The use of CT angiography in the preoperative planning of cervical spine surgery in children

The vertebral artery is potentially vulnerable during cervical spine surgery. The aim of this study was to evaluate the initial application and validate the clinical utility of multidetector computed tomography angiography (CTA) in demonstrating the vertebral arteries in relation to the cervical spine and associated pathology prior to surgical intervention in children. CTA images were obtained in ten children prior to surgery. We retrospectively gathered cases of cervical spine pathology that underwent CT angiography prior to surgery over the course of 2 years. The images were reviewed by two neuroradiologists and discussed with the neurosurgeon. Ten children were imaged; three children had bone tumours, four had segmentation anomalies, one had achondroplasia, one had heterotopic calcification and one had cord compression post-surgical craniocervical fixation. The vertebral arteries were identified in all children, and the course was visualised in relation to normal and pathological bony anatomy on axial 2D and volume-rendered 3D volume. There were no complications of the procedure and no need for magnetic resonance angiography or catheter angiography in any cases. The combination of congenital deformity, small size and a recent trend toward instrumentation of the craniocervical junction in the paediatric population mandates accurate knowledge of the vertebral artery relationships to the local neural and bony structures prior to complex surgical interventions. Whilst we do not advocate imaging of the vertebral arteries in all patients requiring cervical spine surgery, this technique has been shown to be a very useful investigation in selected cases.