Atraumatic vertebral artery dissection after cervical corpectomy: a traction injury?

Area of Science:

• Neurosurgery
• Vascular Surgery
• Spinal Surgery

Background:

• Vertebral artery dissection (VAD) is typically linked to trauma or spontaneous events.
• Cervical spine surgery carries a recognized risk of direct vertebral artery injury.
• Intraoperative cervical traction is a common technique for surgical access and graft placement.

Observation:

• A patient developed vertebral artery dissection secondary to intraoperative traction during cervical spine surgery.
• Postoperative neurological decline was noted, with CT revealing posterior circulation infarcts.
• Angiography confirmed vertebral artery dissection, necessitating aggressive management.

Findings:

• This is the first reported case of VAD caused by intraoperative traction in cervical spine surgery.
• Despite initial medical management, the patient experienced progressive infarcts.
• Surgical intervention, including posterior fossa decompression and vertebral artery sacrifice, was ultimately required.

Implications:

• Surgeons must recognize that cervical traction, even when carefully applied, poses a risk of vertebral artery injury.
• Anatomical variations like anomalous vertebral arteries or osteophytes can increase susceptibility to traction-related dissection.
• Enhanced vigilance and potential modifications in traction techniques may be warranted to mitigate this risk.