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European Spine Journal
Published in: European Spine Journal 12/2012

01-12-2012 | Review Article

The management of vertebral artery injury in anterior cervical spine operation: a systematic review of published cases

Authors: Hyung-Ki Park, Hae-Dong Jho

Published in: European Spine Journal | Issue 12/2012

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Abstract

Purpose

Anterior cervical spine operations (ACSO) are generally considered to be safe and effective, but the vertebral artery (VA) is at risk during the procedure. Because the consequences of VA injury can be catastrophic, properly managing a VA injury is very important. However, due to the rarity of these injuries, there is no agreed upon treatment strategy.

Methods

Studies were identified for inclusion in the review via sensitive searches of electronic databases through 31 December 2011. All cases included in the review were qualitatively analyzed to explore the relationship between type of VA injury management and neurological complications.

Results

Seventeen articles describing 39 cases of VA injury during ACSO were included in this study. Seven patients (17.9 %) had neurological complications followed by VA insufficiency. Two patients (5.1 %) had root damage due to ligation. One case (2.6 %) resulted in intraoperative death due to fatal bleeding. Delayed vascular complications were identified in nine (45.0 %) of the 20 patients that underwent only tamponade or hemostatic agent during the operation. Four patients underwent intraoperative endovascular treatment, and three of these patients had a cerebral infarction. All three patients who underwent clipping also had neurological complications. The five patients treated by direct repair did not have any complications.

