Kahn Max, MacMahon Paul, Russell Thomas, Klopfenstein Jeffrey D, Fassett Daniel R
Department of Neurosurgery, University of Illinois College of Medicine at Peoria, Peoria, Illinois; and.
Department of Neurosurgery, OSF Illinois Neurological Institute, OSF St. Francis Medical Center, Peoria, Illinois.
J Neurosurg Case Lessons. 2021 Nov 1;2(18):CASE21268. doi: 10.3171/CASE21268.
Sectioning the C2 nerve root is increasingly utilized during posterior C1-2 fusion, as the nerve overlies the entry point for C1 lateral mass screws and the C1-2 joint. Nerve sectioning improves visualization for screw placement and enables joint decortication for arthrodesis. While rare, vascular injury is a devastating complication of atlantoaxial fusion. Anomalous vascular anatomy at C1-2 greatly increases risk of iatrogenic injury.
A 78-year-old female with rheumatoid arthritis and prior C2-7 fusion presented with myelopathy from a compressive pannus at C1-2. She underwent C1 laminectomy and C1-2 posterior instrumented fusion. Intraoperatively, arterial bleeding occurred as the right C2 nerve root was sectioned. Vertebral artery injury was suspected, and tamponade was performed while vascular control was established. The artery passed aberrantly beneath the nerve root in the C1-2 foramen. It was repaired microsurgically, and patency was confirmed using indocyanine green. The remainder of the fusion was aborted. The patient wore a cervical collar and was treated with aspirin for 6 weeks before undergoing instrumented fusion. The patient suffered no deficits.
Although rare, anomalous vertebral artery anatomy increases risk of injury at time of C2 nerve root sectioning. Preoperative assessment of the vasculature is vital.
在C1-2后路融合术中，切断C2神经根的操作越来越多地被采用，因为该神经覆盖C1侧块螺钉的进针点和C1-2关节。切断神经可改善螺钉置入的视野，并能对关节进行去皮质处理以实现融合。血管损伤虽然罕见，但却是寰枢椎融合术的一种严重并发症。C1-2处的异常血管解剖结构大大增加了医源性损伤的风险。
一名78岁患有类风湿性关节炎且既往有C2-7融合术史的女性，因C1-2处压迫性血管翳导致脊髓病前来就诊。她接受了C1椎板切除术和C1-2后路器械辅助融合术。术中，在切断右侧C2神经根时出现动脉出血。怀疑有椎动脉损伤，在建立血管控制的同时进行了压迫止血。动脉在C1-2椎间孔内异常地从神经根下方穿过。通过显微手术进行了修复，并使用吲哚菁绿确认了通畅性。其余的融合手术中止。患者佩戴颈托，并在接受器械辅助融合术前服用阿司匹林6周。患者未出现神经功能缺损。
虽然罕见，但椎动脉解剖结构异常会增加切断C2神经根时受伤的风险。术前对血管系统进行评估至关重要。
