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Extracranial Vertebral Artery Injuries.

Michael J Lee¹, Douglas J Weaver, Mostafa H El Dafrawy

¹From the Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, Chicago, IL.

The Journal of the American Academy of Orthopaedic Surgeons

|May 29, 2024

Summary

Vertebral artery injuries (VAI) from cervical spine trauma can cause stroke. Surgeons must know VA anatomy and use imaging to prevent iatrogenic injury, enabling timely treatment to avoid neurological damage.

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Published on: August 30, 2020

Area of Science:

Neurosurgery
Vascular Anatomy
Trauma Surgery

Background:

The paired vertebral arteries (VAs) supply posterior cerebral circulation and are vulnerable to injury during cervical spine trauma.
Vertebral artery injury (VAI) is a significant risk factor for posterior circulation stroke, a feared complication.
Spine surgeons require detailed knowledge of VA anatomy to prevent iatrogenic injury during cervical spine procedures.

Purpose of the Study:

To emphasize the importance of understanding vertebral artery anatomy in the context of cervical spine surgery.
To highlight the risks of iatrogenic vertebral artery injury and its potential consequences, such as stroke.
To underscore the necessity of preoperative imaging and appropriate management strategies for VAI.

Main Methods:

Review of anatomical considerations for vertebral arteries in the cervical spine.
Discussion of risks associated with anterior and posterior cervical spine surgeries.
Emphasis on preoperative assessment using advanced imaging to identify anatomical variations.
Outline of treatment options for iatrogenic VAI.

Main Results:

Cervical spine injuries pose a risk to vertebral arteries, potentially leading to stroke.
Both anterior and posterior cervical spine surgeries can inadvertently injure the VA.
Anatomical variations of the VA necessitate careful preoperative evaluation to prevent iatrogenic injury.
Iatrogenic VAI can be managed with tamponade, ligation, repair, or endovascular interventions.

Conclusions:

A thorough understanding of vertebral artery anatomy is crucial for spine surgeons to prevent iatrogenic injuries.
Preoperative imaging is essential for identifying hazardous VA variations and mitigating surgical risks.
Prompt recognition and management of VAI are vital for preventing severe neurological deficits, including stroke.