Vertebral artery injury during foraminal decompression in "low-risk" cervical spine surgery: incidence and management.

Abstract:

OBJECTIVES:Vertebral artery injury (VAI) during foraminal decompression in cervical spine surgery in the absence of repositioning or screw stabilization is rare. Without immediate recognition and treatment, it may have disastrous consequences. We aimed to describe the incidence and management of iatrogenic VAI in low-risk cervical spine surgery. MATERIALS AND METHODS:The records of all patients who underwent surgical procedures of the cervical spine between January 2007 and May 2012 were retrospectively consecutively evaluated. Anterior cervical discectomy and fusion or arthroplasty as well as dorsal foraminal decompression through the Frykholm approach in degenerative diseases were defined as low-risk surgeries (n = 992). RESULTS:VAI occurred in 0.3 % (n = 3) of 992 procedures: in one case during a dorsal foraminal decompression, and in two cases during the anterior cervical discectomy and fusion (ACDF) of two or four levels, respectively. In the first case, the VAI was intraoperatively misdiagnosed. Despite an initially uneventful course, the patient suffered hemorrhage from a pseudoaneurysm of the injured VA 1 month after surgery. The aneurysm was successfully occluded by endovascular coiling. In both ACDF cases, angiography and endovascular stenting of the lacerated segment proceeded immediately after the surgery. All three patients suffered no permanent deterioration. CONCLUSIONS: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.

journal_name

Acta Neurochir (Wien)

journal_title

Acta neurochirurgica

authors

Obermüller T,Wostrack M,Shiban E,Pape H,Harmening K,Friedrich B,Prothmann S,Meyer B,Ringel F

doi

10.1007/s00701-015-2594-2

subject

Has Abstract

pub_date

2015-11-01 00:00:00

pages

1941-5

issue

11

eissn

0001-6268

issn

0942-0940

pii

10.1007/s00701-015-2594-2

journal_volume

157

pub_type

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