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Bernard H Guiot - One of the best experts on this subject based on the ideXlab platform.
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vertebral Artery Injury after blunt cervical trauma an update
Surgical Neurology, 2006Co-Authors: Joji Inamasu, Bernard H GuiotAbstract:Abstract Background Vertebral Artery Injury (VAI) after blunt cervical trauma has been considered to be rare. The incidence of VAI has increased dramatically within the last decade after a heightened awareness of this entity on the part of spine surgeons. Diagnostic or therapeutic guidelines for VAI have not been established fully, however. Methods A review of the literature published between 1990 and 2004 was conducted. Results The incidence of VAI among total blunt trauma admissions ranged from 0.20% to 0.77%. Most VAI patients remained asymptomatic, but sudden unexpected deterioration was often reported. Distraction/extension, distraction/flexion, and lateral flexion injuries were the major mechanisms of Injury. Dissection and occlusion were the frequent vascular Injury patterns. Facet joint dislocations and the fractures extending into the transverse foramen were the spine Injury patterns closely associated with VAI. Digital subtraction angiography was the most sensitive imaging study, but because of invasiveness, its role as a screening study remained questionable. Neuroradiological intervention was used successfully to treat hemorrhagic VAI and progressing vertebrobasilar stroke. Systemic anticoagulation with heparin was the preferred treatment for mild ischemia. Treatment of asymptomatic patients has been controversial because the natural history of VAI has not been elucidated. Prophylactic anticoagulation with heparin or the use of antiplatelet agents was advocated in recent studies. Conclusions Preemptive treatment may be reasonable in selected patients considering the devastating potentials of VAI. The potential risks of heparin or antiplatelet agents in relation to early cervical spine surgery have not been addressed fully, however, and spine surgeons have to weigh the risk and benefit of such treatment cautiously.
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iatrogenic vertebral Artery Injury
Acta Neurologica Scandinavica, 2005Co-Authors: Joji Inamasu, Bernard H GuiotAbstract:Iatrogenic vertebral Artery Injury (VAI) results from various diagnostic and therapeutic procedures. The objective of this article is to provide an update on the mechanism of Injury and management of this potentially devastating complication. A literature search was conducted using PubMed. The iatrogenic VAIs were categorized according to each diagnostic or therapeutic procedure responsible for the Injury, i.e., central venous catheterization, cervical spine surgery, chiropractic manipulation, diagnostic cerebral angiography, percutaneous nerve block, and radiation therapy. The incidence, mechanisms of Injury, and reparative procedures were discussed for each type of procedure. The type of VAI depends largely on the type of procedure. Laceration was the dominant type of acute Injury in central venous catheterization and cervical spine surgery. Arteriovenous fistulae and pseudoaneurysms were the delayed complications. Arterial dissection was the dominant Injury type in chiropractic manipulation and diagnostic cerebral angiography. Inadvertent arterial injection caused seizures or stroke in percutaneous nerve block. Radiation therapy was responsible for endothelial Injury which in turn resulted in delayed stenosis and occlusion of the vertebral Artery (VA). The proximal VA was the most vulnerable portion of the Artery. Although iatrogenic VAIs are rare, they may actually be more prevalent than had previously been thought. Diagnosis of iatrogenic VAI may not always be easy because of its rarity and deep location, and a high level of suspicion is necessary for its early detection. A precise knowledge of the surgical anatomy of the VA is essential prior to each procedure to prevent its iatrogenic Injury.
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Iatrogenic carotid Artery Injury in neurosurgery
Neurosurgical Review, 2005Co-Authors: Joji Inamasu, Bernard H GuiotAbstract:Iatrogenic carotid Artery Injury (CAI) results from various neurosurgical procedures. A review of the literature was conducted to provide an update on the management of this potentially devastating complication. Iatrogenic CAIs are categorized according to each diagnostic or therapeutic procedure responsible for the Injury, i.e., anterior cervical spine surgery, central venous catheterization, chemical substances, chiropractic manipulation, diagnostic cerebral angiography, middle-ear surgery, percutaneous procedures for trigeminal neuralgia, radiation therapy, skull-base surgery, tracheostomy, and transsphenoidal surgery. The incidence, mechanisms of Injury, diagnostic imaging modalities, and reparative procedures are discussed for each procedure. Iatrogenic CAI may be more prevalent than had previously been thought, mostly because of a heightened awareness on the part of physicians and the earlier detection of asymptomatic patients owing to sophisticated and less-invasive imaging modalities. Prevention is the best treatment for every iatrogenic Injury, and it is expected that further accumulation of experience with and knowledge of iatrogenic CAI will result in further reduction of this complication. Although some CAIs, such as radiation-induced carotid Artery stenosis, may not be preventable, earlier intervention before the patient becomes symptomatic may favorably alter the prognosis. Following the rapid development of endovascular techniques in recent years, surgically inaccessible lesions can be treated in a more reliable and safe manner than before.
