Favorable Long-Term Outcomes for Positional Vertebral Artery Occlusion with Treatment Strategy Prioritizing Spinal Fusion Surgery.

Abstract

Positional vertebral artery occlusion (PVAO) has a fundamental problem in the definition. We analyzed the long-term outcomes with a redefinition of the rare clinical entities as PVAO for a broader conceptualization, and discuss the efficacy of fusion surgery as a treatment option. We analyzed the clinical and radiologic characteristics and outcomes in 8 patients with PVAO who experienced cerebral ischemia during a 10-year period at our institution. The follow-up periods ranged from 60 to 132 months (mean, 93.5 months). All patients were initially treated conservatively with external fixation. If spinal instability was observed at the initial evaluation or a second stroke occurred during conservative treatment, cervical spinal fusion was performed with special consideration for vertebral artery dominance and the presence of its collateral flow regardless of the type of stroke. Conservative therapy was completed for 2 patients, and spinal fusion was performed for the other 6 patients. None of the patients experienced a recurrence of symptoms after discharge until the final follow-up visit, and the outcomes were excellent. Long-term functional outcomes were dependent on the patient's condition before the onset of stroke and the neurologic deficits resulting from the initial or recurrent stroke induced by embolism. We report our single-center experience with PVAO in which 75% of patients had embolic stroke. Because embolic stroke may have a greater risk of recurrence affecting the long-term outcomes, it should be prevented. In addition, if surgical intervention is necessary, spinal fusion surgery may be an effective option.