Vertebral artery insufficiency secondary to trauma and osteoarthritis of the cervical spine.

Obstruction of the vertebral arteries can lead to sudden death, extensive spinal cord destruction, insufficiency of the brain stem, impaired cerebellar function, damage to the occipital cortex, and may well be responsible for certain forms of cerebral palsy. We have recently treated a case of post-traumatic vertebral artery insufficiency by debridement of an osteophyte obstructing the intraspinal portion of the vessel. Reviewing this problem we have found that relatively little attention has been focused on osteophytes obstructing the vertebral arteries and that these vessels are frequently not studied in the management of both traumatic and degenerative diseases of the cervical spine. This is in contrast to those osteophytic growths which cause spinal nerve root compression. Greater consideration for preservation of vertebral artery function may improve the prognosis of certain cervical spine fractures, cervical osteoarthritis (especially in patients with arteriosclerosis of large extracranial vessels), and congenital anomalies of the neck. It is the purpose of this report to emphasize the need for the consideration of vertebral artery circulation in cervical spine lesions, and to present some of the problems encountered in the diagnosis and treatment of such a case.