• World Neurosurg · Jun 2019

    Multicenter Study

    Epidemiology of iatrogenic vertebral artery injury in cervical spine surgery: 21 multicenter studies.

    • Chang-Hyun Lee, Jae Taek Hong, Dong Ho Kang, Ki-Jeong Kim, Sang-Woo Kim, Seok Won Kim, Young Jin Kim, Chun Kee Chung, Jun Jae Shin, Jae Keun Oh, Seong Yi, Jung Kil Lee, Lee Jun Ho JH Department of Neurosurgery, Kyung Hee University Medical Centre, Kyung Hee University College of Medicine, Seoul, Korea., Ho Jin Lee, Hyoung-Joon Chun, Dae-Chul Cho, Yong Jun Jin, Kyung-Chul Choi, In Ho Han, Seung-Jae Hyun, Jung-Woo Hur, and Geun Sung Song.
    • Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
    • World Neurosurg. 2019 Jun 1; 126: e1050-e1054.

    BackgroundThe overall incidence of iatrogenic vertebral artery injury (IVAI) in cervical spine surgeries (CSSs) is reported to be 0.07%-1.4%. Although IVAI occurred during C1-2 fusion, there is no accurate information regarding the surgery-specific risk of IVAI. This study aimed to stratify incidence of IVAI by surgical method and evaluate the correlation between IVAI and its sequelae.MethodsThis retrospective, multicenter study involved clinical and radiologic evaluations for IVAI. All CSSs performed between 2012 and 2016 were included; neck mass excision and pain intervention were excluded. Patient characteristics, diagnosis, surgical technique, complications, and presence of IVAI were collected. In IVAI cases, technique details, characteristics, and sequelae were investigated.ResultsThis study included 14,722 patients with 15,582 CSSs in 21 centers. IVAIs were identified in 13 (0.08%) patients. Surgery-specific incidence of IVAI was 1.35% in cases involving C1-2 posterior fixation and 0.20% in cases involving C3-6 posterior fixation. Common injury mechanisms were screw-in (31%) and high-speed drilling (23%). Screw-related IVAI occurred in 9 (69%) patients, and IVAI of the C1 lateral mass and C2 pedicle screws occurred in 4 and 3 patients, respectively. Of 13 cases of IVAI, 3 (23%) involved cerebellar or stem infarction; the infarction had no substantial correlation with injury grade or dominancy.ConclusionsOverall incidence of IVAI in CSSs was 0.08%. C1-2 posterior fixation had the highest incidence of IVAI (1.35%). Although clinical results of IVAI can be highly variable, controlling risk factors of IVAI is important.Copyright © 2019 Elsevier Inc. All rights reserved.

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