Treatment of Acute Vertebral Artery Injury (VAI)



This chapter describes the acute management of vertebral artery injury during cervical spine surgery. Immediate provisional hemostasis should be achieved via tamponade using the left index finger. When this is not feasible, localized pressure should be applied using a few cottonoid pledgets and gauzes. Once provisional hemostasis is achieved, thorough preparation for the next steps should be carried out prior to removing the index finger or packing materials. Bleeding from the vertebral artery during pedicle screw insertion can be stopped by promptly placing a screw or using bone wax. When the artery is injured in an open space, there are three definitive management options depending on the severity of the injury and dominance of the injured artery: (1) adequate packing with local hemostatic agents in case provisional tamponade for a sufficient time stops bleeding permanently, (2) sacrifice of the injured artery by ligation, clipping, or endovascular coil occlusion, (3) direct suture or endovascular stent placement.

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  1. 1.
    Park HK, Jho HD. The management of vertebral artery injury in anterior cervical spine operation: a systematic review of published cases. Eur Spine J. 2012;21:2475–85.CrossRefGoogle Scholar
  2. 2.
    Neo M, Fujibayashi S, Miyata M, et al. Vertebral artery injury during cervical spine surgery: a survey of more than 5600 operations. Spine. 2008;33:779–85.CrossRefGoogle Scholar
  3. 3.
    Yoon KW, Ko JH, Cho CS, et al. Endovascular treatment of vertebral artery injury during cervical posterior fusion (C1 lateral mass screw): a case report. Interv Neuroradiol. 2013;19:370–6.CrossRefGoogle Scholar
  4. 4.
    Maughan PH, Ducruet AF, Elhadi AM, et al. Multimodality management of vertebral artery injury sustained during cervical or craniocervical surgery. Neurosurgery. 2013;73:271–81.CrossRefGoogle Scholar
  5. 5.
    Peng CW, Chou BT, Bendo JA, et al. Vertebral artery injury in cervical spine surgery: anatomical considerations, management, and preventive measures. Spine J. 2009;9:70–6.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgerySeoul National University Bundang HospitalSungnamSouth Korea

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