Joji Inamasu - One of the best experts on this subject based on the ideXlab platform.
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vertebral Artery Injury after blunt cervical trauma an update
Surgical Neurology, 2006Co-Authors: Joji Inamasu, Bernard H GuiotAbstract:Abstract Background Vertebral Artery Injury (VAI) after blunt cervical trauma has been considered to be rare. The incidence of VAI has increased dramatically within the last decade after a heightened awareness of this entity on the part of spine surgeons. Diagnostic or therapeutic guidelines for VAI have not been established fully, however. Methods A review of the literature published between 1990 and 2004 was conducted. Results The incidence of VAI among total blunt trauma admissions ranged from 0.20% to 0.77%. Most VAI patients remained asymptomatic, but sudden unexpected deterioration was often reported. Distraction/extension, distraction/flexion, and lateral flexion injuries were the major mechanisms of Injury. Dissection and occlusion were the frequent vascular Injury patterns. Facet joint dislocations and the fractures extending into the transverse foramen were the spine Injury patterns closely associated with VAI. Digital subtraction angiography was the most sensitive imaging study, but because of invasiveness, its role as a screening study remained questionable. Neuroradiological intervention was used successfully to treat hemorrhagic VAI and progressing vertebrobasilar stroke. Systemic anticoagulation with heparin was the preferred treatment for mild ischemia. Treatment of asymptomatic patients has been controversial because the natural history of VAI has not been elucidated. Prophylactic anticoagulation with heparin or the use of antiplatelet agents was advocated in recent studies. Conclusions Preemptive treatment may be reasonable in selected patients considering the devastating potentials of VAI. The potential risks of heparin or antiplatelet agents in relation to early cervical spine surgery have not been addressed fully, however, and spine surgeons have to weigh the risk and benefit of such treatment cautiously.
-
iatrogenic vertebral Artery Injury
Acta Neurologica Scandinavica, 2005Co-Authors: Joji Inamasu, Bernard H GuiotAbstract:Iatrogenic vertebral Artery Injury (VAI) results from various diagnostic and therapeutic procedures. The objective of this article is to provide an update on the mechanism of Injury and management of this potentially devastating complication. A literature search was conducted using PubMed. The iatrogenic VAIs were categorized according to each diagnostic or therapeutic procedure responsible for the Injury, i.e., central venous catheterization, cervical spine surgery, chiropractic manipulation, diagnostic cerebral angiography, percutaneous nerve block, and radiation therapy. The incidence, mechanisms of Injury, and reparative procedures were discussed for each type of procedure. The type of VAI depends largely on the type of procedure. Laceration was the dominant type of acute Injury in central venous catheterization and cervical spine surgery. Arteriovenous fistulae and pseudoaneurysms were the delayed complications. Arterial dissection was the dominant Injury type in chiropractic manipulation and diagnostic cerebral angiography. Inadvertent arterial injection caused seizures or stroke in percutaneous nerve block. Radiation therapy was responsible for endothelial Injury which in turn resulted in delayed stenosis and occlusion of the vertebral Artery (VA). The proximal VA was the most vulnerable portion of the Artery. Although iatrogenic VAIs are rare, they may actually be more prevalent than had previously been thought. Diagnosis of iatrogenic VAI may not always be easy because of its rarity and deep location, and a high level of suspicion is necessary for its early detection. A precise knowledge of the surgical anatomy of the VA is essential prior to each procedure to prevent its iatrogenic Injury.
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Iatrogenic carotid Artery Injury in neurosurgery
Neurosurgical Review, 2005Co-Authors: Joji Inamasu, Bernard H GuiotAbstract:Iatrogenic carotid Artery Injury (CAI) results from various neurosurgical procedures. A review of the literature was conducted to provide an update on the management of this potentially devastating complication. Iatrogenic CAIs are categorized according to each diagnostic or therapeutic procedure responsible for the Injury, i.e., anterior cervical spine surgery, central venous catheterization, chemical substances, chiropractic manipulation, diagnostic cerebral angiography, middle-ear surgery, percutaneous procedures for trigeminal neuralgia, radiation therapy, skull-base surgery, tracheostomy, and transsphenoidal surgery. The incidence, mechanisms of Injury, diagnostic imaging modalities, and reparative procedures are discussed for each procedure. Iatrogenic CAI may be more prevalent than had previously been thought, mostly because of a heightened awareness on the part of physicians and the earlier detection of asymptomatic patients owing to sophisticated and less-invasive imaging modalities. Prevention is the best treatment for every iatrogenic Injury, and it is expected that further accumulation of experience with and knowledge of iatrogenic CAI will result in further reduction of this complication. Although some CAIs, such as radiation-induced carotid Artery stenosis, may not be preventable, earlier intervention before the patient becomes symptomatic may favorably alter the prognosis. Following the rapid development of endovascular techniques in recent years, surgically inaccessible lesions can be treated in a more reliable and safe manner than before.
