TY - JOUR
T1 - VertebralArtery Injury with Anterior Cervical Spine Operations
T2 - A Systematic Review of Risk Factors, Clinical Outcomes, and Management Strategies
AU - Barrie, Umaru
AU - Detchou, Donald
AU - Reddy, Raghuram
AU - Tao, Jonathan
AU - Elguindy, Mahmoud
AU - Reimer, Claudia
AU - Hall, Kristen
AU - Brown, Desmond A.
AU - Aoun, Salah G.
AU - Bagley, Carlos A
N1 - Publisher Copyright:
© 2023 Elsevier Inc.
PY - 2023/5
Y1 - 2023/5
N2 - Objective: Anterior cervical spine operations are commonly performed on cervical spine pathologies and to a large extent are safe and successful. However, these surgical procedures expose the vertebral artery, posing a risk of harm to it. Methods: A systematic review was conducted using PubMed, Google Scholar, and Web of Science electronic databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to critically assess primary articles discussing treatment strategies “vertebral artery injury” AND “anterior cervical spine” and develop a management strategy based on our experience and meta-analysis of the literature. In addition, we present an illustrative case of iatrogenic vertebral artery injury presenting with 6 to 7 months’ history of progressive dysphagia was transferred to our care from an outside institution. Results: Included and analyzed were 43 articles that detailed 75 cases involving vertebral artery injury (VAI) in anterior cervical spine operations. Preoperatively, frequent clinical findings reported were sensory deficit (26 patients [63.41%]), motor deficit (20 patients [48.78%]), and pain (17 patients [41.46%]). In total, 32 patients (50.00%) endured injury of their left VA, and 30 patients had a right VAI. The 2 common causes of VAI were drilling (24 patients [40.00%]) and instrumentation (8 patients [13.33%]). Conclusions: Altogether, our review recommends repair or tamponade packing with a hemostatic agent for primary management. Should tamponade packing with a hemostatic agent be used for primary management, secondary management should entail either repair, stenting occlusion, embolization, anticoagulants, or ligation. Further examination of this treatment strategy based on a larger cohort is necessary.
AB - Objective: Anterior cervical spine operations are commonly performed on cervical spine pathologies and to a large extent are safe and successful. However, these surgical procedures expose the vertebral artery, posing a risk of harm to it. Methods: A systematic review was conducted using PubMed, Google Scholar, and Web of Science electronic databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to critically assess primary articles discussing treatment strategies “vertebral artery injury” AND “anterior cervical spine” and develop a management strategy based on our experience and meta-analysis of the literature. In addition, we present an illustrative case of iatrogenic vertebral artery injury presenting with 6 to 7 months’ history of progressive dysphagia was transferred to our care from an outside institution. Results: Included and analyzed were 43 articles that detailed 75 cases involving vertebral artery injury (VAI) in anterior cervical spine operations. Preoperatively, frequent clinical findings reported were sensory deficit (26 patients [63.41%]), motor deficit (20 patients [48.78%]), and pain (17 patients [41.46%]). In total, 32 patients (50.00%) endured injury of their left VA, and 30 patients had a right VAI. The 2 common causes of VAI were drilling (24 patients [40.00%]) and instrumentation (8 patients [13.33%]). Conclusions: Altogether, our review recommends repair or tamponade packing with a hemostatic agent for primary management. Should tamponade packing with a hemostatic agent be used for primary management, secondary management should entail either repair, stenting occlusion, embolization, anticoagulants, or ligation. Further examination of this treatment strategy based on a larger cohort is necessary.
KW - Anterior cervical spine operation
KW - Clinical characteristics
KW - Outcomes
KW - Surgical management
KW - Systematic review
KW - Vertebral artery injury
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U2 - 10.1016/j.wneu.2023.02.078
DO - 10.1016/j.wneu.2023.02.078
M3 - Review article
C2 - 36842528
AN - SCOPUS:85151434187
SN - 1878-8750
VL - 173
SP - 226-236.e12
JO - World neurosurgery
JF - World neurosurgery
ER -