scholarly journals Antiplatelet Versus Anticoagulation for Asymptomatic Patients with Vertebral Artery Injury During Anterior Cervical Surgery—Two Case Reports and Review of Literature

2019 ◽  
Vol 9 (12) ◽  
pp. 345 ◽  
Author(s):  
Michael Hall ◽  
David Cheng ◽  
Wayne Cheng ◽  
Olumide Danisa
Keyword(s):  
Vertebral Artery ◽  
Antiplatelet Therapy ◽  
High Speed ◽  
Anticoagulation Therapy ◽  
Vertebral Artery Injury ◽  
Reconstruction Surgery ◽  
Artery Injury ◽  
Spinal Reconstruction ◽  
Asymptomatic Patients ◽  
Cervical Surgery

Vertebral Artery Injury (VAI) while performing cervical spinal reconstruction surgery is rare, but it can lead to catastrophic events. Treatment for this injury with regard to antiplatelet versus anticoagulation therapy is controversial. The purpose of this report is to discuss two cases of VAI that occurred during the performance of cervical reconstruction surgery and provide a guideline based on a literature review about whether to use anticoagulant or antiplatelet therapy for treatment of asymptomatic VAI. In case 1, iatrogenic injury occurred to the left C5 vertebral artery (VA) during high speed burr removal of an osteophyte on the left C5/6 uncovertebral joint, resulting in VAI. This patient was treated with Heparin resulting in respiratory complication. Case 2 encountered VAI while using the kerrison rongeur to perform a right sided C5/6 foraminotomy. Antiplatelet therapy was administered. Fourteen publications relevant to Antiplatelet versus Anticoagulation treatment were reviewed. Anticoagulation has similar results to antiplatelet therapy. Studies are limited; there were no common guidelines or parameters concerning the utilization of Antiplatelets versus Anticoagulants. Anticoagulation achieved similar results as Antiplatelet therapy; based on the limited relevant data, the superiority of one treatment over the other cannot be concluded in VAI after cervical spinal reconstruction surgery.

Civilian gunshot wounds to the atlantoaxial spine: a report of 10 cases treated using a multidisciplinary approach

2013 ◽  
Vol 19 (6) ◽  
pp. 759-766 ◽  
Author(s):  
Peter Syre ◽  
Leonardo Rodriguez-Cruz ◽  
Rajiv Desai ◽  
Karl A. Greene ◽  
Robert Hurst ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Operative Treatment ◽  
Anticoagulation Therapy ◽  
Vascular Complications ◽  
Gunshot Wounds ◽  
Vertebral Artery Injury ◽  
Treatment Modalities ◽  
Acute Management ◽  
Lateral Mass ◽  
Artery Injury

Object Gunshot wounds to the atlantoaxial spine are uncommon injuries and rarely require treatment, as a bullet traversing this segment often results in a fatal injury. Additionally, these injuries are typically biomechanically stable. The authors report a series of 10 patients with gunshot wounds involving the lateral mass and/or bodies of the atlantoaxial complex. Their care is discussed and conclusions are drawn from these cases to identify the optimal treatment for these injuries. Methods A retrospective review was conducted of patients presenting to the emergency rooms of 3 institutions with gunshot wounds involving the atlantoaxial spine. Mechanism of injury and neurological status were obtained, as was the extent of the osteoligamentous, vascular, and neurological injuries. Nonoperative and operative treatment, complications, and clinical and radiographic outcome were recorded. The data were then analyzed to determine the neurological and biomechanical prognosis of these injuries, the utility of the various diagnostic modalities in the acute management of the injuries, and the nature and effectiveness of the nonoperative and operative treatment modalities. Results Ten patients with gunshot wounds involving the lateral mass and/or bodies of the atlantoaxial complex were identified. All but 2 patients sustained a vertebral artery injury. Each patient was evaluated using cervical radiographs, CT scans, and vascular imaging, 8 in the form of digital subtraction angiography and 2 with high-resolution CT angiography. Uncomplicated patients were treated conservatively using cervical collar immobilization, local wound care, and antibiotics. One patient was treated using a halo for instability and 1 underwent posterior fusion following a posterolateral decompression for delayed myelopathy. One patient underwent transoral resection of a bullet fragment. One patient underwent embolization for a symptomatic arteriovenous fistula and a second patient underwent a neck exploration and a jugular vein ligation. None of the patients received anticoagulation therapy. The mean follow-up duration was 13 months. All but 2 patients regained their previous functional status and all ultimately attained a mechanically stable spine. Conclusions These 10 patients represent a rare form of cervical spine penetrating injury. Unilateral gunshot wounds to the atlantoaxial complex are usually stable and the need for acute surgical intervention is rare. Unilateral vertebral artery injury is well tolerated and any information provided by angiography does not alter the acute management of the patient. Vascular complications from gunshot wounds can be managed effectively by endovascular techniques.

