Delayed Hemorrhage Followed by Vertebral Artery Injury during Cervical Anterior Controllable Antedisplacement and Fusion Surgery: Case Report and Literature Review

Abstract

Background: Vertebral artery injury (VAI) during cervical spine surgery is rare. Anterior controllable ante-displacement and fusion (ACAF) surgery is a novel technique for treating degenerative cervical spine disorders, especially ossification of the posterior longitudinal ligament. To date, there have been no reports of VAI during cervical ACAF surgery. Here, we report a rare case of perioperative complication of VAI during ACAF surgery. The available English literature that provides treatment instructions were reviewed.

Case presentation: A patient diagnosed with mixed ossification of the posterior longitudinal ligament (OPLL) underwent ACAF surgery from C2-C6. Two level transverse foramina were ruptured, and severe bleeding was encountered during ACAF osteotomy. Hemostatic tamponade was performed using bone waxes. The patient had delayed hemorrhage on postoperative day 6. Emergence angiography revealed two vertebral artery pseudoaneurysms in the ruptured transverse foramina. A balloon-expandable covered stent was deployed to treat the pseudoaneurysm. The patient recovered without complications.

Conclusion: ACAF surgery is a good choice for multiple-level OPLL disease, but special attention should be paid to VAI in the perioperative period. Intraoperative tamponade with bone wax and postoperative digital subtraction angiography (DSA) are effective in preventing disaster-related hemorrhage.

Keywords: Angiography; Anterior controllable ante-displacement and fusion; Hemorrhage; Ossification of the posterior longitudinal ligament; Vertebral artery injury.