Takashi Nakamura - One of the best experts on this subject based on the ideXlab platform.
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vertebral Artery Injury during cervical spine surgery a survey of more than 5600 operations
Spine, 2008Co-Authors: Shunsuke Fujibayashi, Masahiko Miyata, Mitsuru Takemoto, Takashi NakamuraAbstract:STUDY DESIGN: Retrospective survey. OBJECTIVE: To clarify the present incidence and management of iatrogenic vertebral Artery Injury (VAI) during cervical spine surgery. SUMMARY OF BACKGROUND DATA: VAI is a rare complication of cervical spine surgery, but it may be catastrophic. Anterior cervical decompression (ACD) and posterior atlantoaxial transarticular screw fixation (Magerl fixation) have been the main causes, with reported incidences of 0.3% to 0.5% and 0% to 8.2%, respectively. Popular new surgical techniques, such as cervical pedicle screw or C1 lateral mass screw fixation, also entail the potential risk of VAI. METHODS: A questionnaire was sent to our affiliated hospitals requesting information regarding iatrogenic VAI during cervical spine surgery. RESULTS: Seven spine surgeon groups and 25 general orthopedist groups responded to the questionnaire, with a response rate of 89%. The overall incidence of VAI was 0.14% (8 cases among 5641 cervical spine surgeries). The incidence in anterior cervical decompression procedures was 0.18% and that in Magerl fixation was 1.3%. Inexperienced surgeons tended to commit VAI more frequently. One case of VAI during C1 lateral mass screw fixation was included, whereas there was no case of VAI caused by cervical pedicle screw fixation. In the case of "VAI in the screw hole," hemostasis was obtained by tamponade or screw insertion, whereas "VAI in the open space" sometimes caused uncontrollable bleeding, in which embolization eventually stopped the bleeding. There were no deaths or apparent neurologic sequelae. CONCLUSION: The incidence of VAI during cervical spine surgery from this survey was similar to or slightly less than that in the literature. Tamponade was effective in many cases, but prompt consultation with an endovascular team is recommended if the bleeding is uncontrollable. Preoperative careful evaluation of the vertebral Artery seems to be most important to prevent iatrogenic VAI and to avoid postoperative neurologic sequelae.
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comparison of the anatomical risk for vertebral Artery Injury associated with the c2 pedicle screw and atlantoaxial transarticular screw
Spine, 2006Co-Authors: Makoto Yoshida, Shunsuke Fujibayashi, Takashi NakamuraAbstract:STUDY DESIGN: We evaluated the trajectories of atlantoaxial transarticular and C2-pedicle screws in 3 dimensions using computerized tomography. OBJECTIVE: To compare the anatomic risk for vertebral Artery Injury associated with C2-pedicle and atlantoaxial transarticular screws. SUMMARY OF BACKGROUND DATA: The atlantoaxial fixation technique using C1-lateral mass screws combined with C2-pedicle screws is considered a safer technique for preventing vertebral Artery Injury than atlantoaxial transarticular fixation. However, few reports have compared the anatomic risk of vertebral Artery Injury associated with C2-pedicle screws with that of transarticular screws. METHODS: A total of 62 consecutive patients with cervical lesions were evaluated using 3-dimensional images reconstructed by a computer-assisted navigation system. We compared the maximum possible diameters of the atlantoaxial transarticular screw and C2-pedicle screw trajectories, and examined whether the maximum possible diameters were limited by the height or width of the bony structure in screw trajectories < or = 4 mm in diameter. RESULTS: Mean maximum possible diameters did not differ significantly between the trajectories of 124 atlantoaxial transarticular and 124 C2-pedicle screws. In screw trajectories < or = 4 mm in diameter, 57.1% of transarticular screw trajectories were limited by the height of the bony structure, and all pedicle screw trajectories were limited by the width. CONCLUSIONS: C2-pedicle screw placement has nearly the same anatomic risk of vertebral Artery Injury as transarticular screw placement. Preoperative 3-dimensional evaluation may be useful for choosing the best surgical technique.
Daniel K Riew - One of the best experts on this subject based on the ideXlab platform.
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carotid Artery Injury in anterior cervical spine surgery multicenter cohort study and literature review
Global Spine Journal, 2017Co-Authors: Roger Hartl, Marjan Alimi, Mohamed Abdelatif Boukebir, Connor Berlin, Rodrigo Navarroramirez, Paul M Arnold, Michael G Fehlings, Thomas E Mroz, Daniel K RiewAbstract:Study Design:Retrospective study and literature review.Objective:To provide more comprehensive data about carotid Artery Injury (CAI) or cerebrovascular accident (CVA) related to anterior cervical ...
