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Common carotid artery medialization and fracture dislocation of the cervical spine. SURGICAL AND RADIOLOGIC ANATOMY : SRA 2022; 44:1073-1077. [PMID: 35857085 DOI: 10.1007/s00276-022-02965-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 05/21/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE To describe the management of the discovery of a retropharyngeal carotid artery in the context of a cervical dislocation. DESCRIPTION OF THE CASE A 68-year-old female presented acute neck pain and incomplete tetraplegia following a fall on the stairs. Radiographs, contrast-enhanced computed tomography scan and magnetic resonance of the cervical spine revealed a C5-C6 bi-articular dislocation. A detailed preoperative assessment of the images discovered a medialization of the left common carotid artery. An external reduction and a left anterior cervical approach allowed a careful management of the vascular variation and an anterior C5-C6 arthrodesis. At six months, a full neurological recovery was assessed and radiographs demonstrated successful fusion of the cervical arthrodesis. DISCUSSION/CONCLUSION Anatomical features such as medialization of the common carotid artery may affect patients with traumatic cervical spine injuries. The severity of the traumatic bone lesions should not overshadow the preoperative analysis of the adjacent anatomical structures encountered during the surgical approach, even in an emergency situation.
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Iatrogenic Vascular Injury Associated with Cervical Spine Surgery: A Systematic Literature Review. World Neurosurg 2021; 159:83-106. [PMID: 34958995 DOI: 10.1016/j.wneu.2021.12.068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Iatrogenic vascular injury is an uncommon complication of anterior and/or posterior surgical approaches to the cervical spine. Although the results of this injury may be life-threatening, mortality/morbidity can be reduced by an understanding of its mechanism and proper management. METHODS We conducted a literature review to provide an update of this devastating complication in spine surgery. A total of 72 articles including 194 cases of vascular lesions following cervical spine surgery between 1962 and 2021 were analyzed. RESULTS There were 53 female and 41 male cases (in addition to 100 cases with unreported sex) with ages ranging from 3 to 86 years. The vascular injuries were classified according to the spinal procedures, such as anterior or posterior cervical spine surgery. The interval between the symptom of the vascular injury and the surgical procedure ranged from 0 to 10 years. Only two-thirds of patients underwent intra- or postoperative imaging and the most frequently injured vessel was the vertebral artery (86.60%). Laceration was the most common lesion (41.24%), followed by pseudoaneurysm (16.49%) and dissection (5.67%). Vascular repair was performed in 114 patients. The mortality rate was 7.22%, and 18.04% of patients had 1 or more other complications. Most presumed causes of vascular lesions were by instrumentation/screw placement (31.44%) or drilling (20.61%). Sixteen patients had an anomalous artery. Direct microsurgical repair was achieved in only 15 cases. CONCLUSIONS Despite increased anatomical knowledge and advanced imaging techniques, we need to consider the risk of vascular injury as a surgical complication in patients with cervical spine pathologies.
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Du YQ, Duan WR, Chen Z, Wu H, Jian FZ. Carotid Artery-Related Perioperative Stroke Following Anterior Cervical Spine Surgery: A Series of 3 Cases and Literature Review. J Stroke Cerebrovasc Dis 2019; 28:458-463. [DOI: 10.1016/j.jstrokecerebrovasdis.2018.10.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/06/2018] [Accepted: 10/16/2018] [Indexed: 12/22/2022] Open
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Tasiou A, Giannis T, Brotis AG, Siasios I, Georgiadis I, Gatos H, Tsianaka E, Vagkopoulos K, Paterakis K, Fountas KN. Anterior cervical spine surgery-associated complications in a retrospective case-control study. JOURNAL OF SPINE SURGERY 2017; 3:444-459. [PMID: 29057356 DOI: 10.21037/jss.2017.08.03] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Anterior cervical spine procedures have been associated with satisfactory outcomes. However, the occurrence of troublesome complications, although uncommon, needs to be taken into consideration. The purpose of our study was to assess the actual incidence of anterior cervical spine procedure-associated complications and identify any predisposing factors. A total of 114 patients undergoing anterior cervical procedures over a 6-year period were included in our retrospective, case-control study. The diagnosis was cervical radiculopathy, and/or myelopathy due to degenerative disc disease, cervical spondylosis, or traumatic cervical spine injury. All our participants underwent surgical treatment, and complications were recorded. The most commonly performed procedure (79%) was anterior cervical discectomy and fusion (ACDF). Fourteen patients (12.3%) underwent anterior cervical corpectomy and interbody fusion, seven (6.1%) ACDF with plating, two (1.7%) odontoid screw fixation, and one anterior removal of osteophytes for severe Forestier's disease. Mean follow-up time was 42.5 months (range, 6-78 months). The overall complication rate was 13.2%. Specifically, we encountered adjacent intervertebral disc degeneration in 2.7% of our cases, dysphagia in 1.7%, postoperative soft tissue swelling and hematoma in 1.7%, and dural penetration in 1.7%. Additionally, esophageal perforation was observed in 0.9%, aggravation of preexisting myelopathy in 0.9%, symptomatic recurrent laryngeal nerve palsy in 0.9%, mechanical failure in 0.9%, and superficial wound infection in 0.9%. In the vast majority anterior cervical spine surgery-associated complications are minor, requiring no further intervention. Awareness, early recognition, and appropriate management, are of paramount importance for improving the patients' overall functional outcome.
