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.