Chang-Hyun Lee1, Jae Taek Hong2, Dong Ho Kang3, Ki-Jeong Kim4, Sang-Woo Kim5, Seok Won Kim6, Young Jin Kim7, Chun Kee Chung8, Jun Jae Shin9, Jae Keun Oh10, Seong Yi11, Jung Kil Lee12, Jun Ho Lee13, Ho Jin Lee14, Hyoung-Joon Chun15, Dae-Chul Cho16, Yong Jun Jin17, Kyung-Chul Choi18, In Ho Han19, Seung-Jae Hyun4, Jung-Woo Hur20, Geun Sung Song21. 1. Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. 2. Department of Neurosurgery, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea; Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea, Seoul, Korea. 3. Department of Neurosurgery, Gyeongsang National University School of Medicine, Jinju, Korea. 4. Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea. 5. Department of Neurosurgery, Yeungnam University Medical Center, Daegu, Korea. 6. Department of Neurosurgery, Chosun University Hospital, Gwangju, Korea. 7. Department of Neurosurgery, Dankook University Hospital, Chonan, Korea. 8. Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea; Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Korea; Clinical Research Institute, Seoul National University Hospital, Seoul, Korea; Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Korea. 9. Department of Neurosurgery, Sanggye Paik Hospital, Inje University, Seoul, Korea. 10. Department of Neurosurgery, Hallym University Sacred Heart Hospital, Anyang, Korea. 11. Department of Neurosurgery, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea. 12. Department of Neurosurgery, Chonnam University Hospital, Chonnam University College of Medicine, Gwangju, Korea. 13. Department of Neurosurgery, Kyung Hee University Medical Centre, Kyung Hee University College of Medicine, Seoul, Korea. 14. Department of Neurosurgery, Incheon St. Maria Hospital, Incheon, Korea. 15. Department of Neurosurgery, Hanyang University Seoul Hospital, Seoul, Korea. 16. Department of Neurosurgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea. 17. Department of Neurosurgery, Inje University Seoul Paik Hospital, Seoul, Korea. 18. Department of Neurosurgery, The Leon Wiltse Memorial Hospital, Anyang, Korea. 19. Department of Neurosurgery, Pusan National University Hospital, Pusan, Korea. 20. Department of Neurosurgery, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea. 21. Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea. Electronic address: gnsong@pusan.ac.kr.
Abstract
BACKGROUND: The overall incidence of iatrogenic vertebral artery injury (IVAI) in cervical spine surgeries (CSSs) is reported to be 0.07%-1.4%. Although IVAI occurred during C1-2 fusion, there is no accurate information regarding the surgery-specific risk of IVAI. This study aimed to stratify incidence of IVAI by surgical method and evaluate the correlation between IVAI and its sequelae. METHODS: This retrospective, multicenter study involved clinical and radiologic evaluations for IVAI. All CSSs performed between 2012 and 2016 were included; neck mass excision and pain intervention were excluded. Patient characteristics, diagnosis, surgical technique, complications, and presence of IVAI were collected. In IVAI cases, technique details, characteristics, and sequelae were investigated. RESULTS: This study included 14,722 patients with 15,582 CSSs in 21 centers. IVAIs were identified in 13 (0.08%) patients. Surgery-specific incidence of IVAI was 1.35% in cases involving C1-2 posterior fixation and 0.20% in cases involving C3-6 posterior fixation. Common injury mechanisms were screw-in (31%) and high-speed drilling (23%). Screw-related IVAI occurred in 9 (69%) patients, and IVAI of the C1 lateral mass and C2 pedicle screws occurred in 4 and 3 patients, respectively. Of 13 cases of IVAI, 3 (23%) involved cerebellar or stem infarction; the infarction had no substantial correlation with injury grade or dominancy. CONCLUSIONS: Overall incidence of IVAI in CSSs was 0.08%. C1-2 posterior fixation had the highest incidence of IVAI (1.35%). Although clinical results of IVAI can be highly variable, controlling risk factors of IVAI is important.
BACKGROUND: The overall incidence of iatrogenic vertebral artery injury (IVAI) in cervical spine surgeries (CSSs) is reported to be 0.07%-1.4%. Although IVAI occurred during C1-2 fusion, there is no accurate information regarding the surgery-specific risk of IVAI. This study aimed to stratify incidence of IVAI by surgical method and evaluate the correlation between IVAI and its sequelae. METHODS: This retrospective, multicenter study involved clinical and radiologic evaluations for IVAI. All CSSs performed between 2012 and 2016 were included; neck mass excision and pain intervention were excluded. Patient characteristics, diagnosis, surgical technique, complications, and presence of IVAI were collected. In IVAI cases, technique details, characteristics, and sequelae were investigated. RESULTS: This study included 14,722 patients with 15,582 CSSs in 21 centers. IVAIs were identified in 13 (0.08%) patients. Surgery-specific incidence of IVAI was 1.35% in cases involving C1-2 posterior fixation and 0.20% in cases involving C3-6 posterior fixation. Common injury mechanisms were screw-in (31%) and high-speed drilling (23%). Screw-related IVAI occurred in 9 (69%) patients, and IVAI of the C1 lateral mass and C2 pedicle screws occurred in 4 and 3 patients, respectively. Of 13 cases of IVAI, 3 (23%) involved cerebellar or stem infarction; the infarction had no substantial correlation with injury grade or dominancy. CONCLUSIONS: Overall incidence of IVAI in CSSs was 0.08%. C1-2 posterior fixation had the highest incidence of IVAI (1.35%). Although clinical results of IVAI can be highly variable, controlling risk factors of IVAI is important.
Authors: Harsh Wadhwa; Karen Malacon; Zachary A Medress; Christopher Leung; Matthew Sklar; Corinna C Zygourakis Journal: J Neurosurg Case Lessons Date: 2021-05-03
Authors: Donghyun Won; Ja Myoung Lee; In Sung Park; Chul Hee Lee; Kwangho Lee; Ji-Yoon Kim; Young Seok Lee Journal: Korean J Neurotrauma Date: 2019-10-07