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Evid Based Spine Care J 2014; 05(01): 016-027
DOI: 10.1055/s-0034-1366980
Systematic Review
Georg Thieme Verlag KG Stuttgart · New York

Vertebral Artery Anomaly and Injury in Spinal Surgery

Robert Molinari
1   Department of Orthopaedic Surgery, University of Rochester Medical Center, Rochester, New York, United States
,
Matthew Bessette
1   Department of Orthopaedic Surgery, University of Rochester Medical Center, Rochester, New York, United States
,
Annie L. Raich
2   Spectrum Research, Inc., Tacoma, Washington, United States
,
Joseph R. Dettori
2   Spectrum Research, Inc., Tacoma, Washington, United States
,
Christine Molinari
1   Department of Orthopaedic Surgery, University of Rochester Medical Center, Rochester, New York, United States
› Author Affiliations
Further Information

Publication History

25 June 2013

15 November 2013

Publication Date:
28 March 2014 (online)

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Abstract

Study Design Systematic review.

Study Rationale The purpose of this review is to further define the published literature with respect to vertebral artery (VA) anomaly and injury in patients with degenerative cervical spinal conditions.

Objectives In adult patients with cervical spine or degenerative cervical spine disorders receiving cervical spine surgery, what is the incidence of VA injury, and among resulting VA injuries, which treatments result in a successful outcome and what percent are successfully repaired?

Materials and Methods A systematic review of pertinent articles published up to April 2013. Studies involving traumatic onset, fracture, infection, deformity or congenital abnormality, instability, inflammatory spinal diseases, or neoplasms were excluded. Two independent reviewers assessed the level of evidence quality using the Grades of Recommendation Assessment, Development and Evaluation criteria; disagreements were resolved by consensus.

Results From a total of 72 possible citations, the following met our inclusion criteria and formed the basis for this report. Incidence of VA injuries ranged from 0.20 to 1.96%. None of the studies reported using preoperative imaging to identify anomalous or tortuous VA. Primary repair and ligation were the most effective in treating VA injuries.

Conclusion The incidence of VA injuries in degenerative cervical spinal surgery might be as high as 1.96% and is likely underreported. Direct surgical repair is the most effective treatment option. The most important preventative technique for VA injuries is preoperative magnetic resonance imaging or computed tomography angiographic imaging to detect VA anomalies. The overall strength of evidence for the conclusions is low.

Keywords

vertebral artery - vertebral artery anatomy - classification systems - vertebral artery injury - complication - iatrogenic - intraoperative complication - cervical spine surgery

Supplementary Material

 

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