Incidence of vertebral artery injury in patients undergoing cervical spine trauma surgery in correlation with surgical approach: A review

Medicine, 2023 · DOI: http://dx.doi.org/10.1097/MD.0000000000034653 · Published: September 15, 2023

Spinal Cord Injury Cardiovascular Science Orthopedics

Simple Explanation

Cervical spine surgeries, while aimed at improving quality of life and preventing paralysis, carry risks due to the proximity of major blood vessels. A significant concern is iatrogenic injury to the vertebral artery, which can occur during the procedure. The review of existing literature suggests that the anterior surgical approach to the cervical spine may be safer than the posterior approach in terms of the incidence of vascular injuries. Preoperative planning, including imaging to understand the anatomical variations of the vertebral artery, is crucial to minimize the risk of intraoperative vascular complications, irrespective of the surgical approach chosen.

Study Duration

Not specified

Participants

Literature review of 35 articles

Evidence Level

Systematic Review and Meta-Analysis

Key Findings

1
The anterior surgical approach to the cervical spine is generally associated with a lower risk of vertebral artery injury (0.3–0.5%) compared to the posterior approach (4.1% to 8.2%).
2
The most common type of vertebral artery damage during cervical spine surgery is intraoperative erosion, accounting for approximately 41% of vascular injuries.
3
Preoperative knowledge of vertebral artery anatomy, including potential variations, is essential for minimizing the risk of iatrogenic vascular injury during cervical spine surgery.

Research Summary

This review investigates the incidence of iatrogenic vertebral artery injury during cervical spine surgery, focusing on the correlation with surgical approach (anterior vs. posterior). The analysis of existing literature suggests that the anterior approach is generally safer in terms of vascular injury risk, but the choice of approach should prioritize the surgeon's expertise. Regardless of the surgical approach, thorough preoperative planning, including imaging to identify anatomical variations of the vertebral artery, is crucial for minimizing intraoperative vascular complications.

Practical Implications

Surgical Approach Selection

Surgeons should carefully consider the surgical approach, with evidence suggesting the anterior approach may be safer regarding vascular injuries. However, prioritize the approach where the surgeon is most experienced.

Preoperative Planning

Implement thorough preoperative planning, including imaging to identify anatomical variations of the vertebral artery, which is crucial for minimizing intraoperative vascular complications.

Intraoperative Management

Have strategies in place for prompt diagnosis and treatment of vertebral artery injuries, including endovascular repair options, to minimize potential neurological damage and mortality.

Study Limitations

1
The review relies on existing literature, which may have variations in study design and reporting.
2
Specific patient factors and surgical techniques can influence the risk of vertebral artery injury, which may not be fully captured in the reviewed studies.
3
The review acknowledges the potential for publication bias, where studies with significant findings are more likely to be published.

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