Anomalous Vertebral Artery Injured During Anterior Cervical Discectomy: A Case Report
Anomalous Vertebral Artery Injured During Anterior Cervical Discectomy: A Case Report
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颈椎前路椎间盘切除术中异常椎动脉损伤：一例报告
DOI：
10.1097/brs.0b013e3182a528e9
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发表时间：
2013
期刊：
影响因子：
3
通讯作者：
Kee D. Kim
中科院分区：
文献类型：
--
作者：
Philip Rosenthal;R. Latchaw;Kee D. Kim
研究设计。案件报告。目标。描述一种新发现的椎动脉畸形的椎间盘切除术后的治疗和损伤预防。背景数据摘要。各种类型的颈段椎动脉(VA)异常是最少见的类型，涉及侵蚀到钩突内侧的椎体。这些椎体的形态包括恢复到对颈椎前路髓核摘除手术免疫的椎间盘水平的侧位。这一病例报告首次报道了椎动脉内侧与椎间盘相邻，仅因椎间盘切除而损伤的情况。VA损伤是一种严重的并发症，在神经系统损伤和死亡中占有相当大的比例。神经放射科医生在阅读薄片术前磁共振成像(MRI)研究时漏掉了这个病变。随后，另外6名对这项研究视而不见的专家都错过了诊断。诊断的难度与另一项研究相似，在49项MRI研究中，6名神经放射科医生漏诊了100%的类似病变。方法：研究方法。1例55岁女性，左侧颈肩无力，C5-C6椎管狭窄，行颈椎前路小间盘摘除术。当使用细尖钻头平滑C6终板上的轻微凸起时，开始出现高压和大量出血。填塞后，患者直接接受血管造影和CT扫描。几天后，患者接受了血管内评估和支架植入术治疗假性动脉瘤。结果。并发症中未出现神经功能障碍。颈部不适和头痛症状部分改善。结论。一个先前未被描述的累及颈椎间盘的椎动脉内侧异常被记录为单纯前路椎间盘切除术的近乎灾难性的出血。核磁共振扫描的术前诊断率令人沮丧。术前检查应持怀疑态度，任何有问题的区域应进一步研究，而不考虑阴性诊断。证据级别：不适用
Study Design. Case report. Objective. To describe treatment and injury prevention from discectomy with a newly described vertebral artery anomaly. Summary of Background Data. Cervical segment vertebral artery (VA) anomalies of various types are described with the least common type involving erosion into the vertebral body medial to the uncinate process. The morphology of these includes return to the lateral position at the disc level where they have been immune to anterior cervical discectomy surgery. This case report demonstrates the first published account of a medial vertebral artery adjacent to a disc and injured by discectomy alone. VA injury is a serious complication with a significant percentage of neurological injury and death. The lesion was missed by a neuroradiologist reading the thin slice preoperative magnetic resonance imaging (MRI) study. Subsequently, 6 additional specialists blinded to the study all missed the diagnosis. The difficulty of diagnosis is similar to another study where 6 neuroradiologists missed 100% of diagnosis of similar lesions on 49 MRI studies. Methods. A 55-year-old female with left-sided weakness in the neck and shoulder and C5–C6 stenosis underwent anterior cervical microdiskectomy. When a fine-tipped drill bit was used to smoothen a slight convexity on the C6 endplate, high pressure and volume hemorrhage started. After tamponade, the patient was brought directly to angiography and CT scanning. Several days later, the patient underwent endovascular evaluation and stenting for a pseudoaneurysm. Results. No neurological deficits occurred from the complication. Cervical discomfort and headache symptoms partially improved. Conclusion. A previously undescribed medial vertebral artery anomaly involving the cervical disc level is documented with near disastrous hemorrhage from simple anterior discectomy. The rate of preoperative diagnosis from MRI scans is dismal. Preoperative studies should be scrutinized with suspicion and any questionable area studied further regardless of a negative diagnosis. Level of Evidence: N/A