+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Epidemiology of Iatrogenic Vertebral Artery Injury in Cervical Spine Surgery: 21 Multicenter Studies



Epidemiology of Iatrogenic Vertebral Artery Injury in Cervical Spine Surgery: 21 Multicenter Studies



World Neurosurgery 126: E1050



The overall incidence of iatrogenic vertebral artery injury (IVAI) in cervical spine surgeries (CSSs) is reported to be 0.07%-1.4%. Although IVAI occurred during C1-2 fusion, there is no accurate information regarding the surgery-specific risk of IVAI. This study aimed to stratify incidence of IVAI by surgical method and evaluate the correlation between IVAI and its sequelae. This retrospective, multicenter study involved clinical and radiologic evaluations for IVAI. All CSSs performed between 2012 and 2016 were included; neck mass excision and pain intervention were excluded. Patient characteristics, diagnosis, surgical technique, complications, and presence of IVAI were collected. In IVAI cases, technique details, characteristics, and sequelae were investigated. This study included 14,722 patients with 15,582 CSSs in 21 centers. IVAIs were identified in 13 (0.08%) patients. Surgery-specific incidence of IVAI was 1.35% in cases involving C1-2 posterior fixation and 0.20% in cases involving C3-6 posterior fixation. Common injury mechanisms were screw-in (31%) and high-speed drilling (23%). Screw-related IVAI occurred in 9 (69%) patients, and IVAI of the C1 lateral mass and C2 pedicle screws occurred in 4 and 3 patients, respectively. Of 13 cases of IVAI, 3 (23%) involved cerebellar or stem infarction; the infarction had no substantial correlation with injury grade or dominancy. Overall incidence of IVAI in CSSs was 0.08%. C1-2 posterior fixation had the highest incidence of IVAI (1.35%). Although clinical results of IVAI can be highly variable, controlling risk factors of IVAI is important.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 066596203

Download citation: RISBibTeXText

PMID: 30878743

DOI: 10.1016/j.wneu.2019.03.042


Related references

Epidemiology and Outcomes of Vertebral Artery Injury in 16 582 Cervical Spine Surgery Patients: An AOSpine North America Multicenter Study. Global Spine Journal 7(1 Suppl): 21s, 2017

Iatrogenic vertebral artery injury during anterior cervical spine surgery. Spine Journal 5(5): 508, 2005

"Iatrogenic vertebral artery injury during anterior cervical spine surgery", by Dr. Burke JP, et al. Spine Journal 3(1): 89; Author Reply 89, 2003

Iatrogenic Vertebral Artery Injury During Anterior Cervical Spine Surgery: A Systematic Review. World Neurosurgery 106: 715-722, 2017

Endovascular embolization of iatrogenic vertebral artery injury during anterior cervical spine surgery: report of two cases and review of the literature. Spine 31(23): E891-E894, 2006

Iatrogenic vertebral artery injury secondary to vessel tortuosity in a grossly degenerate cervical spine. British Journal of Neurosurgery 28(3): 423-425, 2014

Vertebral artery injury in cervical spine surgery. Instructional Course Lectures 58: 717-728, 2009

Indirect vertebral artery injury during cervical spine surgery. Canadian Journal of Anaesthesia 53(7): 738-739, 2006

Anatomic basis of the anterior surgery on the cervical spine: relationships between uncus-artery-root complex and vertebral artery injury. Surgical and Radiologic Anatomy 20(6): 389-392, 1998

Vertebral artery injury during cervical spine surgery: a survey of more than 5600 operations. Spine 33(7): 779-785, 2008

Risks for Vascular Injury During Anterior Cervical Spine Surgery: Prevalence of a Medial Loop of Vertebral Artery and Internal Carotid Artery. Spine 41(4): 293-298, 2016

Vertebral artery injury during foraminal decompression in "low-risk" cervical spine surgery: incidence and management. Acta Neurochirurgica 157(11): 1941-1945, 2015

Vertebral artery injury in cervical spine surgery: anatomical considerations, management, and preventive measures. Spine Journal 9(1): 70-76, 2009

Direct Damage to a Vertebral Artery Better Predicts a Vertebral Artery Injury than Elongation in Cervical Spine Dislocation. Acta Medica Okayama 71(5): 427-432, 2017

Unilateral vertebral artery injury in a patient with displaced upper cervical spine fractures: the treatment for one case of vertebral artery embolism. European Spine Journal 27(Suppl 3): 409-414, 2018