Vertebral artery injury following cervical disc arthroplasty - A systematic review

Cervical Disc Arthroplasty (CDA) treats cervical disc degeneration while preserving spinal mobility. Although effective, the procedure poses a risk to the Vertebral Artery (VA), which transverses the foramina of C2-C6 and enters the skull via the foramen magnum. While the vertebral artery injury (VAI) is rare, it can lead to serious complications. This review analyses VAI during CDA by examining anatomical variations, surgeon experience, and strategies for prevention, diagnosis, and management.

The articles chosen were from 06/30/2000 to 04/30/2025 and sourced from PubMed, Science Direct, and Web of Science. The keywords were cervical, cervical disc, vertebral artery, vertebral artery injury, disc arthroplasty, and degenerative disc.

Anatomic VA variations occurred in 7.6 % of 250 individuals. The anterior approach in CDA shows a 0.4 % VAI rate. Preoperative MRI and postoperative imaging should be widely used to assess VA course. Surgeon experience of <300 cases had a 0.33 % VAI prevalence versus 0.06 % in those with >300. Although CDA has been used in Europe since 1960 s, it was FDA approved in 2007. Of 11 approved devices, eight reported blood loss, two vascular injuries and one cerebrovascular bleed, yet no VAI is listed a complication. Only two published case reports document VAI during CDA. Stenting has a proved 97 % success rate but may require reintervention. The rise in CDA use of 190 % from 2007 to 2013 suggest a likely increase in reported VAI cases.

VAI must be considered when approaching a CDA due the higher prevalence of these procedures being implemented. Anatomic variations, Physician Experience, and preventative and treatment management are factors to consider in VAI.