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Iatrogenic vertebral artery injury

Vertebral artery arteriovenous fistula (AVF), after iatrogenic vertebral artery injury (VAI), is a serious complication of upper cervical spine fixation surgery.

Since the cervical lateral mass screw fixation technique has been well established, the concern of vertebral artery injury is higher than ever before 1).

Although vertebral artery injury (V2) may occur during an anterior cervical approach, (uncoforaminotomy), the frequency of vertebral artery injury is actually low 2) 3).

Qian et al., report a case of a 59-year-old female patient who had a vertebral AVF following transpedicular occipitocervical fixation surgery. Endovascular embolization of the AVF was successfully performed using ethylene vinyl alcohol. From this case they learned that preoperative evaluation of the course of the vertebral artery is necessary, and vertebral artery embolism is an effective and safe method to treat vertebral AVF after proof of a patent second vertebral artery 4).

In standard anterior cervical discectomy, complete resection of the uncinate process is not commonly attempted because of the risk of injury to the vertebral artery. This may result in incomplete decompression of the nerve root when there is severe osseous cervical foraminal stenosis.

Iatrogenic vertebral artery injury (VAI) is a rare but significant complication of anterior cervical spine surgery. In the grossly degenerate cervical spine the VA may adopt a tortuous pathway thus predisposing to inadvertent injury during surgery 5).

In a high-volume surgical center, the incidence of VAI during low-risk cervical spine surgery is extremely low, comprising 0.3 % of all cases. The major risks are delayed sequels of the vessel wall laceration. In cases of VAI, immediate angiographic diagnostics and generous indications for endovascular treatment are obligatory 6).

Abumi K, Itoh H, Taneichi H, Kaneda K. Transpedicular screw fixation for traumatic lesions of the middle and lower cervical spine: description of the techniques and preliminary report. Journal of spinal disorders 1994;7:19-28.
Cho KH, Shin YS, Yoon SH, Kim SH, Ahn YH, Cho KG. Poor surgical technique in cervical plating leading to vertebral artery injury and brain stem infarction–case report. Surgical neurology 2005;64:221-225.
Hsu WK, Kannan A, Mai HT, Fehlings MG, Smith ZA, Traynelis VC, Gokaslan ZL, Hilibrand AS, Nassr A, Arnold PM, Mroz TE, Bydon M, Massicotte EM, Ray WZ, Steinmetz MP, Smith GA, Pace J, Corriveau M, Lee S, Isaacs RE, Wang JC, Lord EL, Buser Z, Riew KD. Epidemiology and Outcomes of Vertebral Artery Injury in 16 582 Cervical Spine Surgery Patients: An AOSpine North America Multicenter Study. Global spine journal 2017;7:21s-27s
Qian R, Li Z, Li M. Vertebral Arteriovenous Fistula: A Rare Complication Following Transpedicular Occipitocervical Fixation in a Patient with Atlantoaxial Dislocation. J Neurol Surg A Cent Eur Neurosurg. 2018 Jul 2. doi: 10.1055/s-0038-1655771. [Epub ahead of print] PubMed PMID: 29966140.
Khan SA, Coulter I, Marks SM. Iatrogenic vertebral artery injury secondary to vessel tortuosity in a grossly degenerate cervical spine. Br J Neurosurg. 2014 Jun;28(3):423-5. doi: 10.3109/02688697.2014.913772. Epub 2014 May 8. PubMed PMID: 24810983.
Obermüller T, Wostrack M, Shiban E, Pape H, Harmening K, Friedrich B, Prothmann S, Meyer B, Ringel F. Vertebral artery injury during foraminal decompression in “low-risk” cervical spine surgery: incidence and management. Acta Neurochir (Wien). 2015 Nov;157(11):1941-5. doi: 10.1007/s00701-015-2594-2. Epub 2015 Sep 29. PubMed PMID: 26416610.
iatrogenic_vertebral_artery_injury.txt · Last modified: 2018/09/16 21:52 by administrador