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Vertebral artery injury

Rex A W Marco, Christopher I Phelps, Rebecca C Kuo, W U Zhuge, Clinton W Howard, Vivek P Kushwaha, Derek T Bernstein
Background: Preoperative assessment of C2 pedicle morphology is critical to safe pedicle screw placement. To avoid iatrogenic injury, complex digital templating software has been introduced; however, this technology may not be available in many centers. We report a technique for preoperative assessment of C2 pedicle screw placement safety based upon 2-dimensional sagittal computed tomography (CT) scan images and verify its utility in clinical practice. Methods: A total of 46 consecutive patients underwent cervical spine CT scans between 2005 and 2011...
January 2018: International Journal of Spine Surgery
Kaitlyn M Rountree, Julie A Zachwieja, Jesse A Coleman, Isaac J Hinton, Peter P Lopez
No abstract text is available yet for this article.
September 1, 2018: American Surgeon
Kaitlyn M Rountree, Julie A Zachwieja, Jesse A Coleman, Isaac J Hinton, Peter P Lopez
No abstract text is available yet for this article.
September 1, 2018: American Surgeon
Alexandros G Brotis, Georgios Karagiorgas, Anastasia Tasiou, Charalambos Gatos, Eftychia Kapsalaki, Kostas N Fountas
We describe a rare case of a 69-year-old male who developed a hemorrhagic transformation of a posterior fossa ischemia after the initiation of antithrombotic therapy for the management of blunt vertebral artery injury (BVAI). To the best of our knowledge, this is the first reported case in the literature so far. Thus, we present our diagnostic approach, its associated treatment challenges, and its overall outcome.
2018: AME case reports
Lucy Thomas, Juanita Low, Kalos Chan, Gail Durbridge
BACKGROUND: Cervical arterial dissection, can occur spontaneously and is a rare but catastrophic adverse event associated with neck manipulation. Pathophysiology involves altered integrity of the arterial wall increasing its vulnerability to minor trauma. Those at risk are difficult to detect. Previous screening investigated blood flow but altered mechanical properties as stiffness of cervical arterial wall could provide a more valid indication of arterial integrity or even early dissection...
September 18, 2018: Musculoskeletal Science & Practice
Young Lu, Yu-Po Lee, Nitin N Bhatia, Thay Q Lee
STUDY DESIGN: A biomechanical in vitro study using human cadaveric spines. OBJECTIVE: To compare atlantoaxial stability and stiffness of a C1 lateral mass - C2 short pedicle - C3 lateral mass screw-rod construct versus C1 lateral mass - C2 pedicle screw-rod construct. SUMMARY OF BACKGROUND DATA: The C1 lateral mass - C2 pedicle screw-rod construct provides excellent atlantoaxial fixation but C2 pedicle screw placement is associated with risk of vertebral artery injury...
September 17, 2018: Spine
Narayanam Anantha Sai Kiran, Laxminadh Sivaraju, Kanneganti Vidyasagar, Sarita Aryan, Vivek Raj, Niranjana Rajagopal, Dilip Mohan, Sumit Thakar, Arun Sadashiva Rao, Alangar S Hegde
OBJECTIVE: To evaluate the safety and accuracy of anatomic- and lateral fluoroscopic-guided placement of C2 pars/pedicle, C1 lateral mass screws, and freehand placement of C2 laminar screws. METHODS: All the patients who underwent posterior cervical/occipitocervical fixation that involved the placement of C1/C2 screws during a 5-year period (2011-2015) at our institute were included in this study. RESULTS: C1/C2 screws were placed in a total of 94 patients during this period...
October 2018: World Neurosurgery
C Yang, S Weisbrode, J Yardley, E Schroeder, C Premanandan
Ischaemia-induced physeal injury has not been described previously in the horse. A 1-month-old Quarter horse foal was submitted for necropsy examination due to an acute onset of ataxia followed by a 4-week history of progressive decline. Focal narrowing of the spinal canal due to ventral compression by the rotation of the cranial aspect of the third cervical vertebra (C3) was observed. The metaphysis and diaphysis of C3 were markedly shortened and white-tan in colour. Microscopically, there was complete loss of the dorsal compact bone of C3 and replacement of 80% of the physis that runs parallel to the vertebral canal with fibrous tissue and thickened viable trabecular bone...
