J Korean Orthop Assoc.  2020 Feb;55(1):85-89. 10.4055/jkoa.2020.55.1.85.

Bow Hunter's Syndrome Caused by Bilateral Dynamic Occlusion of the Subaxial Vertebral Arteries during Neck Extension

  • 1Department of Orthopaedic Surgery, Dankook University College of Medicine, Cheonan, Korea.
  • 2Department of Orthopaedic Surgery, National Medical Center, Seoul, Korea. hosunghan.md@gmail.com


Bow hunter's syndrome is a rare disease that shows the symptoms of vertebrobasilar insufficiency resulting from a dynamic obstruction or stenosis of the vertebral arteries during neck movement. This paper reports a case of a 59-year-old male who visited the emergency room with diplopia, tinnitus, and gait disturbance. Magnetic resonance imaging and angiography revealed a multiple cerebellar infarct, total obstruction of the right vertebral artery, and dynamic obstruction of the left vertebral artery during neck extension. As the infarction worsened, a thrombectomy was done. Posterior decompression and fusion at C5-6 were performed for the left vertebral artery. The left vertebral arterial patency was confirmed by intraoperative and postoperative angiography. No recurrence of the symptoms was observed for six months after surgery. Physicians need to pay attention to the diagnosis of vertebrobasilar insufficiency caused by an obstruction of the vertebral arteries during neck extension in cervical instability patients.


bow hunter's syndrome; vertebrobasilar insufficiency; endovascular therapy; surgical therapy; cervical spondylosis
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