Department of Orthopaedic Surgery, Yodogawa Christian Hospital, Osaka, Japan.
Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
Mod Rheumatol Case Rep. 2020 Jan;4(1):11-15. doi: 10.1080/24725625.2019.1662985. Epub 2019 Nov 25.
Bow hunter's syndrome, or rotational vertebral artery (VA) occlusion, refers to vertebrobasilar insufficiency due to mechanical occlusion of the VA. We present a case of surgical treatment for bow hunter's syndrome that occurred after cervical laminoplasty in a patient with rheumatoid arthritis with bony ankylosis of the facet joints. A 59-year-old female with rheumatoid arthritis experienced sudden incomplete left hemiplegia. Fifteen months earlier, the patient had undergone cervical decompression surgery between C3 and C7. MRI of the head showed cerebral infarction in the right VA area, while vertebral angiography with the head rotated to the right revealed that the right VA was occluded at the level of C3-C4. The patient was successfully treated via posterior cervical fusion from C2 to C7. Patients with rheumatoid arthritis have a potential risk of cervical bony ankyloses. Cervical laminoplasty for patients with cervical bony ankyloses can induce rotational VA occlusion due to spinal rotational instability.
弓型Hunter 氏综合征，又称旋转性椎动脉（VA）闭塞，是由于 VA 机械性闭塞引起的椎基底动脉供血不足。我们报告了 1 例类风湿关节炎伴关节突骨强直的患者在接受颈椎板成形术后发生弓型 Hunter 氏综合征的手术治疗。1 例 59 岁女性，类风湿关节炎患者突发不完全性左侧偏瘫。15 个月前，患者在 C3 至 C7 之间接受了颈椎减压手术。头部 MRI 显示右侧 VA 区脑梗死，而头向右转位的椎动脉造影显示右侧 VA 在 C3-C4 水平闭塞。患者成功地接受了从 C2 到 C7 的后路颈椎融合术治疗。类风湿关节炎患者存在颈椎骨强直的潜在风险。对于颈椎骨强直的患者，颈椎板成形术可因脊柱旋转不稳而导致旋转性 VA 闭塞。
