Embolisation of Vertebral Artery Damaged Following Cervical Disc Removal
  • Johannes Borkert
    Klinische und Interventionelle Angiologie, Asklepios Klinik St. Georg , Hamburg, Germany
  • Annika Hirte
    Klinische und Interventionelle Angiologie, Asklepios Klinik St. Georg , Hamburg, Germany
  • Jacobus Reimers
    Klinische und Interventionelle Angiologie, Asklepios Klinik St. Georg , Hamburg, Germany
  • Nicoline Jochmann
    Klinische und Interventionelle Angiologie, Asklepios Klinik St. Georg , Hamburg, Germany
  • Sigrid Nikol
    Klinische und Interventionelle Angiologie, Asklepios Klinik St. Georg , Hamburg, Germany

Keywords

vertebral artery injury, embolisation

Abstract

Introduction: The incidence of vertebral artery (VA) injury during cervical spine surgery is rare. Even though tamponade is effective in many cases, early consultation of an endovascular team is recommended if bleeding cannot be controlled. We report a case of emergent endovascular embolisation of left VA due to iatrogenic injury during anterior cervical disc removal and fusion.

Case: A 47-year-old woman was admitted to our emergency department with serious arterial bleeding from the neck only hours after undergoing anterior cervical disc removal and fusion surgery.  She was intubated and mechanically ventilated, however hemorrhage could not be successfully controlled by packing with surgical hemostatic agents. Cranial computed tomography, computed tomography of the cervical spine and CT angiography confirmed the suspected diagnosis of injury to the VA. Emergent endovascular embolisation successfully stopped the bleeding. Occlusion of the vessel was achieved by vascular plugging. The patient was discharged from our hospital 14 days after the intervention, receiving a revision surgery of the cervical spine on the day of embolisation. At the date of discharge she presented without any focal neurological deficit.

Conclusion: Pre-operative radiographic imaging of the cervical spine should be used routinely to identify anatomic abnormalities of the vertebral arteries. Endovascular embolisation appears to be effective in treating acute iatrogenic dissection of the vertebral arteries.

VIEW THE ENTIRE ARTICLE

References

  • Burke JP, Gerszten PC, Welch WC. Iatrogenic vertebral artery injury during anterior cervical spine surgery. Spine J 2005;5:508–514.
  • Devin CJ, Kang JD. Vertebral artery injury in cervical spine surgery. Instr Course Lect 2009;58:717–728.
  • Lunardini DJ, Eskander MS, Even JL, Dunlap JT, Chen AF, Lee JY, et al. Vertebral artery injuries in cervical spine surgery. Spine J 2014;14:1520–1525.
  • Molinari R, Bessette M, Raich AL, Dettori JR, Molinari C. Vertebral artery anomaly and injury in spinal surgery. Evid Based Spine Care J 2014;5:16–27.
  • Neo M, Fujibayashi S, Miyata M, Takemoto M, Nakamura T. Vertebral artery injury during cervical spine surgery: a survey of more than 5600 operations. Spine J 2008;33:779–785.
  • Peng CW, Chou BT, Bendo JA, Spivak JM. Vertebral artery injury in cervical spine surgery: anatomical considerations, management, and preventive measures. Spine J 2009;9:70–76.
  • Schroeder GD, Hsu WK. Vertebral artery injuries in cervical spine surgery. Surg Neurol Int 2013;4:S362–S367.
  • Pait TG, Killefer JA, Arnautovic KI. Surgical anatomy of the anterior cervical spine: the disc space, vertebral artery, and associated bony structures. Neurosurgery 1996;39:769–776.
  • Choi JQ, Lee JK, Moon KS, Yim 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 2006;31:E891–864.
  • Views: 2163
    HTML downloads: 760
    PDF downloads: 331
    Figures downloads: 0
    Untitled downloads: 0
    Untitled downloads: 0
    Untitled downloads: 0
    Untitled downloads: 0
    Untitled downloads: 0


    Published: 2015-10-01
    Issue: Vol. 2 No. 6 (2015) (view)


    How to cite:
    1.
    Borkert J, Hirte A, Reimers J, Jochmann N, Nikol S. Embolisation of Vertebral Artery Damaged Following Cervical Disc Removal. EJCRIM 2015;2 doi:10.12890/2015_000244.