The management of vertebral artery injury in anterior cervical spine operation: a systematic review of published cases

Park, Hyung-Ki; Jho, Hae-Dong

doi:10.1007/s00586-012-2423-8

Cited by 45 publications

(35 citation statements)

References 44 publications

(97 reference statements)

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“…Although rare, potential sequelae include thrombosis, embolism, cerebral ischemia, late-onset hemorrhage, death, and others. 20 Risk factors include technical errors and unrecognized vertebral artery anomalies. 7 In the present study, 1 case involved an aberrant medial vertebral artery, and in the second case, a vertebral artery dissection was recognized postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Long-term clinical outcomes following 3- and 4-level anterior cervical discectomy and fusion

Ramos

Ramhmdani

et al. 2016

SPI

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OBJECTIVE The purpose of this study was to report the long-term clinical outcomes following 3- and 4-level anterior cervical discectomy and fusion (ACDF). METHODS A retrospective review of all adult neurosurgical patients undergoing elective ACDF for degenerative disease at a single institution between 1996 and 2013 was performed. Patients who underwent first-time 3- or 4-level ACDF were included; patients with previous cervical spine surgery, those undergoing anterior/posterior approaches, and those with corpectomy were excluded. Outcome measures included perioperative complication rates, fusion rates, need for revision surgery, Nurick Scores, Odom's criteria, symptom resolution, neck visual analog scale (VAS) pain score, and persistent narcotics usage. RESULTS Seventy-one patients who underwent 3-level ACDF and 26 patients who underwent 4-level ACDF were identified and followed for an average of 7.6 ± 4.2 years. There was 1 case (3.9%) of deep wound infection in the 4-level group and 1 case in the 3-level group (1.4%; p = 0.454). Postoperatively, 31% of patients in the 4-level group complained of dysphagia, compared with 12.7% in the 3-level group (p = 0.038). The fusion rate was 84.6% after 4-level ACDF and 94.4% after 3-level ACDF (p = 0.122). At last follow-up, a significantly higher proportion of patients in the 4-level group continued to have axial neck pain (53.8%) than in the 3-level group (31%; p = 0.039); the daily oral morphine equivalent dose was significantly higher in the 4-level group (143 ± 97 mg/day) than in the 3-level group (25 ± 10 mg/day; p = 0.030). Outcomes based on Odom's criteria were also different between cohorts (p = 0.044), with a significantly lower proportion of patients in the 4-level ACDF group experiencing an excellent/good outcome. CONCLUSIONS In this study, patients who underwent 4-level ACDF had significantly higher rates of dysphagia, postoperative neck pain, and postoperative narcotic usage when compared with patients who underwent 3-level ACDF. Pseudarthrosis and deep wound infection rates were also higher in the 4-level group, although this did not reach statistical significance. Additionally, a smaller proportion of patients achieved a good/excellent outcome in the 4-level group than in the 3-level group. These findings suggest a significant increase of perioperative morbidity and worsened outcomes for patients who undergo 4- versus 3-level ACDF.

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Section: Discussionmentioning

confidence: 99%

Long-term clinical outcomes following 3- and 4-level anterior cervical discectomy and fusion

Ramos

Ramhmdani

et al. 2016

SPI

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“…Additionally, neurovascular or adjacent organ injuries have been reported (17,20,27,(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39). Implant related complications have also been reported in the literature (20,27,(40)(41)(42)(43)(44).…”

Section: Introductionmentioning

confidence: 99%

Anterior cervical spine surgery-associated complications in a retrospective case-control study

Τάσιου¹,

Giannis²,

Brotis³

et al. 2017

J. Spine Surg.

116

113

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Anterior cervical spine procedures have been associated with satisfactory outcomes. However, the occurrence of troublesome complications, although uncommon, needs to be taken into consideration.The purpose of our study was to assess the actual incidence of anterior cervical spine procedure-associated complications and identify any predisposing factors. A total of 114 patients undergoing anterior cervical procedures over a 6-year period were included in our retrospective, case-control study. The diagnosis was cervical radiculopathy, and/or myelopathy due to degenerative disc disease, cervical spondylosis, or traumatic cervical spine injury. All our participants underwent surgical treatment, and complications were recorded.The most commonly performed procedure (79%) was anterior cervical discectomy and fusion (ACDF).Fourteen patients (12.3%) underwent anterior cervical corpectomy and interbody fusion, seven (6.1%) ACDF with plating, two (1.7%) odontoid screw fixation, and one anterior removal of osteophytes for severe Forestier's disease. Mean follow-up time was 42.5 months (range, 6-78 months). The overall complication rate was 13.2%. Specifically, we encountered adjacent intervertebral disc degeneration in 2.7% of our cases, dysphagia in 1.7%, postoperative soft tissue swelling and hematoma in 1.7%, and dural penetration in 1.7%. Additionally, esophageal perforation was observed in 0.9%, aggravation of preexisting myelopathy in 0.9%, symptomatic recurrent laryngeal nerve palsy in 0.9%, mechanical failure in 0.9%, and superficial wound infection in 0.9%. In the vast majority anterior cervical spine surgery-associated complications are minor, requiring no further intervention. Awareness, early recognition, and appropriate management, are of paramount importance for improving the patients' overall functional outcome.

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“…42 Of these injuries, 7 patients (17.9%) experienced symptoms of VA insufficiency, 2 patients (5.1%) had root damage from ligation, and 1 patient died. Delayed ischemic complications were observed in 9 (45%) of the 20 patients that underwent only tamponade.…”

Section: Outcome Associated With Repair Of Va Injuriesmentioning

confidence: 98%

Multimodality Management of Vertebral Artery Injury Sustained During Cervical or Craniocervical Surgery

Maughan

Ducruet

Elhadi

et al. 2013

Operative Neurosurgery

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The management of vertebral artery injury in anterior cervical spine operation: a systematic review of published cases

Cited by 45 publications

References 44 publications

Long-term clinical outcomes following 3- and 4-level anterior cervical discectomy and fusion

Long-term clinical outcomes following 3- and 4-level anterior cervical discectomy and fusion

Anterior cervical spine surgery-associated complications in a retrospective case-control study

Multimodality Management of Vertebral Artery Injury Sustained During Cervical or Craniocervical Surgery

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