Vertebral artery injury during cervical spine surgery - A survey of more than 5600 operations
Vertebral artery injury during cervical spine surgery - A survey of more than 5600 operations
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DOI：
10.1097/brs.0b013e31816957a7
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发表时间：
2008-04-01
期刊：
影响因子：
3
通讯作者：
Nakamura, Takashi
中科院分区：
文献类型：
--
作者：
Neo, Masashi;Fujibayashi, Shunsuke;Nakamura, Takashi
研究设计.回顾性调查。Objective.目的：探讨颈椎手术中医源性椎动脉损伤的发生率及处理方法。背景数据总结。VAI是颈椎手术的罕见并发症，但可能是灾难性的。颈椎前路减压（ACD）和后路寰枢椎经关节螺钉固定（Magerl固定）是主要原因，报告的发生率分别为0.3%-0.5%和0%-8.2%。流行的新手术技术，如颈椎椎弓根螺钉或C1侧块螺钉固定，也有潜在的风险VAI。方法.向我们的附属医院发送了一份调查问卷，要求提供颈椎手术中医源性VAI的相关信息。结果7个脊柱外科医生组和25个普通骨科医生组回答了问卷，回答率为89%。VAI的总发生率为0.14%（5641例颈椎手术中8例）。颈椎前路减压术的发生率为0.18%，Magerl内固定术的发生率为1.3%。经验不足的外科医生倾向于更频繁地进行VAI。纳入了1例C1侧块螺钉固定期间的VAI，而没有一例颈椎椎弓根螺钉固定引起的VAI。在“螺孔内VAI”的情况下，通过填塞或螺钉插入实现止血，而“开放空间内VAI”有时会导致无法控制的出血，其中栓塞最终止血。无死亡或明显神经系统后遗症。结论本研究中颈椎手术中VAI的发生率与文献中相似或略低。填塞在许多情况下是有效的，但如果出血无法控制，建议立即咨询血管内团队。术前仔细评估椎动脉似乎是最重要的，以防止医源性VAI和避免术后神经后遗症。
Study Design. Retrospective survey. Objective. To clarify the present incidence and management of iatrogenic vertebral artery injury (VAI) during cervical spine surgery. Summary of Background Data. VAI is a rare complication of cervical spine surgery, but it may be catastrophic. Anterior cervical decompression (ACD) and posterior atlantoaxial transarticular screw fixation (Magerl fixation) have been the main causes, with reported incidences of 0.3% to 0.5% and 0% to 8.2%, respectively. Popular new surgical techniques, such as cervical pedicle screw or C1 lateral mass screw fixation, also entail the potential risk of VAI. Methods. A questionnaire was sent to our affiliated hospitals requesting information regarding iatrogenic VAI during cervical spine surgery. Results. Seven spine surgeon groups and 25 general orthopedist groups responded to the questionnaire, with a response rate of 89%. The overall incidence of VAI was 0.14% (8 cases among 5641 cervical spine surgeries). The incidence in anterior cervical decompression procedures was 0.18% and that in Magerl fixation was 1.3%. Inexperienced surgeons tended to commit VAI more frequently. One case of VAI during C1 lateral mass screw fixation was included, whereas there was no case of VAI caused by cervical pedicle screw fixation. In the case of "VAI in the screw hole," hemostasis was obtained by tamponade or screw insertion, whereas " VAI in the open space" sometimes caused uncontrollable bleeding, in which embolization eventually stopped the bleeding. There were no deaths or apparent neurologic sequelae. Conclusion. The incidence of VAI during cervical spine surgery from this survey was similar to or slightly less than that in the literature. Tamponade was effective in many cases, but prompt consultation with an endovascular team is recommended if the bleeding is uncontrollable. Preoperative careful evaluation of the vertebral artery seems to be most important to prevent iatrogenic VAI and to avoid postoperative neurologic sequelae.