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risk of vertebral Artery Injury comparison between c1 c2 transarticular and c2 pedicle screws
The Spine Journal, 2013Co-Authors: Jin Sup Yeom, Jacob M Buchowski, Bongsoon Chang, Daniel K RiewAbstract:Abstract Background context To our knowledge, no large series comparing the risk of vertebral Artery Injury by C1–C2 transarticular screw versus C2 pedicle screw have been published. In addition, no comparative studies have been performed on those with a high-riding vertebral Artery and/or a narrow pedicle who are thought to be at higher risk than those with normal anatomy. Purpose To compare the risk of vertebral Artery Injury by C1–C2 transarticular screw versus C2 pedicle screw in an overall patient population and subsets of patients with a high-riding vertebral Artery and a narrow pedicle using computed tomography (CT) scan images and three-dimensional (3D) screw trajectory software. Study design Radiographic analysis using CT scans. Patient sample Computed tomography scans of 269 consecutive patients, for a total of 538 potential screw insertion sites for each type of screw. Outcome measures Cortical perforation into the vertebral Artery groove of C2 by a screw. Methods We simulated the placement of 4.0 mm transarticular and pedicle screws using 1-mm-sliced CT scans and 3D screw trajectory software. We then compared the frequency of C2 vertebral Artery groove violation by the two different fixation methods. This was done in the overall patient population, in the subset of those with a high-riding vertebral Artery (defined as an isthmus height ≤5 mm or internal height ≤2 mm on sagittal images) and with a narrow pedicle (defined as a pedicle width ≤4 mm on axial images). Results There were 78 high-riding vertebral arteries (14.5%) and 51 narrow pedicles (9.5%). Most (82%) of the narrow pedicles had a concurrent high-riding vertebral Artery, whereas only 54% of the high-riding vertebral arteries had a concurrent narrow pedicle. Overall, 9.5% of transarticular and 8.0% of pedicle screws violated the C2 vertebral Artery groove without a significant difference between the two types of screws (p=.17). Among those with a high-riding vertebral Artery, vertebral Artery groove violation was significantly lower (p=.02) with pedicle (49%) than with transarticular (63%) screws. Among those with a narrow pedicle, vertebral Artery groove violation was high in both groups (71% with transarticular and 76% with pedicle screws) but without a significant difference between the two groups (p=.55). Conclusions Overall, neither technique has more inherent anatomic risk of vertebral Artery Injury. However, in the presence of a high-riding vertebral Artery, placement of a pedicle screw is significantly safer than the placement of a transarticular screw. Narrow pedicles, which might be anticipated to lead to higher risk for a pedicle screw than a transarticular screw, did not result in a significant difference because most patients (82%) with narrow pedicles had a concurrent high-riding vertebral Artery that also increased the risk with a transarticular screw. Except in case of a high-riding vertebral Artery, our results suggest that the surgeon can opt for either technique and expect similar anatomic risks of vertebral Artery Injury.
William C Welch - One of the best experts on this subject based on the ideXlab platform.
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iatrogenic vertebral Artery Injury during anterior cervical spine surgery
The Spine Journal, 2005Co-Authors: James P Burke, Peter C Gerszten, William C WelchAbstract:Abstract Background context Iatrogenic Injury to the vertebral Artery during an anterior cervical decompression is a rarely mentioned but potentially catastrophic complication. Purpose This study was designed to examine the incidence and management of iatrogenic vertebral Artery Injury (IVAI) in a large database. Study design/setting This was a retrospective study performed at a large teaching institution over a 7-year period (1994–2001). Patient sample All anterior cervical spinal procedures performed for herniated or degenerative disc disease, or cervical spondylosis were identified, as were incidences of IVAI. Anterior cervical procedures performed for trauma, neoplasia, or infection were excluded from this study. Outcome measures Neurological and associated morbidity as well as mortality were recorded. Methods Data were accessed through an institution-wide electronic medical record search through the operative reports of 10 spine surgeons. Hospital and clinical charts of IVAI cases were subsequently reviewed. Demographic data and intraoperative strategies for repair were recorded. Results A total of 1,976 patients underwent anterior cervical spinal procedures in the review period. Six cases of IVAI were identified. In three of the six patients, arterial bleeding was controlled with hemostatic agents. Of these three, two suffered complications. The initial management of controlling arterial bleeding is by hemostatic agents; however, one must also consider repair or ligation. The remaining three patients were treated with primary repair or ligation, and no complications were noted. Conclusions IVAI is a rare complication (0.3%) of anterior cervical procedures. The arterial bleeding can usually be controlled with topical hemostatic agents, but mortality may occur in instances where it cannot be adequately addressed in a timely fashion.
