caa a22 4500 606216715 CHVBK 20210128101104.0 cr unu---uuuuu 210128e20151101xx s 000 0 eng 10.1007/s00701-015-2594-2 doi (NATIONALLICENCE)springer-10.1007/s00701-015-2594-2 Vertebral artery injury during foraminal decompression in "low-risk" cervical spine surgery: incidence and management [Elektronische Daten] [Thomas Obermüller, Maria Wostrack, Ehab Shiban, Haiko Pape, Kathrin Harmening, Benjamin Friedrich, Sascha Prothmann, Bernhard Meyer, Florian Ringel] Objectives: Vertebral artery injury (VAI) during foraminal decompression in cervical spine surgery in the absence of repositioning or screw stabilization is rare. Without immediate recognition and treatment, it may have disastrous consequences. We aimed to describe the incidence and management of iatrogenic VAI in low-risk cervical spine surgery. Materials and methods: The records of all patients who underwent surgical procedures of the cervical spine between January 2007 and May 2012 were retrospectively consecutively evaluated. Anterior cervical discectomy and fusion or arthroplasty as well as dorsal foraminal decompression through the Frykholm approach in degenerative diseases were defined as low-risk surgeries (n = 992). Results: VAI occurred in 0.3% (n = 3) of 992 procedures: in one case during a dorsal foraminal decompression, and in two cases during the anterior cervical discectomy and fusion (ACDF) of two or four levels, respectively. In the first case, the VAI was intraoperatively misdiagnosed. Despite an initially uneventful course, the patient suffered hemorrhage from a pseudoaneurysm of the injured VA 1month after surgery. The aneurysm was successfully occluded by endovascular coiling. In both ACDF cases, angiography and endovascular stenting of the lacerated segment proceeded immediately after the surgery. All three patients suffered no permanent deterioration. Conclusions: In a high-volume surgical center, the incidence of VAI during low-risk cervical spine surgery is extremely low, comprising 0.3% of all cases. The major risks are delayed sequels of the vessel wall laceration. In cases of VAI, immediate angiographic diagnostics and generous indications for endovascular treatment are obligatory. Springer-Verlag Wien, 2015 Vertebral artery injury nationallicence Cervical spine surgery nationallicence Complication nationallicence Endovascular treatment nationallicence Obermüller Thomas Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany aut Wostrack Maria Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany aut Shiban Ehab Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany aut Pape Haiko Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany aut Harmening Kathrin Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany aut Friedrich Benjamin Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany aut Prothmann Sascha Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany aut Meyer Bernhard Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany aut Ringel Florian Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany aut Acta Neurochirurgica Springer Vienna 157/11(2015-11-01), 1941-1945 0001-6268 157:11<1941 2015 157 701 https://doi.org/10.1007/s00701-015-2594-2 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s00701-015-2594-2 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Obermüller Thomas Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany aut NATIONALLICENCE 700 1- Wostrack Maria Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany aut NATIONALLICENCE 700 1- Shiban Ehab Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany aut NATIONALLICENCE 700 1- Pape Haiko Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany aut NATIONALLICENCE 700 1- Harmening Kathrin Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany aut NATIONALLICENCE 700 1- Friedrich Benjamin Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany aut NATIONALLICENCE 700 1- Prothmann Sascha Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany aut NATIONALLICENCE 700 1- Meyer Bernhard Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany aut NATIONALLICENCE 700 1- Ringel Florian Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany aut NATIONALLICENCE 773 0- Acta Neurochirurgica Springer Vienna 157/11(2015-11-01), 1941-1945 0001-6268 157:11<1941 2015 157 701