Injury of an aberrant vertebral artery during a routine corpectomy: a case report and literature review.
METHODS
A case report of a 58-year-old man who sustained a laceration of his left vertebral artery during a routine corpectomy for cervical myelopathy is reported.


OBJECTIVE
To report iatrogenic injury of a tortuous vertebral artery during anterior cervical spine surgery and discuss appropriate diagnosis and treatment options for this complication.


METHODS
UMass Memorial Medical Center, Worcester, MA, USA.


BACKGROUND
Vertebral artery anomalies, although rare, are typically present with degenerative processes and great care must be taken to avoid damage during a corpectomy. Cross-sectional imaging coupled with intraoperative angiography is helpful for the urgent evaluation of the injury site and identification of the contralateral vertebral artery's status.


METHODS
This is a single case of a patient sustaining a laceration of the left vertebral artery during surgery, which resulted in a lateral medullary stroke.


RESULTS
After the left vertebral artery laceration, hemostasis was achieved. With the intent to better visualize and possibly embolize or stent the injury, an angiographic study was carried out. The angiogram revealed a laceration of the left vertebral artery within the vertebral foramina at vertebral body level C6, but intact distal flow. The patient underwent angiographic embolization and a subsequent magnetic resonance imaging (MRI) revealed a left lateral medullary stroke consistent with the lack of flow through the left vertebral artery from C6 to the basilar artery.


CONCLUSIONS
If a tortuous vertebral artery is suspected, then meticulous review of preoperative cross-sectional imaging should be implemented along with angiographic examination. If anomalies are detected and the standard procedure cannot be safely carried out, then alterations, such as preoperative stent placement, need to be considered.
Eskander
M S
MS
Department of Orthopedics, UMass Medical School, Worcester, MA, USA. eskanm01@ummhc.org
Connolly
P J
PJ
Eskander
J P
JP
Brooks
D D
DD
D002533:Cerebral Angiography; D002560:Cerebrovascular Circulation / Q000502:physiology; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control; D007431:Intraoperative Complications / Q000209:etiology / Q000517:prevention & control; D014854:Lateral Medullary Syndrome / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control; D011300:Preoperative Care; D012249:Rhombencephalon / Q000098:blood supply / Q000473:pathology; D013117:Spinal Cord Compression / Q000601:surgery*; D055009:Spondylosis / Q000601:surgery*; D014711:Vertebral Artery / Q000002:abnormalities* / Q000293:injuries*