Vertebral artery anomaly and injury in spinal surgery.
METHODS
Systematic review.


OBJECTIVE
The purpose of this review is to further define the published literature with respect to vertebral artery (VA) anomaly and injury in patients with degenerative cervical spinal conditions.


OBJECTIVE
In adult patients with cervical spine or degenerative cervical spine disorders receiving cervical spine surgery, what is the incidence of VA injury, and among resulting VA injuries, which treatments result in a successful outcome and what percent are successfully repaired?


METHODS
A systematic review of pertinent articles published up to April 2013. Studies involving traumatic onset, fracture, infection, deformity or congenital abnormality, instability, inflammatory spinal diseases, or neoplasms were excluded. Two independent reviewers assessed the level of evidence quality using the Grades of Recommendation Assessment, Development and Evaluation criteria; disagreements were resolved by consensus.


RESULTS
From a total of 72 possible citations, the following met our inclusion criteria and formed the basis for this report. Incidence of VA injuries ranged from 0.20 to 1.96%. None of the studies reported using preoperative imaging to identify anomalous or tortuous VA. Primary repair and ligation were the most effective in treating VA injuries.


CONCLUSIONS
The incidence of VA injuries in degenerative cervical spinal surgery might be as high as 1.96% and is likely underreported. Direct surgical repair is the most effective treatment option. The most important preventative technique for VA injuries is preoperative magnetic resonance imaging or computed tomography angiographic imaging to detect VA anomalies. The overall strength of evidence for the conclusions is low.
Department of Orthopaedic Surgery, University of Rochester Medical Center, Rochester, New York, United States.
Robert
R
Molinari
Department of Orthopaedic Surgery, University of Rochester Medical Center, Rochester, New York, United States.
Matthew
M
Bessette
Spectrum Research, Inc., Tacoma, Washington, United States.
Annie L
AL
Raich
Spectrum Research, Inc., Tacoma, Washington, United States.
Joseph R
JR
Dettori
Department of Orthopaedic Surgery, University of Rochester Medical Center, Rochester, New York, United States.
Christine
C
Molinari
cervical spine surgery; classification systems; complication; iatrogenic; intraoperative complication; vertebral artery; vertebral artery anatomy; vertebral artery injury