Epidemiology and Outcomes of Vertebral Artery Injury in 16 582 Cervical Spine Surgery Patients: An AOSpine North America Multicenter Study

Abstract

Study Design:A multicenter retrospective case series was compiled involving 21 medical institutions. Inclusion criteria included patients who underwent cervical spine surgery between 2005 and 2011 and who sustained a vertebral artery injury (VAI).Objective:To report the frequency, risk factors, outcomes, and management goals of VAI in patients who have undergone cervical spine surgery.Methods:Patients were evaluated on the basis of condition-specific functional status using the Neck Disability Index (NDI), modified Japanese Orthopaedic Association (mJOA) score, the Nurick scale, and the 36-Item Short-Form Health Survey (SF-36).Results:VAIs were identified in a total of 14 of 16 582 patients screened (8.4 per 10 000). The mean age of patients with VAI was 59 years (±10) with a female predominance (78.6%). Patient diagnoses included myelopathy, radiculopathy, cervical instability, and metastatic disease. VAI was associated with substantial blood loss (770 mL), although only 3 cases required transfusion. Of the 14 cases, 7 occurred with an anterior-only approach, 3 cases with posterior-only approach, and 4 during circumferential approach. Fifty percent of cases of VAI with available preoperative imaging revealed anomalous vessel anatomy during postoperative review. Average length of hospital stay was 10 days (±8). Notably, 13 of the 14 (92.86%) cases resolved without residual deficits. Compared to preoperative baseline NDI, Nurick, mJOA, and SF-36 scores for these patients, there were no observed changes after surgery (P = .20-.94).Conclusions:Vertebral artery injuries are potentially catastrophic complications that can be sustained from anterior or posterior cervical spine approaches. The data from this study suggest that with proper steps to ensure hemostasis, patients recover function at a high rate and do not exhibit residual deficits.

3D-Customized Guiding Template for Posterior Fixation in Complex Atlantoaxial Instability—Preliminary Experiences of National Cheng Kung University Hospital

“…The risk factors of VA injury include complex cervical deformity, narrow C2 pedicle, and VA path variation. 8 The preoperative imaging surveys include cervical spine X-ray, CT angiography, and cervical spine magnetic resonance imaging. Informed consent was given after oral explanation.…”

“…In recent years, many studies have proved guiding template for pedicle screw insertion has high accuracy and safety in lumbar and thoracic spine. [8][9][10][11] In this study, we report our experience of performing atlantoaxial fixation in complex cervical deformity cases with 3D-customized guiding template.…”

Stab wound with transection of left vertebral artery at V3

“…Other studies have also shown that with proper management, patients experience uneventful recovery without residual effects. [1] While neurologic deficits are rare complications of vertebral artery injury, when neurologic deficit occurs, they could be devastating and permanent. [1] Other severe outcomes are complications of stroke, pseudoaneurysm, late-onset hemorrhage, brain stem and cerebellar infarcts, and death; [1,5,8,9] early diagnosis and management are therefore critical to positive outcome.…”

“…An epidemiology study by Hsu et al [1] identified 14 cases, 0.08% of vertebral artery injuries in a multi-institutional database of 16,582 patients, a prevalence rate of 8.4 per 10,000. When examining penetrating trauma to the neck, the incidence has been reported as between 1.0-7.4%, with some variation attributed to mechanism (gunshot wound versus stab wound).…”

“…Preoperative imaging revealed anomalous variations in 50% of patients with vertebral artery injuries, in a multicenter study. [1] With increasing incidence of vertebral artery injury in patients with cervical spine trauma, [5] vertebral artery injuries should be ruled out in patients presenting with neck and cervical spine trauma. [6] Early diagnosis and intervention is critical to successful management of vertebral artery injuries.…”