Tortuous vertebral artery injury complicating anterior cervical spinal fusion in a symptomatic rheumatoid cervical spine.
METHODS
A case report of a 60-year-old patient with rheumatoid arthritis who sustained injury of a tortuous vertebral artery after anterior cervical spinal fusion is reported. The literature relevant to this topic is reviewed.


OBJECTIVE
To report the surgical injury of a tortuous vertebral artery resulting from rheumatoid arthritis and to stress the value of cross-sectional imaging in identifying this anomaly before surgery in these patients.


BACKGROUND
Rheumatoid arthritis causes well-known bony complications such as atlantoaxial and subaxial subluxation and spinal stenosis with spinal cord compression. Less emphasized is vertebral artery loop formation and vascular compression. Anomalous vertebral artery position could jeopardize otherwise successful anterior diskectomy and corpectomy in these patients.


METHODS
A 60-year-old man with rheumatoid arthritis sustained a vertebral artery injury during anterior corpectomy, which resulted in cerebral and cerebellar infarction.


RESULTS
Computed tomography and magnetic resonance imaging and angiography confirmed the medially deviated vertebral artery. A computed tomography scan confirmed the cerebral infarction that resulted from dissection and injury of the artery at the time of surgery.


CONCLUSIONS
The patient with rheumatoid arthritis of the cervical spine could have associated tortuosity of the vertebral artery, mandating a thorough awareness of vascular anatomy before surgical decompression. Cross-sectional imaging effectively locates the position of the vertebral arteries and should be carefully studied before anterior cervical spinal fusion in these patients.
Department of Orthopedics, Naval Hospital, Guam.
Luis M
LM
Tumialan
Franz J
FJ
Wippold
Robert A
RA
Morgan
D002574:Cervical Vertebrae / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D013123:Spinal Fusion / Q000009:adverse effects; D013167:Spondylitis, Ankylosing / Q000601:surgery*; D014102:Torsion Abnormality; D014711:Vertebral Artery / Q000002:abnormalities* / Q000293:injuries*