Poor surgical technique in cervical plating leading to vertebral artery injury and brain stem infarction--case report

Lateral mass plating is a safe fixating system for lower cervical fractures. Brain stem infarction after cervical lateral mass screw plating has not been reported in previous literature. We report a case of poor surgical technique leading to vertebral artery injury and brain stem infarction after cervical lateral mass plating.

A 41-year-old male patient was transferred to our hospital because of hemiparesis and dysarthria immediately after lateral mass plating for fracture and dislocation of the fifth and sixth cervical vertebrae. Brain magnetic resonance imaging showed infarction of the left posterior inferior cerebellar artery territory, and the vertebral artery angiography showed complete occlusion of the left vertebral artery. The cervical computed tomography revealed a left screw of the fifth and sixth cervical vertebrae penetrating the central portion of the transverse foramen. The patient was managed with anticoagulant and supportive therapy only, with subsequent improvement of hemiparesis and dysarthria.

Poor surgical technique of lateral mass plating in the cervical spine could lead to vertebral artery injury and even brain stem infarction. Postoperative brain infarction in cervical fusion could be a complication of the usually safe lateral mass plating of the cervical spine.