Control of the vertebral artery from a posterior approach: a technical report

被引:9
作者
Ye, Jason Y. [1 ]
Ayyash, Omar M. [1 ]
Eskander, Mark S. [1 ]
Kang, James D. [1 ]
机构
[1] Univ Pittsburgh, Med Ctr, Dept Orthoped Surg, Pittsburgh, PA 15213 USA
关键词
Vertebral artery; Stroke; Cervical; Posterior approach; Occlusion; Arterial injury; TRANSARTICULAR SCREW FIXATION; ARTHRODESIS; SPINE;
D O I
10.1016/j.spinee.2013.11.059
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
BACKGROUND CONTEXT: Vertebral artery (VA) injury is a rare but potentially devastating complication of cervical spinal fusion. The Magerl and Harms techniques are associated with a rate between 0% to 8% and 0% to 5%, respectively. Most of reported VA injuries are related to surgical exposure or screw placement, which in turn is likely due to variability in VA anatomy. PURPOSE: The purpose of this report was to present the case of a 77-year-old woman, with a history of right VA occlusion, who sustained an intraoperative left VA injury during posterior cervical spine fusion and the subsequent intraoperative and postoperative management strategies. STUDY DESIGN: This is a single-patient case report. METHODS: The patient was placed prone and into Mayfield tongs. A midline incision was made, and dissection was carried down to the lamina and facet joints from occiput to T2. During dissection, she sustained a left-sided VA injury, which was subsequently controlled. RESULTS: The patient was doing well at her 1-year postoperative visit without any residual neurologic deficits. Her severe neck pain had resolved. CONCLUSION: A detailed understanding of VA anatomy of each individual patient is paramount. There are four types of anomalies: intraforaminal; extraforaminal; arterial; and anomalies of the surrounding bony and soft-tissue architecture. In the event of a posterior intraoperative VA injury, we outlined an algorithm to deal with this complication: control bleeding temporarily to gain visualization of the arterial injury; remove lateral masses and tissue to adequately visualize the arterial injury; once visualized, control the bleeding and see if there are any neuromonitoring changes as a result of the VA occlusion; and proceed with definitive control of the artery by either repair or ligation. (C) 2014 Elsevier Inc. All rights reserved.
引用
收藏
页码:E37 / E41
页数:5
相关论文
共 13 条
[1]   Identification of Type 1 Interforaminal Vertebral Artery Anomalies in Cervical Spine MRIs [J].
Aubin, Michelle E. ;
Eskander, Mark S. ;
Drew, Jacob M. ;
Marvin, Julianne ;
Eskander, Jonathan P. ;
Eck, Jason ;
Connolly, Patrick J. .
SPINE, 2010, 35 (26) :E1610-E1611
[2]   ATLANTO-AXIAL ARTHRODESIS BY WEDGE COMPRESSION METHOD [J].
BROOKS, AL ;
JENKINS, EB .
JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, 1978, 60 (03) :279-284
[3]   C1-C2 POSTERIOR CERVICAL FUSION - LONG-TERM EVALUATION OF RESULTS AND EFFICACY [J].
COYNE, TJ ;
FEHLINGS, GM ;
WALLACE, MC ;
BERNSTEIN, M ;
TATOR, CH .
NEUROSURGERY, 1995, 37 (04) :688-692
[4]   Biomechanical characteristics of C1-2 cable fixations [J].
Dickman, CA ;
Crawford, NR ;
Paramore, CG .
JOURNAL OF NEUROSURGERY, 1996, 85 (02) :316-322
[5]   THE INTERSPINAL METHOD OF POSTERIOR ATLANTOAXIAL ARTHRODESIS [J].
DICKMAN, CA ;
SONNTAG, VKH ;
PAPADOPOULOS, SM ;
HADLEY, MN .
JOURNAL OF NEUROSURGERY, 1991, 74 (02) :190-198
[6]   The Characteristics of Patients With Type 1: Intraforaminal Vertebral Artery Anomalies? [J].
Eskander, Mark S. ;
Aubin, Michelle E. ;
Major, Joshua W. ;
Huning, Bree A. ;
Drew, Jacob ;
Marvin, Julianne ;
Connolly, Patrick J. .
ORTHOPEDICS, 2011, 34 (06) :438-438
[7]   Vertebral Artery Anatomy A Review of Two Hundred Fifty Magnetic Resonance Imaging Scans [J].
Eskander, Mark S. ;
Drew, Jacob M. ;
Aubin, Michelle E. ;
Marvin, Juliane ;
Franklin, Patricia D. ;
Eck, Jason C. ;
Patel, Nihal ;
Boyle, Katherine ;
Connolly, Patrick J. .
SPINE, 2010, 35 (23) :2035-2040
[8]  
Fiore Amory J, 2002, Neurosurg Focus, V12, pE5
[9]  
Gallie W.E., 1939, Am. J. Surg, V46, P495, DOI [10.1016/S0002-9610(39)90309-0, DOI 10.1016/S0002-9610(39)90309-0]
[10]   POSTERIOR STABILIZATION WITH AN INTERLAMINAR CLAMP IN CERVICAL INJURIES - TECHNICAL NOTE AND REVIEW OF THE LONG-TERM EXPERIENCE WITH THE METHOD [J].
HOLNESS, RO ;
HUESTIS, WS ;
HOWES, WJ ;
LANGILLE, RA .
NEUROSURGERY, 1984, 14 (03) :318-322