End-to-End Anastomosis of an Unanticipated
Vertebral Artery Injury During C2 Pedicle Screwing

This section is compiled by Frank M. Painter, D.C.
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FROM:   J Korean Neurosurg Soc. 2010 (Oct); 48 (4): 363–366

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Nam KH, Sung JK, Park J, Cho DC.

Department of Neurosurgery,
Kyungpook National University Hospital,
Daegu, Korea

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Vertebral artery (VA) injury is a rare and serious complication of cervical spine surgery; this is due to difficulty in controlling hemorrhage, which can result in severe hypotension and cardiac arrest, and uncertain neurologic consequences. The authors report an extremely rare case of a 56-year-old woman who underwent direct surgical repair by end-to-end anatomosis of an unanticipated VA injury during C2 pedicle screwing. Postoperatively, the patient showed no neurological deterioration and computed tomography angiography of the VA demonstrated normal blood flow. Although direct occlusion of an injured VA by surgical ligation or endovascular embolization has been used for management of an unanticipated VA injury during surgery, these methods may be associated with significant morbidity and mortality. However, despite its technical demand, microvascular primary repair can restore normal blood flow and minimizes the risk of immediate or delayed ischemic complications. Here we report an iatrogenic VA injury during C2 pedicle screwing, which was successfully treated by end-to-end anastomosis.

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