Vertebral Artery Injury

Christopher T. Martin

John G. Heller

Steven M. Presciutti

John M. Rhee

Radiologic Assessment

The risk of vertebral artery injury can be minimized by careful review of preoperative imaging. Tortuous branching patterns or enlarged arteries should be noted (Figures 38-1 and 38-2) and the surgical approach should be adjusted accordingly in order to minimize risk.

Figure 38-1 ▪ Anomalous right vertebral artery, which is much more dorsal than usual and potentially at risk during anterior foraminotomy. Note the more normal position of the left artery.

Figure 38-2 ▪ This patient underwent anterior cervical diskectomy and fusion elsewhere and had persistent symptoms but, thankfully, no vertebral artery injury. Note the anomalous transverse foramen on the left near the anterior cervical plate, suggesting that the artery is enlarged and medially encroaching into the lateral aspect of the vertebral body.

The size and caliber of the two vertebral arteries should be compared in order to help assess vertebral artery dominance.
If a vertebral artery injury occurs, an angiogram should be obtained postoperatively in order to verify adequacy of flow both in the injured artery and on the contralateral side (Figure 38-3).

Figure 38-3 ▪ Postoperative angiogram of the right vertebral artery in the case of a patient with a right-sided vertebral artery injury that occurred during an anterior cervical diskectomy and fusion. The artery is patent, but tortuous at the site of the injury (arrow).