August 2018: Journal of Comparative Pathology
Akihito Sato, Sakyo Hirai, Yoshiki Obata, Taketoshi Maehara, Masaru Aoyagi
Background  The far lateral approach includes exposure of the C1 transverse process, vertebral artery, posterior arch of the atlas, and occipital condyle. We designed a method for systematic muscular-stage dissection and present our experience with this approach. Operative Methods  We used a horseshoe scalp flap that was reflected downward and medially. The lateral muscle layers were separated layer to layer to expose the suboccipital triangle. The medial muscle layers were separated in the midline and reflected in a single layer...
October 2018: Journal of Neurological Surgery. Part B, Skull Base
Zhimin Pan, Junlong Zhong, Shiming Xie, Limin Yu, Chunyang Wu, Yoon Ha, Keung Nyun Kim, Youshan Zhang, Kai Cao
BACKGROUND: Biomechanical studies revealed that pedicle screw instrumentation has a superior stabilizing effect compared with other internal fixations in reconstructing the subaxial cervical spine. However, severe neurovascular risks preclude surgeons from routinely conducting pedicle screw manipulation in cervical spine. OBJECTIVE: To evaluate the accuracy and safety of the lateral vertebral notch (LVN)-referred technique used in subaxial cervical pedicle screw (CPS) placement...
September 4, 2018: Operative Neurosurgery (Hagerstown, Md.)
Daniel G Tobert, Hai V Le, Justin A Blucher, Mitchel B Harris, Andrew J Schoenfeld
BACKGROUND: Advanced-imaging screening for asymptomatic blunt cerebrovascular injury is controversial. Vertebral artery injury (VAI) is most commonly associated with cervical spine fracture, and many guidelines advocate indiscriminate screening for all cervical spine fractures. The purpose of this study was to determine whether the addition of computed tomographic angiography (CTA) results in a change in management for patients with cervical spine fractures. METHODS: Adult patients treated for acute cervical spine fractures after blunt trauma during the period of 2000 to 2015 were retrospectively identified...
September 5, 2018: Journal of Bone and Joint Surgery. American Volume
Brittany A Walsh, W Douglas Gregorie, Jessica S Whittle
Blunt cerebrovascular injury (BCVI) is a term encompassing traumatic carotid and vertebral artery dissection or disruption. While the reported incidence appears to be increasing as diagnostic modalities improve, these injuries are often diagnosed only after patients have developed acute neurologic symptoms. These injuries often result in severe permanent neurologic disability or death. The gold standard for diagnosis has historically been a 4-vessel arteriogram. However, newer data are suggesting that computed tomographic angiography may be more appropriate for most patients and new criteria for its utilization have been developed...
2018: Case Reports in Emergency Medicine
Theresa Elder, Faiz Tuma
INTRODUCTION: Blunt vertebral artery injury (BVI) is a potentially catastrophic event associated with a variety of trauma mechanisms, particularly in the setting of cervical spine injury. Early detection and treatment of BVI and blunt carotid artery injury (BCI) - collectively termed blunt cerebrovascular injuries (BCVI) - is a known determinant of favorable outcomes, except in the case of complete transection injuries. The limited existing reports of these injuries demonstrate a 100% mortality rate regardless of the management approach taken, and further investigation is essential in better understanding the nature of the injury and improving patient outcomes...
August 15, 2018: International Journal of Surgery Case Reports
Yuichi Fujita, Hideo Aihara, Hiroaki Nagashima, Akitsugu Morishita, Kenji Aoki, Hiroyuki Takayama, Toshihiko Harada, Yoshiki Tohma, Yoshie Hara, Eiji Kohmura
OBJECTIVE: Vertebral artery injury(VAI)associated with cervical spine trauma has the potential to cause catastrophic vertebrobasilar stroke. However, there are no well-defined treatment recommendations for VAI. The purpose of this study was to identify an effective treatment strategy for VAI following cervical spine trauma. METHODS: Ninety-seven patients with blunt cervical spine trauma were treated at Hyogo Prefectural Kakogawa Medical Center between January 2013 and September 2017...
