Vertebral artery injury of upper cervical spine fracture with posterior internal fixation

English Keywords:Upper cervical spine fracture  Vertebral artery injury  Clinical analysis

English Abstract:

  【Abstract】 Objectives: To analyze the reasons, surgical treatment strategies and preventive measures of vertebral artery injury of upper cervical spine with posterior internal fixation. Methods: From January 2013 to December 2017, 96 patients who suffered from upper cervical fracture and dislocation were treated with posterior internal fixation in our hospital. Among them, 6 patients were diagnosed vertebral artery injury after the posterior instrumentation, 4 males and 2 females, aging from 32 to 57 years(39.8±8.3 years) old. The length of stay ranged from 18 to 26d(22.0±2.5d). Before surgery, 2 patients had no vertebral artery injury in MR angiography(MRA), other 4 patients had no MRA examination. All the 6 patients were treated with posterior internal fixation, and cerebral ischemia appeared at 3 to 42 hours after surgery. Four patients had incision bleeding or hematoma formation and accepted exploratory operation. After CT angiography(CTA) and digital subtraction angiography(DSA) examination showing the vertebral artery injury, all the 6 patients were given interventional treatment. Cerebral ischemia improvement was observed in follow-up after discharged. Results: In addition to 1 case of atlantoaxial compound fracture and 1 case of mixed fracture, all the other patients were smoothly treated. Four patients who had V3 part of vertebral artery injury(bilateral damage in 1 case, unilateral damage in 3 cases) accepted membrane stent implantation, two patients with pseudoaneurysm in unilateral V3 part of vertebral artery accepted artery occlusion operation. The hemorrhage of vertebral artery was effectively controlled after interventional therapy. All patients were followed up after discharge with the time of 6-12 months(10.0±2.2 months). One patient with bilateral vascular wall injury still suffered from dizziness, headache and facial numbness at one year after discharged. Three patients with unilateral vessel wall injury were relieved of cerebral ischemia when discharged and complained no special discomfort during 1-year followed-up. Two patients with unilateral vertebral artery pseudoaneurysm experienced gradually relieved of cerebral ischemia at 6 months and 9 months after vertebral artery occlusion. In the patients with vertebral artery injury, 2 cases were caused by internal fixation, 4 cases were undefined about the reason due to no MRA and CTA examination before surgery. Conclusions: Vertebral artery injury can be caused by upper cervical fracture dislocation and internal fixation in surgical reduction. According to the imaging examination, interventional therapy can achieve an optimal outcome. A detailed imaging examination and evaluation should be performed before the surgery for upper cervical spine fracture. The operation should be carefully regulated to avoid the vertebral artery injury.