Modified classification system of high-riding vertebral artery for the C2 screw placement strategy: a large-scale, cross-sectional study.

ABSTRACT: High-riding vertebral artery (HRVA) increases vertebral artery injury risk during C2 instrumentation. We conducted a cross-sectional study of cervical computed tomography angiography (CTA) in southern Chinese adults (18-60 years; four centers, 2019-2025) to validate a modified HRVA classification. Measurements included C2 isthmus height (C2IsH) and C2 internal height (C2InH) on sagittal reconstructions 3 mm lateral to the spinal canal border, and C2 pedicle width (C2PW) and C2 lamina width (C2LW) in axial images. The modified classification includes two previously unrecognized variants: Type 4 (isthmio-absent; C2IsH = 0 mm) and Type 5 (internal-absent; C2InH = 0 mm). Among 1,804 participants, yielding 3,608 potential screw insertion sites (PSIS), HRVA prevalence was 29.60%. Mean C2IsH and

SUBMITTER: Du Y 

PROVIDER: S-EPMC12686391 | biostudies-literature | 2025 Dec

REPOSITORIES: biostudies-literature