Obermüller Thomas, Wostrack Maria, Shiban Ehab, Pape Haiko, Harmening Kathrin, Friedrich Benjamin, Prothmann Sascha, Meyer Bernhard, Ringel Florian
Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
Acta Neurochir (Wien). 2015 Nov;157(11):1941-5. doi: 10.1007/s00701-015-2594-2. Epub 2015 Sep 29.
Vertebral artery injury (VAI) during foraminal decompression in cervical spine surgery in the absence of repositioning or screw stabilization is rare. Without immediate recognition and treatment, it may have disastrous consequences. We aimed to describe the incidence and management of iatrogenic VAI in low-risk cervical spine surgery.
The records of all patients who underwent surgical procedures of the cervical spine between January 2007 and May 2012 were retrospectively consecutively evaluated. Anterior cervical discectomy and fusion or arthroplasty as well as dorsal foraminal decompression through the Frykholm approach in degenerative diseases were defined as low-risk surgeries (n = 992).
VAI occurred in 0.3 % (n = 3) of 992 procedures: in one case during a dorsal foraminal decompression, and in two cases during the anterior cervical discectomy and fusion (ACDF) of two or four levels, respectively. In the first case, the VAI was intraoperatively misdiagnosed. Despite an initially uneventful course, the patient suffered hemorrhage from a pseudoaneurysm of the injured VA 1 month after surgery. The aneurysm was successfully occluded by endovascular coiling. In both ACDF cases, angiography and endovascular stenting of the lacerated segment proceeded immediately after the surgery. All three patients suffered no permanent deterioration.
In a high-volume surgical center, the incidence of VAI during low-risk cervical spine surgery is extremely low, comprising 0.3 % of all cases. The major risks are delayed sequels of the vessel wall laceration. In cases of VAI, immediate angiographic diagnostics and generous indications for endovascular treatment are obligatory.
在颈椎手术的椎间孔减压过程中，在没有重新定位或螺钉固定的情况下发生椎动脉损伤（VAI）的情况很少见。如果不能立即识别和治疗，可能会产生灾难性后果。我们旨在描述低风险颈椎手术中医源性VAI的发生率及处理方法。
回顾性连续评估2007年1月至2012年5月期间所有接受颈椎手术患者的记录。将退行性疾病的前路颈椎间盘切除融合术或人工关节置换术以及通过Frykholm入路进行的后路椎间孔减压术定义为低风险手术（n = 992）。
992例手术中有0.3%（n = 3）发生VAI：1例发生在后路椎间孔减压过程中，2例分别发生在两节段或四节段的前路颈椎间盘切除融合术（ACDF）过程中。第一例中，VAI在术中被误诊。尽管最初病程平稳，但患者在术后1个月因受伤椎动脉假性动脉瘤出血。动脉瘤通过血管内栓塞成功闭塞。在两例ACDF病例中，术后立即对撕裂段进行血管造影和血管内支架置入。所有三名患者均未出现永久性神经功能恶化。
在一个大型手术中心，低风险颈椎手术中VAI的发生率极低，占所有病例的0.3%。主要风险是血管壁撕裂的延迟后遗症。对于VAI病例，必须立即进行血管造影诊断并积极进行血管内治疗。
