Inamasu J, Guiot B H
Department of Neurosurgery, University of South Florida College of Medicine, Tampa, 33606, USA.
Acta Neurochir (Wien). 2006 Apr;148(4):375-87. doi: 10.1007/s00701-005-0669-1.
Vascular injury is an uncommon, but not rare complication of spine surgery. The consequence of vascular injury may be quite devastating, but its incidence can be reduced by understanding the mechanisms of injury. Properly managing vascular injury can reduce mortality and morbidity of patients. A review of the literature was conducted to provide an update on the etiology and management of vascular injury and complication in neurosurgical spine surgery. The vascular injuries were categorized according to each surgical procedure responsible for the injury, i.e., anterior screw fixation of the odontoid fracture, anterior cervical spine surgery, posterior C1-2 arthrodesis, posterior cervical spine surgery, anterolateral approach for thoracolumbar spine fracture, posterior thoracic spine surgery, scoliosis surgery, anterior lumbar interbody fusion (ALIF), lumbar disc arthroplasty, lumbar discectomy, and posterior lumbar spine surgery. The incidence, mechanisms of injury, and reparative measures were discussed for each surgical procedure. Detailed coverage was especially given to vascular injury associated with ALIF, which may have been underestimated. The accumulation of anatomical knowledge and advanced imaging studies has made complex spine surgery safer and more reliable. It is not clear, however, whether the incidence of vascular injury has been reduced significantly in all procedures of spine surgery. Emerging new techniques, such as microendoscopic discectomy and lumbar disc arthroplasty, seem to be promising, but we need to keep in mind their safety issues, including vascular injury and complication.
血管损伤是脊柱手术中一种不常见但并非罕见的并发症。血管损伤的后果可能相当严重，但其发生率可通过了解损伤机制而降低。妥善处理血管损伤可降低患者的死亡率和发病率。本文对相关文献进行综述，以更新神经外科脊柱手术中血管损伤及并发症的病因和处理方法。血管损伤根据导致损伤的每种手术操作进行分类，即齿状突骨折前路螺钉固定术、颈椎前路手术、C1 - 2后路关节融合术、颈椎后路手术、胸腰椎骨折前路外侧入路手术、胸椎后路手术、脊柱侧弯手术、腰椎前路椎间融合术（ALIF）、腰椎间盘置换术、腰椎间盘切除术以及腰椎后路手术。针对每种手术操作讨论了其发生率、损伤机制及修复措施。特别详细阐述了与ALIF相关的血管损伤，其可能一直被低估。解剖学知识的积累和先进影像学研究已使复杂的脊柱手术更安全、更可靠。然而，目前尚不清楚在所有脊柱手术操作中血管损伤的发生率是否已显著降低。新兴的新技术，如显微内镜下椎间盘切除术和腰椎间盘置换术，似乎很有前景，但我们需要牢记其安全问题，包括血管损伤及并发症。
