DOI QR코드

DOI QR Code

Emergent Endovascular Embolization for Iatrogenic Vertebral Artery Injury during Cervical Discectomy and Fusion

  • Jung, Hyeun-Jin (Department of Neurosurgery, College of Medicine, Chosun University) ;
  • Kim, Dong-Min (Department of Internal Medicine, College of Medicine, Chosun University) ;
  • Kim, Seok-Won (Department of Neurosurgery, College of Medicine, Chosun University) ;
  • Lee, Sung-Myung (Department of Neurosurgery, College of Medicine, Chosun University)
  • Received : 2010.12.07
  • Accepted : 2011.11.29
  • Published : 2011.12.28

Abstract

Injury to the vertebral artery during anterior cervical discectomy is rare but potentially fatal. We report a case of cerebellar infarction after endovascular embolization for iatrogenic vertebral artery injury at C5-C6 during an anterior cervical discectomy and fusion. A 61-year-old man had an intraoperative injury of the right vertebral artery that occurred during anterior cervical discectomy and fusion at C5-C6. Hemorrhage was not controlled successfully by packing with surgical hemostatic agents. While the patient was still intubated, an emergency angiogram was performed. The patient underwent endovascular occlusion of the right V2 segment with coils. After the procedure, his course was uneventful and he did not show any neurologic deficits. Brain computed tomographic scans taken 3 days after the operation revealed a right cerebellar infarction. Anti-coagulation medication was administered, and at 3-month follow-up examination, he had no neurologic sequelae in spite of the cerebellar infarction.

Keywords

References

  1. Burke JP, Gerszten PC, Welch WC : Iatrogenic vertebral artery injury during anterior cervical spine surgery. Spine J 5 : 508-514; discussion 514, 2005 https://doi.org/10.1016/j.spinee.2004.11.015
  2. Choi JW, Lee JK, Moon KS, Kim YS, Kwak HJ, Joo SP, et al. : Endovascular embolization of iatrogenic vertebral artery injury during anterior cervical spine surgery : report of two cases and review of the literature. Spine (Phila Pa 1976) 31 : E891-E894, 2006 https://doi.org/10.1097/01.brs.0000244614.84685.c2
  3. Cosgrove GR, Theron J : Vertebral arteriovenous fistula following anterior cervical spine surgery. Report of two cases. J Neurosurg 66 : 297-299, 1987 https://doi.org/10.3171/jns.1987.66.2.0297
  4. Daentzer D, Deinsberger W, Boker DK : Vertebral artery complications in anterior approaches to the cervical spine : report of two cases and review of literature. Surg Neurol 59 : 300-309; discussion 309, 2003
  5. de los Reyes RA, Moser FG, Sachs DP, Boehm FH : Direct repair of an extracranial vertebral artery pseudoaneurysm : case report and review of the literature. Neurosurgery 26 : 528-533, 1990 https://doi.org/10.1227/00006123-199003000-00025
  6. Gantwerker BR, Baaj AA, Maughan PH, McDougall CG, White WL : Vertebral artery injury during cervical discectomy and fusion in a patient with bilateral anomalous arteries in the disc space : case report. Neurosurgery 67 : E874-E875; discussion E875, 2010 https://doi.org/10.1227/01.NEU.0000374858.18717.33
  7. Garcia Alzamora M, Rosahl SK, Lehmberg J, Klisch J : Life-threatening bleeding from a vertebral artery pseudoaneurysm after anterior cervical spine approach : endovascular repair by a triple stent-in-stent method. Case report. Neuroradiology 47 : 282-286, 2005 https://doi.org/10.1007/s00234-005-1343-2
  8. Golfinos JG, Dickman CA, Zabramski JM, Sonntag VK, Spetzler RF : Repair of vertebral artery injury during anterior cervical decompression. Spine (Phila Pa 1976) 19 : 2552-2556, 1994 https://doi.org/10.1097/00007632-199411001-00010
  9. Lee DG, Rhim SC, Roh SW, Im SB, Kwon Y, Kwun BD : Vertebral artery injury during anterior cervical spine surgery : report of two cases. J Korean Neurosurg Soc 30 : 231-238, 2001
  10. Mendez JC, Gonzelez-Llanos F : Endovascular treatment of a vertebral artery pseudoaneurysm following posterior C1-C2 transarticular screw fixation. Cardiovasc Intervent Radiol 28 : 107-109, 2005 https://doi.org/10.1007/s00270-004-4068-4
  11. Smith MD, Emery SE, Dudley A, Murray KJ, Leventhal M : Vertebral artery injury during anterior decompression of the cervical spine. A retrospective review of ten patients. J Bone Joint Surg Br 75 : 410-415, 1993

Cited by

  1. Epidemiology and Outcomes of Vertebral Artery Injury in 16 582 Cervical Spine Surgery Patients: An AOSpine North America Multicenter Study vol.7, pp.1, 2017, https://doi.org/10.1177/2192568216686753