Conclusion

Our review suggests the management of VA injury should be considered in order listed: (1) performing tamponade with a hemostatic agent, (2) direct repair, (3) postoperative endovascular procedures to prevent delayed complications. If tamponade fails to achieve proper hemostasis, additional procedures as endovascular embolization, clipping and ligation should be considered but carry the risk of neurological complications. Because of the limitations of this review, further studies are recommended with larger sample sizes.
Literature
1.
Bedi AD, Toms SA, Dehdashti AR (2011) Use of hemostatic matrix for hemostasis of the cavernous sinus during endoscopic endonasal pituitary and suprasellar tumor surgery. Skull Base 21(3):189–192. doi:10.​1055/​s-0031-1275632 PubMedCrossRef
2.
Bilbao G, Duart M, Aurrecoechea JJ, Pomposo I, Igartua A, Catalan G, Jauregui ML, Garibi J (2010) Surgical results and complications in a series of 71 consecutive cervical spondylotic corpectomies. Acta Neurochir 152(7):1155–1163CrossRef
3.
Bruneau M, Cornelius JF, George B (2006) Microsurgical cervical nerve root decompression by anterolateral approach. Neurosurgery 58 (Suppl 1):ONS-108-ONS-113
4.
5.
Choi JW, Lee JK, Moon KS, Kim YS, Kwak HJ, Joo SP, Kim JH, Kim SH (2006) Endovascular embolization of iatrogenic vertebral artery injury during anterior cervical spine surgery: report of two cases and review of the literature. Spine (Phila Pa 1976) 31(23):E891–E894. doi:10.​1097/​01.​brs.​0000244614.​84685.​c2 CrossRef
6.
7.
Daentzer D, Deinsberger W, Boker DK (2003) Vertebral artery complications in anterior approaches to the cervical spine: report of two cases and review of literature. Surg Neurol 59(4):300–309PubMedCrossRef
8.
Daniels AH, Riew KD, Yoo JU, Ching A, Birchard KR, Kranenburg AJ, Hart RA (2008) Adverse events associated with anterior cervical spine surgery. J Am Acad Orthop Surg 16(12):729–738PubMed
9.
de los Reyes RA, Moser FG, Sachs DP, Boehm FH (1990) Direct repair of an extracranial vertebral artery pseudoaneurysm: case report and review of the literature. Neurosurgery 26(3):528–533PubMedCrossRef
10.
Demetriades D, Theodorou D, Asensio J, Golshani S, Belzberg H, Yellin A, Weaver F, Berne TV (1996) Management options in vertebral artery injuries. Br J Surg 83(1):83–86PubMedCrossRef
11.
12.
Ebraheim NA, Lu J, Brown JA, Biyani A, Yeasting RA (1996) Vulnerability of vertebral artery in anterolateral decompression for cervical spondylosis. Clin Orthop Relat Res 322:146–151PubMedCrossRef
13.
Epstein NE (2003) From the neurointerventional lab…intraoperative cervical vertebral artery injury treated by tamponade and endovascular coiling. Spine J 3(5):404–405PubMedCrossRef
14.
Eskander M, Drew J, Aubin M, Marvin J, Franklin P, Eck J, Patel N, Boyle K, Connolly P (2010) Vertebral artery anatomy: a review of two hundred fifty magnetic resonance imaging scans. Spine (Phila Pa 1976) 1 35(23):2035–2040
15.
Eskander MS, Connolly PJ, Eskander JP, Brooks DD (2009) Injury of an aberrant vertebral artery during a routine corpectomy: a case report and literature review. Spinal Cord 47(10):773–775PubMedCrossRef
16.
Fukao S, Hashimoto N, Kazekawa K, Kaku Y (1995) Percutaneous transvenous embolisation of iatrogenic vertebral arteriovenous fistula. Neuroradiology 37:400–402PubMedCrossRef
17.
18.
Garcia Alzamora M, Rosahl SK, Lehmberg J, Klisch J (2005) Life-threatening bleeding from a vertebral artery pseudoaneurysm after anterior cervical spine approach: endovascular repair by a triple stent-in-stent method. Case report. Neuroradiology 47(4):282–286. doi:10.​1007/​s00234-005-1343-2 PubMedCrossRef
19.
Golfinos JG, Dickman CA, Zabramski JM, Sonntag VK, Spetzler RF (1994) Repair of vertebral artery injury during anterior cervical decompression. Spine (Phila Pa 1976) 19(22):2552–2556CrossRef
20.
21.
22.
Kast E, Mohr K, Richter HP, Borm W (2006) Complications of transpedicular screw fixation in the cervical spine. Eur Spine J 15(3):327–334PubMedCrossRef
23.
24.
25.
26.
Oga M, Yuge I, Terada K, Shimizu A, Sugioka Y (1996) Tortuosity of the vertebral artery in patients with cervical spondylotic myelopathy. Risk factor for the vertebral artery injury during anterior cervical decompression. Spine (Phila Pa 1976) 21(9):1085–1089CrossRef
27.
Paolini S, Lanzino G (2006) Anatomical relationships between the V(2) segment of the vertebral artery and the cervical nerve roots. Journal of Neurosurgery: Spine 5(5):440–442PubMedCrossRef
28.
29.
Pfeifer BA, Freidberg SR, Jewell ER (1994) Repair of injured vertebral artery in anterior cervical procedures. Spine (Phila Pa 1976) 19(13):1471–1474CrossRef
30.
Pham MH, Rahme RJ, Arnaout O, Hurley MC, Bernstein RA, Batjer HH, Bendok BR (2011) Endovascular stenting of extracranial carotid and vertebral artery dissections: a systematic review of the literature. Neurosurgery 68(4):856–866PubMed
31.
Richter M, Mattes T, Cakir B (2004) Computer-assisted posterior instrumentation of the cervical and cervico-thoracic spine. Eur Spine J 13(1):50–59PubMedCrossRef
32.
33.
Schlenzka D, Laine T, Lund T (2000) Computer-assisted spine surgery. Eur Spine J 9(Suppl 1):S57–S64PubMedCrossRef
34.
35.
Smith MD, Emery SE, Dudley A, Murray KJ, Leventhal M (1993) Vertebral artery injury during anterior decompression of the cervical spine. A retrospective review of ten patients. J Bone Joint Surg Br 75(3):410–415PubMed
36.
Song F, Khan K, Dinnes J, Sutton A (2002) Asymmetric funnel plots and publication bias in meta-analyses of diagnostic accuracy. Int J Epidemiol 31:88–95PubMedCrossRef
37.
Surber R, Werner GS, Cohnert TU, Wahlers T, Figulla HR (2003) Recurrent vertebral arteriovenous fistula after surgical repair: treatment with a self-expanding stent-graft. J Endovas Ther 10(1):49–53CrossRef
38.
Tubbs RS, Shah NA, Sullivan BP, Marchase ND, Cohen-Gadol AA (2009) Surgical anatomy and quantitation of the branches of the V(2) and V(3) segments of the vertebral artery: laboratory investigation. J Neurosurg: Spine 11(1):84–87CrossRef
39.
Tumialan LM, Wippold FJ 2nd, Morgan RA (2004) Tortuous vertebral artery injury complicating anterior cervical spinal fusion in a symptomatic rheumatoid cervical spine. Spine (Phila Pa 1976) 29(16):E343–E348CrossRef
40.
41.
Waldman DL, Barquist E, Poynton FG, Numaguchi Y (1998) Stent graft of a traumatic vertebral artery injury: case report. J Trauma 44(6):1094–1097PubMedCrossRef
42.
Weinberg PE, Flom RA (1973) Traumatic vertebral arteriovenous fistula. Surg Neurol 1(3):162–167PubMed
43.
Metadata
Title
The management of vertebral artery injury in anterior cervical spine operation: a systematic review of published cases
Authors
Hyung-Ki Park
Hae-Dong Jho
Publication date
01-12-2012
Publisher
Springer-Verlag
Published in
European Spine Journal / Issue 12/2012
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-012-2423-8

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