Comparison of C1–2 posterior fusion and decompression of the vertebral artery in the treatment of bow hunter's stroke

✓ Bow hunter's stroke results from vertebrobasilar insufficiency caused by mechanical occlusion or stenosis of the vertebral artery (VA) at the C1–2 level on head rotation. Surgical treatment of this condition may be chosen to avoid life-threatening accidents or because patients complain that conservative treatments such as verbal warnings or use of a neck brace to limit head and neck rotation are ineffective and thus restrict their lifestyle. Posterior fusion involving C1–2 has long been used to limit atlantoaxial rotational movements. However, it has the serious disadvantage that the range of head motion is severely reduced. Recently, decompression of the atlantoaxial portions of the affected VA has been used because it does not limit physiological neck movements. However, no long-term follow-up review of patients who have undergone this procedure has been conducted, and it is unclear whether this procedure always provides relief of symptoms. To answer this question, the results of C1–2 posterior fusion were compared with decompression of the VA for the treatment of bow hunter's stroke.