Kim Donghee, Jang Younkyu, Whang Kum, Kim Jongyeon, Cho Sungmin
Department of Neurosurgery, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Korea.
Korean J Neurotrauma. 2021 Oct 11;17(2):199-203. doi: 10.13004/kjnt.2021.17.e30. eCollection 2021 Oct.
The subaxial screw fixation technique is commonly used for fixation in a wide range of cervical diseases, including traumatic, degenerative, and neoplastic diseases, rheumatoid arthritis (RA), and spondyloarthropathy. Although it is regarded as a relatively safe procedure, several complications may be encountered during surgery, such as vertebral artery (VA) and nerve root injuries, facet violation, and mass fracture. We report a case of endovascular embolization after VA injury during a high cervical spinal surgery. A 48-year-old woman was scheduled for C-1-2-3 posterior fixation. Plain radiography of the cervical spine revealed a severely unstable state. During dissection around the C1 lateral mass on the right side, sudden brisk arterial bleeding was observed. On vertebral angiography, flow voiding was noted above the right V3 portion. After checking patent collateral flow from the contralateral VA, routine coil embolization was performed to pack the V3 segment. Iatrogenic vascular injuries due to spinal surgery are rare but serious complications. For patients with RA, we recommend careful preoperative evaluation before a high cervical surgical procedure to avoid iatrogenic VA injury and endovascular interventions that are safe and effective in the diagnosis and treatment of such vascular injuries.
下颈椎螺钉固定技术常用于多种颈椎疾病的固定，包括创伤性、退行性和肿瘤性疾病、类风湿关节炎（RA）以及脊柱关节病。尽管该技术被认为是一种相对安全的手术，但手术过程中仍可能出现一些并发症，如椎动脉（VA）和神经根损伤、关节突侵犯以及大块骨折。我们报告一例高位颈椎手术中VA损伤后行血管内栓塞的病例。一名48岁女性计划行C1-2-3后路固定术。颈椎X线平片显示严重不稳定状态。在右侧C1侧块周围解剖时，观察到突然大量动脉出血。椎动脉造影显示右侧V3段上方有血流缺失。在检查对侧VA的侧支循环通畅后，进行常规弹簧圈栓塞以填塞V3段。脊柱手术引起的医源性血管损伤虽罕见但属于严重并发症。对于RA患者，我们建议在高位颈椎手术前进行仔细的术前评估，以避免医源性VA损伤以及采用安全有效的血管内干预措施来诊断和治疗此类血管损伤。
