Epidemiology and Management of Iatrogenic Vertebral Artery Injury Associated With Cervical Spine Surgery

Abstract

Iatrogenic vertebral artery injury (VAI) caused by surgical interventions involving the cervical spine is an uncommon but catastrophic complication associated with high morbidity or mortality due to ischemic stroke, intra- or extra-dural hemorrhage, and the formation of pseudoaneurysm or arteriovenous fistulae. In cervical spine surgeries, VAI may occur during the peri- or postoperative period. This may be induced by an anterior or posterior surgical approach. Despite advanced imaging techniques and increased anatomical knowledge, VAI during cervical spinal surgery remains a challenge. Techniques for managing VAI include hemostatic tamponade, ligation, microvascular repair or anastomosis, and endovascular management. We need to consider the risk of iatrogenic VAI as a complication in patients undergoing cervical spine surgeries and a better understanding of its mechanism and proper management.

Endovascular Management of Iatrogenic Vertebral Artery Pseudoaneurysm: A Case Report

“…Although there is no consensus on the optimal treatment strategy for vertebral artery injury in cervical spine surgeries, a systematic management method has been reported ( 3 ). In brief, when possible, direct surgical treatment such as microvascular repair or surgical ligation should be attempted.…”

Incidence of vertebral artery injury in patients undergoing cervical spine trauma surgery in correlation with surgical approach: A review

“…Blood vessels exposed during an operation are the vertebral artery, carotid artery and its branches, thyroid arteries, and internal jugular vein. [1] Intraoperative vertebral artery injury is the most recurrent vascular injury in cervical spine surgery, accountable for potentially devastating complications, exhibiting rates as high as 86.6% compared to other vascular injuries. [1] The overall incidence of iatrogenic vertebral artery injury is mercifully rare (0.8-1.4%), with percentages that vermiculate according to the surgical approach employed.…”

“…[1] Intraoperative vertebral artery injury is the most recurrent vascular injury in cervical spine surgery, accountable for potentially devastating complications, exhibiting rates as high as 86.6% compared to other vascular injuries. [1] The overall incidence of iatrogenic vertebral artery injury is mercifully rare (0.8-1.4%), with percentages that vermiculate according to the surgical approach employed. More specifically, posterior access at the C1-C2 level leads to vertebral artery injury in 4.1% to 8.2%, while the anterior approach accounts for 0.3% to 0.5% of iatrogenic vertebral artery injuries.…”

“…Less commonly, it can be provoked during soft tissue manipulation, detachment of the ossified posterior longitudinal ligament or by using diathermy and manipulations nearby the vertebral artery. [1] The sorts of spinal column vascular damage are classified as arterial rupture, which is the most frequent form (41.24%), dissection (5.67%), pseudoaneurysm formation (16.49%) or arteriovenous fistula (2.58%), thrombosis, embolism or even complete blockage (4.64%). [2] The clinical presentation of patients sustaining vertebral artery injury varies from being utterly asymptomatic to hypovolemic shock, depending on the graveness of the injury, irrespectively of neurological complications.…”

“…Most symptoms linked to vertebral artery injury are precipitate, although late-onset symptoms may appear due to delayed bleeding complications, ruptured pseudoaneurysm or arteriovenous communication. [1] Posterior circulation infarcts are characterized by atypical symptoms, such as unsteadiness, vertigo, diplopia, cortical blindness, alternating paresthesia, tinnitus, dysphasia, dysarthria, tetraplegia or ataxia. In addition, late-onset ischemic complications may be related to embolism due to partial occlusion or destruction of the vertebral artery.…”