Safety of early posterior fusion surgery without endovascular embolization for asymptomatic vertebral artery occlusion associated with cervical spine trauma.

Abstract

PURPOSE:

Vertebral artery occlusion (VAO) is an increasingly recognized complication of cervical spine trauma. However, the management strategy of VAO remains heavily debated. Therefore, the aim of this retrospective study was to investigate the safety of early fusion surgery for traumatic VAO.

METHODS:

This study included a total of 241 patients (average age 64.7 years; 201 men) who underwent early surgical treatment for acute cervical spine injury between 2012 and 2019. The incidence of VAO, cerebral infarction rates, the recanalization rates, and cerebral thromboembolism after recanalization were retrospectively analyzed.

RESULTS:

VAO occurred in 22 patients (9.1%). Of the 22 patients with VAO, radiographic cerebral infarction was detected in 4 patients (21.1%) at initial evaluation, including 1 symptomatic medullar infarction (4.5%) and 3 asymptomatic cerebrum infarctions. A patient who experienced right medullar infarction showed no progression of the neurologic damage. Follow-up imaging revealed that the VAOs of 9 patients (40.9%) were recanalized, and the recanalization did not correlate with clinical adverse outcomes. The arteries of the remaining 13 (59.1%) patients remained occluded and clinically silent until the final follow-up (mean final follow-up 33.0 months).

CONCLUSION:

Despite the lack of a concurrent control group with preoperative antiplatelet therapy or endovascular embolization for VAO, our results showed low symptomatic stroke rate (4.5%), high recanalization rate (40.9%), and low mortality rate (0%). Therefore, we believe that the indication for early stabilization surgery as management strategy of asymptomatic VAO might be one of the safe and effective treatment options for prevention of symptomatic cerebral infarction.

• Authors: Mitsuru Asukai, Hiroki Ushirozako, Kota Suda, Satoko Matsumoto Harmon, Miki Komatsu, Akio Minami, Masahiko Takahata, Norimasa Iwasaki, Yukihiro Matsuyama
• Journal: European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society (Eur Spine J) Vol. 31 Issue 12 Pg. 3392-3401 (Dec 2022) ISSN: 1432-0932 [Electronic] Germany
• PMID: 35821446 (Publication Type: Journal Article)
• Copyright: © 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

Topics

• Male
• Humans
• Middle Aged
• Vertebral Artery (diagnostic imaging, surgery, injuries)
• Retrospective Studies
• Spinal Injuries (complications)
• Cerebral Infarction (etiology)
• Treatment Outcome
• Neck Injuries (complications)
• Cervical Vertebrae (diagnostic imaging, surgery, injuries)