Blunt Cerebrovascular Injuries

2017 ◽  
Author(s):  
Clay Cothren Burlew
Keyword(s):  
Carotid Artery ◽  
Vertebral Artery ◽  
Blunt Trauma ◽  
Computed Tomographic Angiography ◽  
Vertebral Artery Injury ◽  
Trauma Patients ◽  
Carotid Artery Injury ◽  
Computed Tomographic ◽  
Artery Injury ◽  
Asymptomatic Patients

Blunt cerebrovascular injuries (BCVIs) are increasingly recognized in trauma patients, with 1 to 3% of all blunt trauma patients being diagnosed with a carotid artery injury or a vertebral artery injury. Specific injury patterns are associated with BCVI and serve as the trigger for injury screening in asymptomatic patients. Multislice (> 64-slice) computed tomographic angiography is the routine imaging test performed to identify BCVI. Once an injury is identified, antithrombotic treatment almost universally prevents BCVI-related stroke. Endovascular therapy for BCVI is reserved for those patients who are markedly symptomatic or have an enlarging pseudoaneurysm on repeat imaging. Key Words: blunt cerebrovascular injuries, blunt trauma, carotid artery injury, stroke, vertebral artery injury

Blunt Cerebrovascular Injuries

2017 ◽  
Author(s):  
Clay Cothren Burlew
Keyword(s):  
Carotid Artery ◽  
Vertebral Artery ◽  
Blunt Trauma ◽  
Computed Tomographic Angiography ◽  
Vertebral Artery Injury ◽  
Trauma Patients ◽  
Carotid Artery Injury ◽  
Computed Tomographic ◽  
Artery Injury ◽  
Asymptomatic Patients

Blunt cerebrovascular injuries (BCVIs) are increasingly recognized in trauma patients, with 1 to 3% of all blunt trauma patients being diagnosed with a carotid artery injury or a vertebral artery injury. Specific injury patterns are associated with BCVI and serve as the trigger for injury screening in asymptomatic patients. Multislice (> 64-slice) computed tomographic angiography is the routine imaging test performed to identify BCVI. Once an injury is identified, antithrombotic treatment almost universally prevents BCVI-related stroke. Endovascular therapy for BCVI is reserved for those patients who are markedly symptomatic or have an enlarging pseudoaneurysm on repeat imaging. Key Words: blunt cerebrovascular injuries, blunt trauma, carotid artery injury, stroke, vertebral artery injury

Blunt Cerebrovascular Injuries

2017 ◽  
Author(s):  
Clay Cothren Burlew
Keyword(s):  
Carotid Artery ◽  
Vertebral Artery ◽  
Blunt Trauma ◽  
Computed Tomographic Angiography ◽  
Vertebral Artery Injury ◽  
Trauma Patients ◽  
Carotid Artery Injury ◽  
Computed Tomographic ◽  
Artery Injury ◽  
Asymptomatic Patients

