Iatrogenic Vascular Injury Associated with Cervical Spine Surgery: A Systematic Literature Review

Turğut, Mehmet; Akhaddar, Ali; Turgut, Ahmet Tuncay; Hall, Walter A.

doi:10.1016/j.wneu.2021.12.068

Cited by 9 publications

(16 citation statements)

References 87 publications

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“…Recent systematic reviews indicate that the most common cause of VAI in cervical spine surgeries was drilling (20.6 to 61%) or instrumentation (16% to 31.44%). 20 55) Other causes of VAI are soft tissue retraction, removal of an ossified posterior longitudinal ligament, dissection with cautery, and VA manipulation. Mechanisms of vascular injury during cervical spine surgery reported by Turgut et al include laceration (most common, 41.24%), pseudoaneurysm (16.49%), arterial dissection (5.67%), thrombosis, emboli or occlusion (4.64%), and AVF (2.58%).…”

Section: Epidemiology and Clinical Findings Of Vaimentioning

confidence: 99%

“…Mechanisms of vascular injury during cervical spine surgery reported by Turgut et al include laceration (most common, 41.24%), pseudoaneurysm (16.49%), arterial dissection (5.67%), thrombosis, emboli or occlusion (4.64%), and AVF (2.58%). 55) Symptoms after cervical spine surgery for VAI may be immediate or manifest several years later. 27) Clinical findings of iatrogenic VAI include intraoperative bleeding, posterior circulation infarcts, neck swelling, hypotension, dyspnea, altered consciousness, hemorrhagic shock, and death, or may be asymptomatic.…”

Section: Epidemiology and Clinical Findings Of Vaimentioning

confidence: 99%

“… 22 53) Surgical procedures for cervical spine entail anterior, posterior, and combined (anterior and posterior) approaches. 55) The various complications associated with cervical spine surgeries depend on the approach. An anterior approach is associated with dysphagia, esophageal injury, superior and recurrent laryngeal nerve palsy, and Horner’s syndrome.…”

Section: Introductionmentioning

confidence: 99%

“… 22) In addition, vascular injury due to cervical spine surgeries is rare but fatal, and involve various blood vessels, including vertebral artery (VA), carotid artery, thyroid arteries, or internal jugular vein. 24 45 55 57)…”

Section: Introductionmentioning

confidence: 99%

“…A recent systematic review by Turgut et al showed that the most commonly injured vessels during cervical spine surgery were VA (86.6%). 55) VAI can result in severe neurologic damage and even death due to acute and late-onset hemorrhage, arteriovenous fistulae (AVF), pseudoaneurysms, thrombosis, embolism, and cerebral ischemia. 44 45) The incidence of iatrogenic VAI in cervical spine surgeries has yet to be reported accurately given the case reports or series, and retrospective single- or multi-center studies.…”

Section: Introductionmentioning

confidence: 99%

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

2022

Korean J Neurotrauma

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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.

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Section: Epidemiology and Clinical Findings Of Vaimentioning

confidence: 99%

Section: Epidemiology and Clinical Findings Of Vaimentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

2022

Korean J Neurotrauma

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Potential causes of iatrogenic intraoperative bleeding during C1 surgeries: a CT 3D rendering study

Wang,

Shan,

et al. 2024

The Spine Journal

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Preventing Iatrogenic Injury to the Vertebral Artery in Cervical Spine Surgery

Garg,

Maniakhina,

Muir

et al. 2024

Clinical Spine Surgery

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Summary of Background Data: Iatrogenic injury of the vertebral artery (VA) in the context of surgical approaches to the cervical spine has been cited as a relatively rare complication with varying degrees of severity ranging from minimal injury to acute stroke and can result in death. It is estimated that ~50% of cases of iatrogenic VA injury are preventable after postoperatively examining a patient’s preoperative imaging. Despite the low incidence (<2%) of this complication, the potential associated morbidity demonstrates the importance of meticulous preoperative vascular consideration. Objective: This study aims to emphasize the importance of preoperative vascular screening during anterior cervical access planning visualized through a rare case of a VA aberration in a 47-year-old patient. Study Design: This study is designed as a retrospective case report. Methods: A thorough chart review was performed for this subject including all prior medical records, imaging studies, imaging reports, operative notes, and communication records. Results: The subject was found to have a history of patent foramen ovale (PFO) repair with a rare vertebral artery malformation described as a medial transposition of the vertebral artery out of the vertebral artery foramen between C3 and C4. Conclusions: Consideration of cervical anatomy, particularly the VA, is key to minimizing the risk of adverse surgical outcomes in both anterior and posterior approaches to the cervical spine. During the workup process, the patient’s primary care providers, radiologists, and surgeons should be aware of the potential variations of the VA with particular attention given to the course of the VA on MR imaging. Level of Evidence: Level IV.

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Iatrogenic Vascular Injury Associated with Cervical Spine Surgery: A Systematic Literature Review

Cited by 9 publications

References 87 publications

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

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

Potential causes of iatrogenic intraoperative bleeding during C1 surgeries: a CT 3D rendering study

Preventing Iatrogenic Injury to the Vertebral Artery in Cervical Spine Surgery

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