Diao Yinze, Sun Yu, Wang Shaobo, Zhang Fengshan, Pan Shengfa, Liu Zhongjun
Department of Orthopaedics, Peking University Third Hospital, Beijing, China. Beijing Key Laboratory of Spinal Disease, Beijing, China.
Medicine (Baltimore). 2018 Feb;97(8):e9883. doi: 10.1097/MD.0000000000009883.
The typical intraoperative presentation of vertebral artery injury (VAI) usually involves profuse bleeding and requires immediate treatment. However, an occult VAI may occur intraoperatively and result in delayed life-threatening epidural pseudoaneurysm several days postoperatively.
A 21-year-old man with compressive cervical myelopathy resulting from canal stenosis of skeletal fluorosis underwent decompression of C1 to C7 and instrumentation from C2 to C7. No impressive bleeding event occurred during the operation. On postoperative day 40, progressive quadriplegia developed.
Pseudoaneurysm of the VA was established by angiography.
After occlusion of the right VA, the patient underwent hematoma clearing.
Fortunately, the patient experienced significant recovery of neurologic function after the second surgery.
From this case, we realize even in the absence of obvious signs of VAI during a cervical operation, postoperative evaluation should be mandatory for suspected bleeding events occurring at VAI-prone sites during surgery. Moreover, the bone morphological abnormality of skeletal fluorosis was determined to be the most important risk contributing to VAI in this case. The safety limits of bone removal should be determined preoperatively to avoid the effects of bone morphological abnormalities.
椎动脉损伤（VAI）的典型术中表现通常包括大量出血，需要立即治疗。然而，隐匿性VAI可能在术中发生，并在术后数天导致危及生命的硬膜外假性动脉瘤。
一名21岁男性因氟骨症椎管狭窄导致压迫性颈髓病，接受了C1至C7减压及C2至C7内固定术。术中未发生明显出血事件。术后第40天，患者出现进行性四肢瘫痪。
通过血管造影确诊为椎动脉假性动脉瘤。
在闭塞右侧椎动脉后，患者接受了血肿清除术。
幸运的是，患者在第二次手术后神经功能有显著恢复。
从该病例中我们认识到，即使在颈椎手术中没有明显的VAI迹象，对于手术中VAI易发生部位出现的可疑出血事件，术后评估也是必要的。此外，在该病例中，氟骨症的骨形态异常被确定为导致VAI的最重要风险因素。术前应确定骨切除的安全限度，以避免骨形态异常的影响。