Blunt cerebrovascular injuries (BCVIs) are increasingly recognized in trauma patients, with 1 to 3% of all blunt trauma patients being diagnosed with a carotid artery injury or a vertebral artery injury. Specific injury patterns are associated with BCVI and serve as the trigger for injury screening in asymptomatic patients. Multislice (> 64-slice) computed tomographic angiography is the routine imaging test performed to identify BCVI. Once an injury is identified, antithrombotic treatment almost universally prevents BCVI-related stroke. Endovascular therapy for BCVI is reserved for those patients who are markedly symptomatic or have an enlarging pseudoaneurysm on repeat imaging. Key Words: blunt cerebrovascular injuries, blunt trauma, carotid artery injury, stroke, vertebral artery injury

Blunt Cerebrovascular Injuries

2017 ◽  
Author(s):  
Clay Cothren Burlew
Keyword(s):  
Carotid Artery ◽  
Vertebral Artery ◽  
Blunt Trauma ◽  
Computed Tomographic Angiography ◽  
Vertebral Artery Injury ◽  
Trauma Patients ◽  
Carotid Artery Injury ◽  
Computed Tomographic ◽  
Artery Injury ◽  
Asymptomatic Patients

Blunt cerebrovascular injuries (BCVIs) are increasingly recognized in trauma patients, with 1 to 3% of all blunt trauma patients being diagnosed with a carotid artery injury or a vertebral artery injury. Specific injury patterns are associated with BCVI and serve as the trigger for injury screening in asymptomatic patients. Multislice (> 64-slice) computed tomographic angiography is the routine imaging test performed to identify BCVI. Once an injury is identified, antithrombotic treatment almost universally prevents BCVI-related stroke. Endovascular therapy for BCVI is reserved for those patients who are markedly symptomatic or have an enlarging pseudoaneurysm on repeat imaging. Key Words: blunt cerebrovascular injuries, blunt trauma, carotid artery injury, stroke, vertebral artery injury

Blunt Cerebrovascular Injuries

2017 ◽  
Author(s):  
Clay Cothren Burlew
Keyword(s):  
Carotid Artery ◽  
Vertebral Artery ◽  
Blunt Trauma ◽  
Computed Tomographic Angiography ◽  
Vertebral Artery Injury ◽  
Trauma Patients ◽  
Carotid Artery Injury ◽  
Computed Tomographic ◽  
Artery Injury ◽  
Asymptomatic Patients

Blunt cerebrovascular injuries (BCVIs) are increasingly recognized in trauma patients, with 1 to 3% of all blunt trauma patients being diagnosed with a carotid artery injury or a vertebral artery injury. Specific injury patterns are associated with BCVI and serve as the trigger for injury screening in asymptomatic patients. Multislice (> 64-slice) computed tomographic angiography is the routine imaging test performed to identify BCVI. Once an injury is identified, antithrombotic treatment almost universally prevents BCVI-related stroke. Endovascular therapy for BCVI is reserved for those patients who are markedly symptomatic or have an enlarging pseudoaneurysm on repeat imaging. Key Words: blunt cerebrovascular injuries, blunt trauma, carotid artery injury, stroke, vertebral artery injury

Risk of Vertebral Artery Injury: A Comparison between C2 Subarticular Segmental and C1-2 Transarticular Screws

2008 ◽  
Vol 43 (5) ◽  
pp. 572 ◽  
Author(s):  
Seong Wan Kim ◽  
Jin S. Yeom ◽  
Yoon Ju Kwon ◽  
Seung Min You ◽  
Young Hee An ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Vertebral Artery Injury ◽  
Artery Injury

Vertebral Artery Injury in the Cervical Spine

JBJS Reviews ◽  
2021 ◽  
Vol 9 (1) ◽  
pp. e20.00118-e20.00118
Author(s):  
Pradip Ramamurti ◽  
Jeffrey Weinreb ◽  
Safa C. Fassihi ◽  
Raj Rao ◽  
Shalin Patel
Keyword(s):  
Cervical Spine ◽  
Vertebral Artery ◽  
Vertebral Artery Injury ◽  
Artery Injury
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