Letter to the Editor concerning "Rotational vertebral artery occlusion ('bow hunter syndrome')" by Schulz R, Donoso R, Weissman K (Eur Spine J. 2021 Jan 2. doi:10.1007/s00586-020-06, 680-5)

A case of bow hunter syndrome, secondary to rotational vertebral artery occlusion is reported by Schulz et al. After one year of conservative treatment and symptoms worsening a dynamic angio-CT showed absence of blood flow in the left vertebral artery. A posterior C1-C2 arthrodesis was performed with relief of symptoms. This case encourages a debate on appropriate criteria for selecting a C1-C2 fixation in patients with suspected posterior circulatory cerebro-vascular insufficiency syndrome.