Prevention, Management, and Monitoring of Vertebral Artery Injuries. Current State of Knowledge of Spine Surgeons in Argentina
Abstract
Introduction: Vertebral artery injury is a serious event. The objective of this work is to evaluate the degree of knowledge of spinal surgeons in Argentina regarding the diagnostic and therapeutic measures of vertebral artery injury. Materials and Methods: An observational descriptive study was carried out through a survey transmitted through AANC and SAPCV. Results: Of 157 responses, 47.4% consider it relevant to evaluate the anatomy of the vertebral artery in all types of pathology by angiographic methods. Half of those surveyed diagnosed an anatomical variant of the artery, 29.2% reported having encountered an artery injury during their practice and only 35% had an action protocol for the management of this adverse event. 77% adopted tamponade as their first measure. In the postoperative follow-up, the majority of surgeons studied the final state of the situation using angiographic methods. Around 10% would try to establish some measure of antithrombotic prophylaxis. 76.6% have an hemodynamics service with an endovascular surgeon. Conclusion: We found an underestimation of this complication. Less than half of surgeons routinely use diagnostic tools for possible anatomical changes. Management or monitoring protocols for these injurieshave not been observed.Downloads
References
Riew KD, Reidler JS, Benzel E, Goel A, Vialle L, Abumi K, et al. Expert Advice Forum on AOSpine International.
Management of Intraoperative Vertebral Artery Lacerations, 2020. Dissertation. Disponible en: https://aovideos.
aofoundation.org/media/lng=en/1_f9bv2m7y?_ga=2.106769415.52853214.1641727860-1224076216.1632358289
Hsu WK, Kannan A, Mai, HT, Fehlings MG, Smith ZA, Traynelis VC, et al. Epidemiology and outcomes of
vertebral artery injury in 16 582 cervical spine surgery patients: An AOSpine North America Multicenter Study.
Global Spine J 2017;7(1 suppl):21S-27S. https://doi.org/10.1177/2192568216686753
Neo M, Fujibayashi S, Miyata M, Takemoto M, Nakamura T. Vertebral artery injury during cervical spine surgery: a survey of more than 5600 operations. Spine (Phila PA 1976) 2008;33(7):779-85. https://doi.org/10.1097/BRS.0b013e31816957a7
Lunardini DJ, Eskander MS, Even JL, Dunlap JT, Chen AF, Lee JY, et al. Vertebral artery injuries in cervical spine
surgery. Spine J 2014;14(8):1520-5. https://doi.org/10.1016/j.spinee.2013.09.016
Eskander MS, Jacob MD, Aubin ME, Marvin J, Franklin PD, Eck JC, et al. Vertebral artery anatomy. A review of
two hundred fifty magnetic resonance imaging scans. Spine (Phila PA 1976) 2010;35(23):2035-40.
https://doi.org/10.1097/BRS.0b013e3181c9f3d4
Lee SH, Park DH, Kim SD, Huh DS, Kim KT. Analysis of 3-dimensional course of the intra-axial vertebral artery
for C2 pedicle screw trajectory: a computed tomographic study. Spine (Phila Pa 1976) 2014;39(17):E1010-4.
https://doi.org/10.1097/BRS.0000000000000418
Sano A, Hirano T, Watanabe K, Izumi T, Endo N, Ito T, Inagawa S. Preoperative evaluation of the vertebral arteries and posterior portion of the circle of Willis for cervical spine surgery using 3-dimensional computed tomography angiography. Spine (Phila Pa 1976) 2013;38(15):E960-7. https://doi.org/10.1097/BRS.0b013e318296e542
Wakao N, Takeuchi M, Nishimura M, Riew KD, Kamiya M, Hirasawa A, et al. Risks for vascular injury during
anterior cervical spine surgery: prevalence of a medial loop of vertebral artery and internal carotid artery. Spine
(Phila PA 1976) 2016;41(4):293-8. https://doi.org/10.1097/BRS.0000000000001241
Young JP, Young PH, Ackermann MJ, Anderson PA, Riew KD. The ponticulus posticus: implications for screw
insertion into the first cervical lateral mass. J Bone Joint Surg Am 2005;87(11): 2495-8. https://doi.org/10.2106/JBJS.E.00184
Choi B, Granero R, Pak A. Catalog of bias in health questionnaires. Rev Costarr Salud Pública 2010;19:106-18.
Disponible en: https://www.scielo.sa.cr/scielo.php?pid=S1409-14292010000200008&script=sci_arttext&tlng=en
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