Vertebral artery complications in anterior approaches to the cervical spine

“…To facilitate precise preoperative planning, preoperative CT in the ER-position is useful for avoiding the risk of corpectomy. In addition, intraoperative use of imageguided navigation or intraoperative ultrasonography can be beneficial [1,5,23,24]. Thus, the anterior approach without rotation may be better and safer than that with rotation.…”

Section: Discussionmentioning

confidence: 99%

“…Third, with regard to position, anesthetic management is easier. However, there are also several complications associated with the approach, including dysphagia, instrumentation backout, esophageal injury, cerebrospinal fluid leakage, wound infection, radiculopathy, C5 nerve palsy, and vertebral artery (VA) injury [2,[4][5][6][7][8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Alterations in axial curvature of the cervical spine with a combination of rotation and extension in the conventional anterior cervical approach

et al. 2013

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Purpose Alterations of three-dimensional cervical curvature in conventional anterior cervical approach position are not well understood. The purpose of this study was to evaluate alignment changes of the cervical spine in the position. In addition, simulated corpectomy was evaluated with regard to sufficiency of decompression and perforation of the vertebral artery canal. Methods Fifty patients with cervical spinal disorders participated. Cervical CT scanning was performed in the neutral and supine position (N-position) and in extension and right rotation simulating the conventional anterior approach position (ER-position). Rotation at each vertebral level was measured. With simulation of anterior corpectomy in a vertical direction with a width of 17 mm, decompression width at the posterior wall of the vertebrae and the distance from each foramen of the vertebral artery (VA) were measured. Results In the ER-position, the cervical spine was rotated rightward by 37.2°± 6.2°between the occipital bone and C7. While the cervical spine was mainly rotated at C1/2, the subaxial vertebrae were also rotated by several degrees. Due to the subaxial rotation, the simulated corpectomy resulted in smaller decompression width on the left side and came closer to the VA canal on the right side. Conclusions In the ER-position, the degrees of right rotation of subaxial vertebrae were small but significant. Therefore, preoperative understanding of this alteration of cervical alignment is essential for performing safe and sufficient anterior corpectomy of the cervical spine.

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“…8,10,19,23,26,29,32,33,40 Vertebral artery injury is a rare but well recognized catastrophic iatrogenic complication of cervical spine surgery with a reported incidence of 0.3%-0.5%. 6,7,13,14,25,28,30 In the case presented in this report, the left VA was at risk during the exposure, osteotomies, and bone reduction for 2 reasons: 1) proximity of the artery to the partially autofused C2-3 vertebral bodies with potential for injury during osteotomy; and 2) anticipated significant alteration in its course that would occur with successful realignment, placing the vessel at risk for shear injury or kinking during translation. Unroofing of the transverse foramen has been previously described to prevent VA kinking during correction of cervical deformity.…”

Section: Role Of Prophylactic Arterial Graftingmentioning

confidence: 91%

“…Equally important is the caution that needs to be exercised while operating on an injured cervical spine with a unilateral VA occlusion. 6,7,13,14,25,28,30 We hypothesize that initial stabilization with a halo vest orthosis might have prevented this outcome, and even if the halo had failed, at that early stage the patient likely would have been adequately stabilized with a simple posterior instrumented fusion.…”

Section: Surgical Timingmentioning

confidence: 99%

Traumatic, high-cervical, coronal-plane spondyloptosis with unilateral vertebral artery occlusion: treatment using a prophylactic arterial bypass graft, open reduction, and instrumented segmental fusion

Manjila¹,

Chowdhry²,

Bambakidis³

et al. 2014

SPI

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The authors present a case of traumatic, complete, high cervical spine injury in a patient with gradual worsening deformity and neck pain while in rigid cervical collar immobilization, ultimately resulting in coronal-plane spondyloptosis. Due to the extent of lateral displacement of the spinal elements, preoperative evaluation included catheter angiography, which revealed complete right vertebral artery (VA) occlusion. A prophylactic arterial bypass graft from the right occipital artery to the extradural right VA was fashioned to augment posterior circulation blood supply prior to reduction and circumferential instrumented fusion. Following surgery, the patient was able to participate in an aggressive rehabilitation program allowing early mobilization, and he ceased to be ventilator-dependent following implantation of a diaphragmatic pacer. The authors review factors leading to progression of this type of injury and suggest technical pearls as well as highlight specific management pitfalls, including operative risks.

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Vertebral artery complications in anterior approaches to the cervical spine

Cited by 87 publications

References 26 publications

The Immediate Safety Profile after Complex Anterior Cervical Reconstruction Surgery

The Immediate Safety Profile after Complex Anterior Cervical Reconstruction Surgery

Alterations in axial curvature of the cervical spine with a combination of rotation and extension in the conventional anterior cervical approach

Traumatic, high-cervical, coronal-plane spondyloptosis with unilateral vertebral artery occlusion: treatment using a prophylactic arterial bypass graft, open reduction, and instrumented segmental fusion

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