• Jeong-Wook Choi, Jung-Kil Lee, Kyung-Sub Moon, Yeon-Seong Kim, Hyoung-Jun Kwak, Sung-Pil Joo, Jae-Hyoo Kim, and Soo-Han Kim.
• Department of Neurosurgery, Chonnam National University Hospital, Gwangju, Korea.
• Spine. 2006 Nov 1;31(23):E891-4.

Study DesignCase description.ObjectivesTo report 2 cases of vertebral artery injury (VAI) during anterior cervical decompression surgery and review the pertinent medical literature.Summary Of Background DataThe incidence of VAI during an anterior surgical approach to the cervical spine is rare but potentially lethal. The spine surgeon should be aware of the detailed surgical anatomy and be prepared to manage an inadvertent injury to the vertebral artery.MethodsIn the first case presented, infection was the cause of VAI. During aggressive irrigation and pus drainage, massive bleeding was encountered. For the second case, the vertebral artery was injured during decompression of cervical spondylosis while drilling the neural foramen. Intraoperative direct packing with hemostatic agents provided effective control of hemorrhage.ResultsTen days after surgery, sudden neck swelling and mental deterioration occurred because of rebleeding from a pseudoaneurysm in the first case. In the second case, a pseudoaneurysm was detected by angiography, obtained 4 days after surgery. Both pseudoaneurysms were successfully occluded by an endovascular technique without any neurologic sequelae.ConclusionsIn case of bleeding control by hemostatic packing, there remains a risk of delayed hemorrhage from pseudoaneurysm. Postoperative vertebral angiography is helpful to avoid life-threatening complications. Endovascular treatment can be a good alternative in the treatment of VAI.

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