• BACKGROUND
    • The overall incidence of iatrogenic vertebral artery injury (IVAI) in cervical spine surgeries (CSSs) is reported to be 0.07%-1.4%. Although IVAI occurred during C1-2 fusion, there is no accurate information regarding the surgery-specific risk of IVAI. This study aimed to stratify incidence of IVAI by surgical method and evaluate the correlation between IVAI and its sequelae.
  • METHODS
    • This retrospective, multicenter study involved clinical and radiologic evaluations for IVAI. All CSSs performed between 2012 and 2016 were included; neck mass excision and pain intervention were excluded. Patient characteristics, diagnosis, surgical technique, complications, and presence of IVAI were collected. In IVAI cases, technique details, characteristics, and sequelae were investigated.
  • RESULTS
    • This study included 14,722 patients with 15,582 CSSs in 21 centers. IVAIs were identified in 13 (0.08%) patients. Surgery-specific incidence of IVAI was 1.35% in cases involving C1-2 posterior fixation and 0.20% in cases involving C3-6 posterior fixation. Common injury mechanisms were screw-in (31%) and high-speed drilling (23%). Screw-related IVAI occurred in 9 (69%) patients, and IVAI of the C1 lateral mass and C2 pedicle screws occurred in 4 and 3 patients, respectively. Of 13 cases of IVAI, 3 (23%) involved cerebellar or stem infarction; the infarction had no substantial correlation with injury grade or dominancy.
  • CONCLUSIONS
    • Overall incidence of IVAI in CSSs was 0.08%. C1-2 posterior fixation had the highest incidence of IVAI (1.35%). Although clinical results of IVAI can be highly variable, controlling risk factors of IVAI is important.