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Affiliation(s)
- Anastasia Tasiou
- Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Theofanis Giannis
- Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Alexandros G Brotis
- Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Ioannis Siasios
- Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Iordanis Georgiadis
- Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Haralampos Gatos
- Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Eleni Tsianaka
- Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Konstantinos Vagkopoulos
- Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Konstantinos Paterakis
- Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Kostas N Fountas
- Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
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Abstract
PURPOSE OF REVIEW Cervical disc replacement (CDR) is a surgical option for appropriately indicated patients, and high success rates have been reported in the literature. Complications and failures are often associated with patient indications or technical variables, and the goal of this review is to assist surgeons in understanding these factors. RECENT FINDINGS Several investigations have been published in the last 5 years supporting the use of CDR in specific patient populations. CDR has been shown to be comparable or favorable to anterior cervical discectomy and fusion in several meta-analyses and mid-term follow-up studies. CDR was developed as a technique to preserve motion following a decompression procedure while minimizing several of the complications associated with fusion and posterior cervical spine procedures. Though success with cervical fusion and posterior foraminotomy has been well documented in the literature, high rates of mid- and long-term complications have been clearly established. CDR has also been associated with several complications and challenges with regard to surgical technique, though improvements in implant design have lead to an increase in utilization. Several devices currently exist and vary in terms of material, design, and outcomes. This review paper discusses indications, surgical technique, and technical pearls and reviews the CDR devices currently available.
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Härtl R, Alimi M, Abdelatif Boukebir M, Berlin CD, Navarro-Ramirez R, Arnold PM, Fehlings MG, Mroz TE, Riew KD. Carotid Artery Injury in Anterior Cervical Spine Surgery: Multicenter Cohort Study and Literature Review. Global Spine J 2017; 7:71S-75S. [PMID: 28451496 PMCID: PMC5400196 DOI: 10.1177/2192568216688192] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective study and literature review. OBJECTIVE To provide more comprehensive data about carotid artery injury (CAI) or cerebrovascular accident (CVA) related to anterior cervical spine surgery. METHODS We conducted a retrospective, multicenter, case series study involving 21 high-volume surgical centers from the AOSpine North America Clinical Research Network. Medical records of 17 625 patients who went through cervical spine surgery (levels from C2 to C7) between January 1, 2005, and December 31, 2011, were analyzed. Also, we performed a literature review using Medline and PubMed databases. The following terms were used alone, and in combination, to search for relevant articles: cervical, spine, surgery, complication, iatrogenic, carotid artery, injury, cerebrovascular accident, CVA, and carotid stenosis. RESULTS Among 17 625 patients that were analyzed, no cases were reported to experienced CAI or CVA after cervical spine surgery. Nevertheless, in our PubMed search we found 157 articles, but only 5 articles matched our study objective criteria; 2 cases were reported to present CAI and 3 cases presented CVA. CONCLUSIONS CAI and CVA related to anterior cervical spine surgeries are extremely rare. We were not able to find neither in our retrospective study nor in our literature research a correlation between the type or length of anterior cervical spine procedure with CVA or CAI complications. However, surgeons should be aware of the possibility of vascular complications and minimize intraoperative direct vascular manipulations or retraction. Preoperative screening for underlying vascular pathology and risk factors is also important.
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Affiliation(s)
- Roger Härtl
- Weill Cornell Brain & Spine Center, New York, NY, USA,Weill Cornell Medical College, Cornell University, New York, NY, USA,Roger Härtl, Weill Cornell Brain & Spine Center, 525 East 68th Street, Box 99, New York, NY 10065, USA.
| | - Marjan Alimi
- Weill Cornell Medical College, Cornell University, New York, NY, USA
| | - Mohamed Abdelatif Boukebir
- Weill Cornell Medical College, Cornell University, New York, NY, USA,University Saad Dahlab Blida, Blida, Algeria
| | - Connor D. Berlin
- Weill Cornell Medical College, Cornell University, New York, NY, USA
| | | | | | | | | | - K. Daniel Riew
- Columbia University, New York, NY, USA,New York-Presbyterian/The Allen Hospital, New York, NY, USA
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Graffeo CS, Puffer RC, Wijdicks EFM, Krauss WE. Delayed cerebral infarct following anterior cervical diskectomy and fusion. Surg Neurol Int 2016; 7:86. [PMID: 27713852 PMCID: PMC5046741 DOI: 10.4103/2152-7806.191022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 05/05/2016] [Indexed: 12/11/2022] Open
Abstract
Background: Ischemic stroke following anterior cervical diskectomy and fusion (ACDF) is an exceedingly rare complication. There are only three previous cases focusing on this problem in the literature; here, we present the fourth case. Case Description: A patient, cared for at an outside institution, developed a delayed ischemic stroke 3 days following an ACDF. This complication was attributed to carotid manipulation precipitating vascular injury in the setting of multiple comorbid vascular and coagulopathic risk factors, including previously undiagnosed carotid atherosclerosis, a prior history of pulmonary embolus requiring Warfarin anticoagulation (held perioperatively), acute dehydration, and atrial fibrillation. Conclusions: This case demonstrates the importance of focused history and examination in appropriate patients prior to ACDF, with special consideration given to the significance of age, comorbidities including coagulopathy and arrhythmia, and potential underlying vascular disease as markers for increased risk of perioperative thrombotic stroke associated with carotid manipulation. Patients at higher risk warrant comprehensive preoperative assessment, including medical evaluation, carotid imaging, and consideration for alternative surgical approaches.
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Affiliation(s)
| | - Ross C Puffer
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - William E Krauss
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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