August 2018: No Shinkei Geka. Neurological Surgery
Xiang Li, Zhu-Wei Zhang, Zhong Wang, Jin-Quan Li, Gang Chen
Stroke, also known as "cerebrovascular accident", is an acute cerebrovascular disease that is caused by a sudden rupture of blood vessels in the brain or obstruction of the blood supply by blockage of blood vessels, thus including hemorrhagic and ischemic strokes. The incidence of ischemic stroke is higher than that of hemorrhagic stroke, and accounts for 80% of the total number of strokes. However, the mortality rate of hemorrhagic stroke is relatively high. Internal carotid artery and vertebral artery occlusion and stenosis can cause ischemic stroke, and especially males over 40 years of age are at a high risk of morbidity...
April 2018: Medical Gas Research
Fabio Ramponi, Michael Seco, James B Edelman, Andrew G Sherrah, Paul G Bannon, R John L Brereton, Michael K Wilson, Michael P Vallely
Coronary surgery performed on an arrested heart, using one internal mammary artery and a saphenous vein carries two main potential drawbacks: the known failure rate of vein grafts and the relatively high rate of neurologic injury. To address these concerns, we describe a technique that achieves complete revascularization without manipulating the ascending aorta (anaortic, off-pump) and utilizing total arterial grafts. All patients undergo thorough preoperative investigation, including bilateral carotid, vertebral and subclavian artery Duplex ultrasounds...
July 2018: Annals of Cardiothoracic Surgery
Jed T Ritter, Chadd K Kraus
Blunt traumatic cervical vascular injury (BCVI) is challenging to recognize, but it is a potentially devastating entity that warrants attention from emergency physicians. Injury to the vertebral or carotid artery can result in a delayed manifestation of neurologic injury that may be preventable if promptly recognized and treated. The modified Denver Criteria are frequently used to guide imaging decisions for BCVI; however, injuries can still be missed. We present a case of BCVI in a trauma patient whose initial presentation evaded standard screening criteria, illustrating the need for a high index of suspicion for BCVI in blunt trauma...
August 2018: Clinical practice and cases in emergency medicine
Joshua D Burks, Andrew K Conner, Robert G Briggs, Phillip A Bonney, Adam D Smitherman, Cordell M Baker, Chad A Glenn, Cameron A Ghafil, Dillon P Pryor, Kyle P O'Connor, Bradley N Bohnstedt
OBJECTIVE A shifting emphasis on efficient utilization of hospital resources has been seen in recent years. However, reduced screening for blunt vertebral artery injury (BVAI) may result in missed diagnoses if risk factors are not fully understood. The authors examined the records of blunt trauma patients with fractures near the craniocervical junction who underwent CTA at a single institution to better understand the risk of BVAI imposed by occipital condyle fractures (OCFs). METHODS The authors began with a query of their prospectively collected trauma registry to identify patients who had been screened for BVAI using ICD-9-CM diagnostic codes...
August 3, 2018: Journal of Neurosurgery. Spine
Tarun Dusad, Vishal Kundnani, Shumayou Dutta, Ankit Patel, Gaurav Mehta, Mahendra Singh
STUDY DESIGN: Retrospective study. PURPOSE: To evaluate the clinico-radiological efficacy of stand-alone minimally invasive transarticular screw (MIS-TAS) fixation without supplemental Gallie fixation in the management of mobile C1-C2 instability. OVERVIEW OF LITERATURE: Data evaluating the efficacy and feasibility of MIS-TAS in the literature is scanty. METHODS: Patients with mobile atlantoaxial instability and >2 years follow-up were included and managed by stand-alone TAS fixation using the Magerl technique and morselized allograft without additional fixation...
August 2018: Asian Spine Journal
Victoria Schunemann, Jeeho Kim, David Dornbos, Shahid M Nimjee
BACKGROUND: Bow hunter's syndrome (BHS) or rotational vertebral artery occlusion is a rare syndrome of vertebrobasilar insufficiency due to compression or occlusion of the contralateral vertebral artery with cervical axial rotation. Compression at the C2-C3 level, the junction between the axial and subaxial spine, has not been described. Management can include medical treatment with antiplatelet medications, surgical fusion, or vertebral artery decompression. CASE DESCRIPTION: The patient presented with dizziness and loss of consciousness with axial head rotation to the left...
October 2018: World Neurosurgery
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