From the Hospital del Mar. Servei de COT. Passeig Maritim 25-29, Barcelona, Spain. CP.
Spine (Phila Pa 1976). 2013 Nov 1;38(23):E1503-5. doi: 10.1097/BRS.0b013e3182a43441.
Case report.
To present a rare case of vertebrobasilar insufficiency (VBI) syndrome secondary to the C6 level isthmic spondylolisthesis.
VBI associated with voluntary head movements is known as the bow hunter syndrome. It may manifest in temporary symptoms of dizziness, syncope, nausea, or motor and sensory deficits in certain head positions. The present syndrome is rare and difficult to diagnose. The authors describe a VBI case caused by vertebral artery compression due to the C6 level isthmic spondylolisthesis (to date, the authors have not found any other similar case described in the literature).
The patient was a 27-year-old male with a 12-month history of vertigo and dizziness in relation to head movements. These problems interfered with his day-to-day activities.With other causes of neurological and cardiac origin dismissed, the patient was sent for an orthopedic evaluation.Radiological imaging showed spondylolisys, spondylolisthesis, and spina bifida between the facets of the C6 and C7. Dynamic radiographies evidenced C6 and C7 cervical instability.Angio-MRI indicated an anomalous trajectory of the right vertebral artery at the C6 level upon entering the foramen transversarium. However, there were no signs of stenosis. Dynamic angiography confirmed partial stenosis of the right vertebral artery upon rightward head rotation. The substantial suspicion of positional VBI after rejecting other diagnoses and the significant disability of the patient led to treating the patient with anterior cervical arthrodesis at the C6-C7 level.
The patient was symptom free for more than 15 months' monitoring and returned to all his daily work and life activities.
Isthmic spondylolisthesis must be considered as a cause within VBI. Surgery presents good results.
病例报告。
报告一例罕见的 C6 水平峡部裂性脊椎滑脱继发椎基底动脉供血不足（VBI）综合征。
与自主头部运动相关的 VBI 被称为“弓猎者综合征”。它可能表现为在特定头部位置出现短暂的头晕、晕厥、恶心或运动和感觉障碍等症状。目前这种综合征较为罕见，难以诊断。作者描述了一例因 C6 水平峡部裂性脊椎滑脱导致椎动脉受压引起的 VBI 病例（截至目前，作者尚未在文献中发现任何其他类似病例）。
患者为 27 岁男性，有 12 个月的与头部运动相关的眩晕和头晕病史。这些问题干扰了他的日常生活。在排除了其他神经和心脏原因后，患者接受了骨科评估。影像学显示 C6 和 C7 椎骨之间的脊椎滑脱、脊椎滑脱和脊椎裂。动态影像学显示 C6 和 C7 颈椎不稳定。血管 MRI 显示 C6 水平右侧椎动脉进入横突孔时的异常轨迹。然而，没有狭窄的迹象。动态血管造影证实右侧椎动脉在头部向右侧旋转时存在部分狭窄。在排除其他诊断并考虑患者存在明显的位置性 VBI 后，且患者存在明显的残疾，这导致对患者进行了 C6-C7 水平前路颈椎融合术治疗。
患者在超过 15 个月的监测中无症状，并且恢复了所有日常工作和生活活动。
峡部裂性脊椎滑脱必须被视为 VBI 的一个病因。手术可取得良好的效果。
