Vertebrobasilar Artery Syndrome

An Overview of Vertebrobasilar Artery Syndrome

(also known as: Vertebrobasilar Artery Insufficiency, Vertebrobasilar Artery Ischemia and “Bow Hunters” Syndrome)

Vertebrobasilar artery syndrome is due to a temporary loss of blood flow from the vertebral artery to the base of the brain. The syndrome occurs when rotating the head to the side and having the vertebral artery become temporarily occluded due to an abnormal bone spur or ligament.

There are many lower brainstem and upper cervical disorders that can mimic this syndrome and in the 30 years I have practiced, I have seen vertebrobasilar artery insufficiency two times but have seen the symptom complaints hundreds of times.

Are you suffering from symptoms of Vertebrobasilar Artery Syndrome?

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(Please keep reading below for more information on this condition.)

Vertebral Artery Anatomy

The vertebral artery starts as a branch of the subclavian artery in the chest. It then winds through the transverse foramen of C6 up to C1 (skips the C7 transverse foramen). Between C1 and C2, this artery makes a sharp right or left turn (depending upon the side). The artery is stretched by the normal rotation that occurs between C1 and C2.

Symptoms (while turning the head to the side of stenosis)
Dizziness
Vertigo (room spins)
Visual disturbances (difficulty with focus and “spots” before the eyes)
Nystagmus (eyes pulsate back and forth)
Ataxia (difficulty with keeping balance)

Wallenberg’s Syndrome

This syndrome is a stroke or arterial occlusion as the base of the brain and can occur as an extension of vertebrobasilar artery insufficiency. This is an infarction (stroke) of the posterior inferior cerebellar artery.

Symptoms include:

Sensory loss on the same side of the face and opposite side of the body
Dysphagia (problems swallowing)
Dysarthria (problems speaking)
Ataxia (difficulty with keeping balance)
Vertigo (the room spins)

Diagnosis

Diagnosis is made with a CT angiogram with the head in neutral position and in the position of the symptoms. Comparison of the two vertebral artery images confirms the stenosis.

Treatment generally includes therapy and strengthening. If the syndrome persists, surgery to remove the spur or occasional fusion of C1 to C2 can be utilized.

To learn more about vertebrobasilar artery syndrome, please contact the Vail, Aspen, Denver and Grand Junction, Colorado area office of spine specialist and neck doctor Dr. Donald Corenman.

(Click to Enlarge) Vertebral Artery Anatomy

(Click to Enlarge) Coronal Normal

(Click to Enlarge) Axial Normal

(Click to Enlarge) Sag Image

(Click to Enlarge) Vert Art Compression

(Click to Enlarge) Axial Rotation

(Click to Enlarge) Bow Hunters Syndrome

Donald Corenman MD DC | Spine Surgeon Colorado | Vail, Denver, Aspen

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Donald Corenman, MD, DC

81 reviews

Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

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Vertebrobasilar Artery Syndrome

An Overview of Vertebrobasilar Artery Syndrome

Are you suffering from symptoms of Vertebrobasilar Artery Syndrome?

Vertebral Artery Anatomy