author":"Anderson RE,","year":"1970","unstructured":"Anderson RE, Shealy CN: Cervical pedicle erosion and rootlet compression caused by a tortuous vertebral artery. 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