Control of the vertebral artery from a posterior approach: a technical report
Control of the vertebral artery from a posterior approach: a technical report
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DOI：
10.1016/j.spinee.2013.11.059
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发表时间：
2014-06-01
期刊：
影响因子：
4.5
通讯作者：
Kang, James D.
中科院分区：
文献类型：
--
作者：
Ye, Jason Y.;Ayyash, Omar M.;Kang, James D.
背景：椎动脉（VA）损伤是颈椎融合术的一种罕见但具有潜在破坏性的并发症。Magerl和Harms技术分别与0%至8%和0%至5%之间的比率相关。大多数报道的VA损伤与手术暴露或螺钉放置有关，这反过来又可能是由于VA解剖结构的变异性。目的：本报告的目的是介绍一例77岁女性患者，有右侧VA闭塞病史，在颈椎后路融合术中持续左侧VA损伤，以及随后的术中和术后管理策略。这是一个单一的病人病例报告。方法：病人被放置在俯卧位和梅菲尔德钳。做一个中线切口，并从枕骨到T2向下解剖至椎板和小关节。在剥离过程中，她持续左侧VA损伤，随后controlled.RESULTS：病人做得很好，在她1年的术后访视没有任何残留的神经功能缺损。她严重的颈部疼痛已经解决。结论：每个病人的VA解剖的详细了解是至关重要的。有四种类型的异常：椎间孔内异常;椎间孔外异常;动脉异常;以及周围骨和软组织结构异常。在术中发生后路VA损伤的情况下，我们概述了处理该并发症的算法：暂时控制出血以获得动脉损伤的可视化;切除侧块和组织以充分可视化动脉损伤;一旦可视化，控制出血并观察VA闭塞是否导致任何神经监测变化;并通过修复或结扎对动脉进行最终控制。(C)2014爱思唯尔公司All rights reserved.
BACKGROUND CONTEXT: Vertebral artery (VA) injury is a rare but potentially devastating complication of cervical spinal fusion. The Magerl and Harms techniques are associated with a rate between 0% to 8% and 0% to 5%, respectively. Most of reported VA injuries are related to surgical exposure or screw placement, which in turn is likely due to variability in VA anatomy.PURPOSE: The purpose of this report was to present the case of a 77-year-old woman, with a history of right VA occlusion, who sustained an intraoperative left VA injury during posterior cervical spine fusion and the subsequent intraoperative and postoperative management strategies.STUDY DESIGN: This is a single-patient case report.METHODS: The patient was placed prone and into Mayfield tongs. A midline incision was made, and dissection was carried down to the lamina and facet joints from occiput to T2. During dissection, she sustained a left-sided VA injury, which was subsequently controlled.RESULTS: The patient was doing well at her 1-year postoperative visit without any residual neurologic deficits. Her severe neck pain had resolved.CONCLUSION: A detailed understanding of VA anatomy of each individual patient is paramount. There are four types of anomalies: intraforaminal; extraforaminal; arterial; and anomalies of the surrounding bony and soft-tissue architecture. In the event of a posterior intraoperative VA injury, we outlined an algorithm to deal with this complication: control bleeding temporarily to gain visualization of the arterial injury; remove lateral masses and tissue to adequately visualize the arterial injury; once visualized, control the bleeding and see if there are any neuromonitoring changes as a result of the VA occlusion; and proceed with definitive control of the artery by either repair or ligation. (C) 2014 Elsevier Inc. All rights reserved.