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Bernatz JT, Naylor RM, Goh BC, Brinjikji W, Sebastian A, Freedman B, Nassr A. Iatrogenic vertebral artery injury with concomitant contralateral idiopathic vertebral artery dissection managed with intravascular intervention: a case report. J Spine Surg 2023; 9:479-486. [PMID: 38196731 PMCID: PMC10772667 DOI: 10.21037/jss-23-67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/31/2023] [Indexed: 01/11/2024]
Abstract
Background Vertebral artery injury (VAI) is a known potential complication of posterior cervical fusion surgery. Pre-operative imaging is used to determine the patency of bilateral vertebral arteries during the planning and execution of surgery. This case illustrates an example of a staged anterior/posterior cervical reconstruction in which an iatrogenic VAI combined with a contralateral idiopathic vertebral artery dissection not identified on pre-operative imaging resulted in absent basilar artery anterograde flow. Case Description A 61-year-old female underwent planned staged anterior cervical decompression C4-T1 with posterior cervical fusion C2-T4 for the treatment of degenerative cervical myeloradiculopathy. During the second stage posterior fusion, iatrogenic VAI occurred during drilling for placement of the right C2 pars screw. Upon post-operative angiography, in addition to the known right VAI, there was a new left vertebral artery dissection that occurred during/after the anterior stage. The basilar artery was only filled in retrograde fashion from the right internal carotid artery across the right posterior communicating artery. The left vertebral artery dissection was treated with telescoping flow diverting stents to restore flow to the basilar artery and the right VAI was treated with coiling. Conclusions Surgeons should be aware of the possibility, while rare, that an occult injury to the non-injured artery is always a possibility if significant deformity correction or alignment change has occurred during cervical spine surgery. Working closely with neurointerventional colleagues can be invaluable to quickly assess and if necessary, restore blood flow to the brain through these life saving techniques.
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Affiliation(s)
- James T. Bernatz
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Ryan M. Naylor
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Brian C. Goh
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Arjun Sebastian
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Brett Freedman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Ahmad Nassr
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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Kong QJ, Sun XF, Wang Y, Sun JC, Sun PD, Lv HD, Wang ZQ, Xu XM, Guo YF, Shi JG. Risk assessment of vertebral artery injury in anterior controllable antedisplacement and fusion (ACAF) surgery: a cadaveric and radiologic study. Eur Spine J 2019; 28:2417-2424. [PMID: 31428861 DOI: 10.1007/s00586-019-06111-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 08/05/2019] [Accepted: 08/11/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE We have introduced a novel surgery technique named anterior controllable antedisplacement and fusion (ACAF) for the treatment of ossification of the posterior longitudinal ligament. As reported, the satisfactory postoperative outcome can be attributed to the larger decompression width. However, it may associate with high prevalence of vertebral artery injury (VAI) theoretically. Thus, assessment of the vulnerability of vertebral artery in ACAF is of great importance. METHODS Computed tomographic scan data of 28 patients were retrospectively studied. Seven radiographic parameters were evaluated: uncinate process (UP) tips distance, transverse foramen (TF)-UP tips distance, TF-LWL (the ipsilateral limited wedging line) distance, the limited distance of lateral decompression, the maximum oblique angle of LWL, TF-LWG (the lateral wall of groove) distance, and width of groove. Eleven fresh cadaveric spines undergoing ACAF surgery were also studied. Two anatomic parameters were evaluated: width of groove and LWG-TF distance. RESULTS The UP tips distance increased from C3 to C6 and tended to be larger in males. The UP tip-TF distance and LWL-TF distance were smallest at C4, but both were larger than 2 mm. Maximum oblique angle decreased from C3 to C6. Postoperatively, both radiographic and cadaveric measurements showed the width of groove was larger than UP tips distance, but LWG-TF distance was larger than 2 mm in all levels. CONCLUSION UP can be used as anatomical landmarks to avoid VAI during ACAF surgery. Radiographic and cadaveric measurements verified the safety of ACAF surgery, even for those cases with wedging and lateral slotting.
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Affiliation(s)
- Qing-Jie Kong
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Xiao-Fei Sun
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Yuan Wang
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China.
| | - Jing-Chuan Sun
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Pei-Dong Sun
- Guangdong Provincial Key Laboratory of Medical Biomechanics, Department of Anatomy, Southern Medical University, No. 1023 Shatai Road, Baiyun District, Guangzhou, 510515, People's Republic of China
| | - Hong-di Lv
- The 990th Hospital of People's Liberation Army, No. 1 Fenghuang Road, Zhumadian, 463000, Henan Province, People's Republic of China
| | - Zi-Qin Wang
- Henan Provincial Corps Hospital of Chinese People's Armed Police Forces, No. 1 Kangfu Zhong Street, Zhengzhou, 450000, Henan Province, People's Republic of China
| | - Xi-Ming Xu
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Yong-Fei Guo
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Jian-Gang Shi
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China.
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