ArticleScientific reports2025
Modified classification system of high-riding vertebral artery for the C2 screw placement strategy: a large-scale, cross-sectional study.
Article in Scientific reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Prevalence of the high-riding vertebral artery depends on how it is defined: a meta-analysis with implications for C2 screw fixation.Anatomical science international · 2026Review
- Review
- Unilateral arcuate foramen with a posteriorly projecting vertebral artery loop between C1-C2: a rare anatomical variation.Surgical and radiologic anatomy : SRA · 2026Article
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9 authors.
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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 C2InH were 7.00 and 6.02 mm, significantly lower than those for Caucasians (7.73 and 7.06 mm; P < 0.01), and HRVA prevalence also differed (P < 0.05). Types 4 and 5 comprised 0.14% and 0.08% of PSIS. Narrow pedicles and laminae were more frequent in HRVA than non-HRVA (both P < 0.01). Intraobserver and interobserver agreements were satisfactory. The modified classification demonstrates high reliability and clinical utility, supporting individualized preoperative assessments and tailored C2 screw placement strategies to reduce vertebral artery injury risk.Research registration: This study has been registered with the Chinese Clinical Trial Registry (ChiCTR2500096630, https://www.chictr.org.cn/ ).
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