gms | German Medical Science

64th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

26 - 29 May 2013, Düsseldorf

Vertebral artery injury during foraminal decompression in "low risk" cervical spine surgery: incidence and management

Meeting Abstract

  • Maria Wostrack - Neurochirurgische Klinik des Klinikums Rechts der Isar, TU München
  • Ehab Shiban - Neurochirurgische Klinik des Klinikums Rechts der Isar, TU München
  • Haiko Pape - Neurochirurgische Klinik des Klinikums Rechts der Isar, TU München
  • Alexander Preuß - Neurochirurgische Klinik des Klinikums Rechts der Isar, TU München
  • Bernhard Meyer - Neurochirurgische Klinik des Klinikums Rechts der Isar, TU München
  • Florian Ringel - Neurochirurgische Klinik des Klinikums Rechts der Isar, TU München

Deutsche Gesellschaft für Neurochirurgie. 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Düsseldorf, 26.-29.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocMI.01.07

doi: 10.3205/13dgnc289, urn:nbn:de:0183-13dgnc2892

Published: May 21, 2013

© 2013 Wostrack et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Objective: Vertebral artery injury (VAI) is a very rare but feared complication of non-instrumented cervical spine surgery. Without immediate recognition and treatment it may have disastrous consequences. The aim of the present study was to describe the incidence and management of iatrogenic VAI at a single center.

Method: Recordings of all patients who underwent non-instrumented anterior or posterior surgical procedures of the cervical spine between 01/2007 and 05/2012 were retrospectively consecutively evaluated.

Results: VAI occurred in 0.3% (n=3) of 992 non-instrumented cervical spine procedures (anterior n=920, posterior n=72). In two cases of anterior cervical discectomy and fusion (ACDF) of two and four levels, respectively, VA was injured during neuroforaminal decompression and resulted in excessive arterial bleeding. The hemorrhage was controlled by hemostatic packing. Immediately after surgery an angiogram was performed with endovascular VA stenting in the same intervention. In the third case during a posterior microforaminotomy a moderate arterial bleeding occurred. Bleeding was easily stopped intraoperatively. No VAI was suspected, therefore, no additional endovascular intervention proceeded. Despite an initially uneventful course, the patient suffered spinal hemorrhage from a pseudoaneurysm of the VA at the operated level 30 days after surgery. Endovascular stenting and aneurysm coiling was performed within 24 hours after the hemorrhage. All three patients suffered no permanent neurological deterioration due to the vascular complication and could improve from preoperative spinal symptoms during follow-up. In all three cases peri- and postinterventional platelet inhibition was required, no secondary hemorrhage occurred.

Conclusions: In a high volume center the incidence of VAI during non-instrumented cervical spine surgery is extremely low. In case of this complication immediate angiographic diagnostic and endovascular occlusion provides beneficial results. To avoid the development of a pseudoaneurysm and the risk of late complications additional angiographic imaging of VA is recommended in cases of intraoperative suspicious strong arterial bleedings.