Death due to extensive cervicomedullary infarction following iatrogenic vertebral artery occlusion
An 85 year old female with a medical history of hypertension and hyperlipidemia was newly diagnosed with carcinoma of the right breast with metastasis to the spine, resulting in a pathological fracture at the level of the second cervical vertebra. She underwent operative stabilization of the cervical spine.
The operation was carried out under general anesthesia via the posterior approach. Occipital-cervical spine stabilization was established with the aid of an occipital plate, C1 lateral mass screws, C2 pars interarticularis screws, C3 lateral mass screws and C4 pedicle screws, with a connecting rod applied across the levels on each side. Immediately after the operation, the anesthetist observed the patient had prolonged apnea, depressed conscious level and a lack of gag reflex, despite cessation of all sedatives for more than an hour and the administration of intravenous naloxone. Her blood pressure started to drift downwards. She was conveyed to the...
KeywordsVertebral Artery Pedicle Screw Cervical Vertebra Cervical Cord Thoracic Outlet Syndrome
- 7.Wright NM, Lauryssen C. Vertebral artery injury in C1–2 transarticular screw fixation: results of a survey of the AANS/CNS section on disorders of the spine and peripheral nerves. American Association of Neurological Surgeons/Congress of Neurological surgeons. J Neurosurg. 1998;88:634–40.PubMedCrossRefGoogle Scholar