A definition-sensitive meta-analysis of high-riding vertebral artery (HRVA) at C2. The paper’s main lesson is methodological: prevalence changes markedly according to the operational definition, population type, and analytical unit.
Tudose RC · Triantafyllou G · Piagkou M · Rusu MC · doi: 10.1007/s12565-026-00954-6
This microsite condenses the paper into interactive reading paths. Use the buttons below to switch between anatomical logic, key findings, and practical implications.
Using the strict Neo/Bloch patient-level definition, pooled prevalence was 32.2%. When all definitions were allowed, pooled prevalence remained around 31.7%, but subgroup estimates ranged from 16.8% to 61.5% depending on what authors chose to measure.
Neo/Bloch: C2 isthmus height ≤ 5 mm and/or internal height ≤ 2 mm.
Including multiple alternative definitions introduces major heterogeneity.
Definition-stratified pooling produced a near fourfold spread (16.8% to 61.5%).
Under the strict patient-level standard definition, general imaging populations pooled to 28.5%, whereas pathological or selected populations pooled to 40.0%. The difference is clinically meaningful because it reflects real preoperative case mix.
About one in four to one in three patients harbour at least one HRVA.
Rates are higher in rheumatoid, congenital, or otherwise selected craniocervical cohorts.
Standard-definition side or joint prevalence pooled to 20.3%.
The clinical reason to care is screw safety. A high-riding vertebral artery reduces the available osseous corridor for C2 instrumentation and can force a change in the chosen fixation method.
HRVA increases the chance of vertebral-artery injury during transarticular or transpedicular screw placement.
Thin-slice parasagittal CT should be routine before craniocervical instrumentation.
When HRVA is present, alternative constructs such as translaminar, pars, or C2–C3 transarticular strategies may be needed.