PMC9371809_01
Preoperative MRA shows normal flow and left VA dominant in the neutral position (a). MRA with neck rotation of 45 degrees revealed severe stenosis (arrow) of left VA (b). Preoperative cerebral angiograms of left VA show (c) normal flow in the neutral position and (d) severe stenosis at C3-4 level (arrow) and decreased flow on leftward neck rotation.
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fig1
The DSA was performed later for a definitive diagnosis, and the results were the same as the MRA results (Figure 1).
Schematic drawings in the sagittal view of anterior cervical discectomy and fusion (ACDF) and postoperative CT. Osteophytes after discectomy are drilled out by a diamond burr (a). Cages are inserted into the disc spaces in the twin-cage and locking fashion after decompression. Postoperative (c) CT and (d) X-ray show sufficient decompression, and the cage was inserted in the optimal position.
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fig2
After removing the intervertebral disc at C3/4, the osteophytes were drilled with a diamond burr and fixed with titanium cylindrical cages (Figure 2).