Abstract：
BACKGROUND: Rotational vertebral artery syndrome, also referred to as Bow Hunter\'s syndrome (BHS), manifests when the vertebral artery (VA) is compressed following head rotation. This compression is often caused by an osteophyte and may lead to symptoms of a posterior stroke. This systematic review aims to shed light on the current management strategies for BHS resulting from osteophytes. Additionally, we present two illustrative cases where the VA compression by an osteophyte was effectively resolved by complete resection of the problematic bone spur.
METHODS: A literature search was conducted across Embase, PubMed and Medline in September 2023. Keywords related to vertebral artery [MESH], vertebrobasilar insufficiency [MESH] and osteophyte [MESH] were the focus of this review. Risk of bias in retained studies was assessed using the Joanna Briggs Institute Critical Appraisal tools for Qualitative Research. A narrative synthesis of our findings is presented.
RESULTS: A total of 30 studies were included in this review. Vertigo was the most reported symptom by patients (n = 16). On imaging, the VA was often compressed at C4-5 (n = 10) and C5-6 (n = 10) with no evident side predominance observed. Anterior cervical discectomy and fusion (ACDF, n = 13) followed by anterior decompression without fusion (n = 8) were the most performed surgical procedures to manage BHS.
CONCLUSIONS: Surgical decompression of the VA is a safe and effective intervention for patients experiencing symptomatic osteophytic compression during head rotation. This procedure restores normal vascular function and reduces the risk of ischemic events. This review highlights the importance of timely diagnosis and intervention in such cases.
METHODS: A literature search was conducted across Embase, PubMed and Medline in September 2023. Keywords related to vertebral artery [MESH], vertebrobasilar insufficiency [MESH] and osteophyte [MESH] were the focus of this review. Risk of bias in retained studies was assessed using the Joanna Briggs Institute Critical Appraisal tools for Qualitative Research. A narrative synthesis of our findings is presented.
RESULTS: A total of 30 studies were included in this review. Vertigo was the most reported symptom by patients (n = 16). On imaging, the VA was often compressed at C4-5 (n = 10) and C5-6 (n = 10) with no evident side predominance observed. Anterior cervical discectomy and fusion (ACDF, n = 13) followed by anterior decompression without fusion (n = 8) were the most performed surgical procedures to manage BHS.
CONCLUSIONS: Surgical decompression of the VA is a safe and effective intervention for patients experiencing symptomatic osteophytic compression during head rotation. This procedure restores normal vascular function and reduces the risk of ischemic events. This review highlights the importance of timely diagnosis and intervention in such cases.
摘要：
背景：旋转椎动脉综合征，也被称为弓亨特综合征(BHS)，表现为头部旋转后椎动脉（VA）被压缩。这种压迫通常是由骨赘引起的，并可能导致后中风的症状。本系统综述旨在阐明骨赘引起的BHS的当前管理策略。此外,我们提供了两个说明性的案例，其中骨赘造成的VA压缩通过完全切除有问题的骨刺而得到有效解决。
方法：在Embase进行了文献检索，PubMed和Medline在2023年9月。与椎动脉相关的关键词[MESH]，椎基底动脉供血不足[MESH]和骨赘[MESH]是本综述的重点。使用JoannaBriggs研究所定性研究关键评估工具评估保留研究中的偏倚风险。介绍了我们研究结果的叙述性综合。
结果：本综述共纳入30项研究。眩晕是患者报告最多的症状（n=16）。在成像方面，VA通常在C4-5（n=10）和C5-6（n=10）处被压缩，没有观察到明显的侧优势。颈椎前路椎间盘切除术和融合术（ACDF，n=13），然后是前路减压而不融合（n=8）是管理BHS的最多手术方法。
结论：对于头部旋转过程中出现有症状骨赘压迫的患者，VA手术减压是一种安全有效的干预措施。该程序恢复正常的血管功能并降低缺血事件的风险。这篇综述强调了在这种情况下及时诊断和干预的重要性。
方法：在Embase进行了文献检索，PubMed和Medline在2023年9月。与椎动脉相关的关键词[MESH]，椎基底动脉供血不足[MESH]和骨赘[MESH]是本综述的重点。使用JoannaBriggs研究所定性研究关键评估工具评估保留研究中的偏倚风险。介绍了我们研究结果的叙述性综合。
结果：本综述共纳入30项研究。眩晕是患者报告最多的症状（n=16）。在成像方面，VA通常在C4-5（n=10）和C5-6（n=10）处被压缩，没有观察到明显的侧优势。颈椎前路椎间盘切除术和融合术（ACDF，n=13），然后是前路减压而不融合（n=8）是管理BHS的最多手术方法。
结论：对于头部旋转过程中出现有症状骨赘压迫的患者，VA手术减压是一种安全有效的干预措施。该程序恢复正常的血管功能并降低缺血事件的风险。这篇综述强调了在这种情况下及时诊断和干预的重要性。
