Hall Michael, Cheng David, Cheng Wayne, Danisa Olumide
UCR School of Medicine, Riverside, CA 92507, USA.
Loma Linda Medical Center, Loma Linda, CA 92354, USA.
Brain Sci. 2019 Nov 28;9(12):345. doi: 10.3390/brainsci9120345.
Vertebral Artery Injury (VAI) while performing cervical spinal reconstruction surgery is rare, but it can lead to catastrophic events. Treatment for this injury with regard to antiplatelet versus anticoagulation therapy is controversial. The purpose of this report is to discuss two cases of VAI that occurred during the performance of cervical reconstruction surgery and provide a guideline based on a literature review about whether to use anticoagulant or antiplatelet therapy for treatment of asymptomatic VAI. In case 1, iatrogenic injury occurred to the left C5 vertebral artery (VA) during high speed burr removal of an osteophyte on the left C5/6 uncovertebral joint, resulting in VAI. This patient was treated with Heparin resulting in respiratory complication. Case 2 encountered VAI while using the kerrison rongeur to perform a right sided C5/6 foraminotomy. Antiplatelet therapy was administered. Fourteen publications relevant to Antiplatelet versus Anticoagulation treatment were reviewed. Anticoagulation has similar results to antiplatelet therapy. Studies are limited; there were no common guidelines or parameters concerning the utilization of Antiplatelets versus Anticoagulants. Anticoagulation achieved similar results as Antiplatelet therapy; based on the limited relevant data, the superiority of one treatment over the other cannot be concluded in VAI after cervical spinal reconstruction surgery.
在进行颈椎重建手术时发生椎动脉损伤（VAI）的情况较为罕见，但可能导致灾难性事件。关于抗血小板治疗与抗凝治疗对这种损伤的处理存在争议。本报告的目的是讨论两例在颈椎重建手术过程中发生的VAI病例，并基于文献综述提供关于对于无症状VAI是使用抗凝治疗还是抗血小板治疗的指导原则。在病例1中，在高速磨钻去除左侧C5/6钩椎关节骨赘的过程中，左侧C5椎动脉（VA）发生医源性损伤，导致VAI。该患者接受肝素治疗后出现呼吸并发症。病例2在使用咬骨钳进行右侧C5/6椎间孔切开术时发生VAI，给予抗血小板治疗。回顾了14篇与抗血小板治疗和抗凝治疗相关的文献。抗凝治疗与抗血小板治疗效果相似。研究有限；关于抗血小板药物与抗凝药物的使用没有通用的指导原则或参数。抗凝治疗与抗血小板治疗取得了相似的结果；基于有限的相关数据，在颈椎重建手术后的VAI中无法得出一种治疗优于另一种治疗的结论。
