Mitsuru Asukai1,2, Hiroki Ushirozako3,4, Kota Suda3, Satoko Matsumoto Harmon3, Miki Komatsu3, Akio Minami3, Masahiko Takahata5, Norimasa Iwasaki5, Yukihiro Matsuyama4. 1. Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, 3-1 Higashi-4 Minami-1, Bibai, Hokkaido, 072-0015, Japan. mitsuruasukai@gmail.com. 2. Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan. mitsuruasukai@gmail.com. 3. Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, 3-1 Higashi-4 Minami-1, Bibai, Hokkaido, 072-0015, Japan. 4. Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan. 5. Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan.
Abstract
PURPOSE: Vertebral artery occlusion (VAO) is an increasingly recognized complication of cervical spine trauma. However, the management strategy of VAO remains heavily debated. Therefore, the aim of this retrospective study was to investigate the safety of early fusion surgery for traumatic VAO. METHODS: This study included a total of 241 patients (average age 64.7 years; 201 men) who underwent early surgical treatment for acute cervical spine injury between 2012 and 2019. The incidence of VAO, cerebral infarction rates, the recanalization rates, and cerebral thromboembolism after recanalization were retrospectively analyzed. RESULTS: VAO occurred in 22 patients (9.1%). Of the 22 patients with VAO, radiographic cerebral infarction was detected in 4 patients (21.1%) at initial evaluation, including 1 symptomatic medullar infarction (4.5%) and 3 asymptomatic cerebrum infarctions. A patient who experienced right medullar infarction showed no progression of the neurologic damage. Follow-up imaging revealed that the VAOs of 9 patients (40.9%) were recanalized, and the recanalization did not correlate with clinical adverse outcomes. The arteries of the remaining 13 (59.1%) patients remained occluded and clinically silent until the final follow-up (mean final follow-up 33.0 months). CONCLUSION: Despite the lack of a concurrent control group with preoperative antiplatelet therapy or endovascular embolization for VAO, our results showed low symptomatic stroke rate (4.5%), high recanalization rate (40.9%), and low mortality rate (0%). Therefore, we believe that the indication for early stabilization surgery as management strategy of asymptomatic VAO might be one of the safe and effective treatment options for prevention of symptomatic cerebral infarction.
PURPOSE: Vertebral artery occlusion (VAO) is an increasingly recognized complication of cervical spine trauma. However, the management strategy of VAO remains heavily debated. Therefore, the aim of this retrospective study was to investigate the safety of early fusion surgery for traumatic VAO. METHODS: This study included a total of 241 patients (average age 64.7 years; 201 men) who underwent early surgical treatment for acute cervical spine injury between 2012 and 2019. The incidence of VAO, cerebral infarction rates, the recanalization rates, and cerebral thromboembolism after recanalization were retrospectively analyzed. RESULTS: VAO occurred in 22 patients (9.1%). Of the 22 patients with VAO, radiographic cerebral infarction was detected in 4 patients (21.1%) at initial evaluation, including 1 symptomatic medullar infarction (4.5%) and 3 asymptomatic cerebrum infarctions. A patient who experienced right medullar infarction showed no progression of the neurologic damage. Follow-up imaging revealed that the VAOs of 9 patients (40.9%) were recanalized, and the recanalization did not correlate with clinical adverse outcomes. The arteries of the remaining 13 (59.1%) patients remained occluded and clinically silent until the final follow-up (mean final follow-up 33.0 months). CONCLUSION: Despite the lack of a concurrent control group with preoperative antiplatelet therapy or endovascular embolization for VAO, our results showed low symptomatic stroke rate (4.5%), high recanalization rate (40.9%), and low mortality rate (0%). Therefore, we believe that the indication for early stabilization surgery as management strategy of asymptomatic VAO might be one of the safe and effective treatment options for prevention of symptomatic cerebral infarction.
Authors: Alexander R Vaccaro; John D Koerner; Kris E Radcliff; F Cumhur Oner; Maximilian Reinhold; Klaus J Schnake; Frank Kandziora; Michael G Fehlings; Marcel F Dvorak; Bizhan Aarabi; Shanmuganathan Rajasekaran; Gregory D Schroeder; Christopher K Kepler; Luiz R Vialle Journal: Eur Spine J Date: 2015-02-26 Impact factor: 3.134
Authors: William W Scott; Steven Sharp; Stephen A Figueroa; Alexander L Eastman; Charles V Hatchette; Christopher J Madden; Kim L Rickert Journal: J Neurosurg Date: 2014-10-24 Impact factor: 5.115
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Authors: W L Biffl; E E Moore; J P Elliott; C Ray; P J Offner; R J Franciose; K E Brega; J M Burch Journal: Ann Surg Date: 2000-05 Impact factor: 12.969