Hsu Wellington K, Kannan Abhishek, Mai Harry T, Fehlings Michael G, Smith Zachary A, Traynelis Vincent C, Gokaslan Ziya L, Hilibrand Alan S, Nassr Ahmad, Arnold Paul M, Mroz Thomas E, Bydon Mohamad, Massicotte Eric M, Ray Wilson Z, Steinmetz Michael P, Smith Gabriel A, Pace Jonathan, Corriveau Mark, Lee Sungho, Isaacs Robert E, Wang Jeffrey C, Lord Elizabeth L, Buser Zorica, Riew K Daniel
Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
Northwestern Memorial Hospital, Chicago, IL, USA.
Global Spine J. 2017 Apr;7(1 Suppl):21S-27S. doi: 10.1177/2192568216686753. Epub 2017 Apr 1.
A multicenter retrospective case series was compiled involving 21 medical institutions. Inclusion criteria included patients who underwent cervical spine surgery between 2005 and 2011 and who sustained a vertebral artery injury (VAI).
To report the frequency, risk factors, outcomes, and management goals of VAI in patients who have undergone cervical spine surgery.
Patients were evaluated on the basis of condition-specific functional status using the Neck Disability Index (NDI), modified Japanese Orthopaedic Association (mJOA) score, the Nurick scale, and the 36-Item Short-Form Health Survey (SF-36).
VAIs were identified in a total of 14 of 16 582 patients screened (8.4 per 10 000). The mean age of patients with VAI was 59 years (±10) with a female predominance (78.6%). Patient diagnoses included myelopathy, radiculopathy, cervical instability, and metastatic disease. VAI was associated with substantial blood loss (770 mL), although only 3 cases required transfusion. Of the 14 cases, 7 occurred with an anterior-only approach, 3 cases with posterior-only approach, and 4 during circumferential approach. Fifty percent of cases of VAI with available preoperative imaging revealed anomalous vessel anatomy during postoperative review. Average length of hospital stay was 10 days (±8). Notably, 13 of the 14 (92.86%) cases resolved without residual deficits. Compared to preoperative baseline NDI, Nurick, mJOA, and SF-36 scores for these patients, there were no observed changes after surgery ( = .20-.94).
Vertebral artery injuries are potentially catastrophic complications that can be sustained from anterior or posterior cervical spine approaches. The data from this study suggest that with proper steps to ensure hemostasis, patients recover function at a high rate and do not exhibit residual deficits.
汇编了一项多中心回顾性病例系列研究，涉及21家医疗机构。纳入标准包括2005年至2011年间接受颈椎手术且发生椎动脉损伤（VAI）的患者。
报告颈椎手术后患者VAI的发生率、危险因素、结局及处理目标。
使用颈部功能障碍指数（NDI）、改良日本骨科协会（mJOA）评分、Nurick量表和36项简明健康调查（SF-36），根据特定病情的功能状态对患者进行评估。
在16582例筛查患者中，共发现14例VAI（每10000例中有8.4例）。VAI患者的平均年龄为59岁（±10岁），女性占优势（78.6%）。患者诊断包括脊髓病、神经根病、颈椎不稳和转移性疾病。VAI与大量失血（770毫升）相关，尽管只有3例需要输血。14例中，7例发生于单纯前路手术，3例发生于单纯后路手术，4例发生于环形手术。术前有影像学资料的VAI病例中，50%在术后复查时显示血管解剖异常。平均住院时间为10天（±8天）。值得注意的是，14例中的13例（92.86%）病情缓解，无残留缺陷。与这些患者术前的基线NDI、Nurick、mJOA和SF-36评分相比，术后未观察到变化（P = .20-.94）。
椎动脉损伤是颈椎前路或后路手术可能发生的灾难性并发症。本研究数据表明，通过采取适当措施确保止血，患者功能恢复率高，且无残留缺陷。
