Novel technique for intraoperative imaging of the vertebral artery in patients undergoing dorsal osteosynthesis of the cervical spine

Abstract

Background: The incidence of fractures in the upper cervical spine is a common entity among elderly patients. The incidence depends on the health care system and the adopted protocols for a computer tomogram in the emergency unit, in order to assure an easier and earlier detection. Injuries to the vertebral artery could occur with devastating consequences, due to this type of fracture. The aim of the current surgical strategies is to stabilize the fractures and avoid further injuries to the vertebral arteries. Methods: We adopted a previously hypothesized method for intraoperative imaging of the vertebral artery when performing an O-Arm navigated cervical osteosynthesis. Three patients were included in this group: one patient with dens fracture type II after Anderson and D’Alonzo, one patient with a complex C1/C2 fracture and dissection of the vertebral artery on the left side and one patient with a kyphotic deformity due to Larynx carcinoma Metastasis in C4-C6. After positioning the patients, a 100 ml contrast was applied prior to the primary O-Arm scan, thus obtaining real-time imaging of the vertebral artery in the navigational CT series. Results: A total of 18 screws were placed. None of the screws bridged the vertebral canal. The average operative time was 174 mins. No new neurological deterioration was observed in the postoperative period. Conclusions: With the development of this technique, it is possible to reduce the surgery-related injury of the vertebral artery to 0%. Further studies are necessary to assess the feasibility of this technique. This technique could be especially helpful in the cases of distorted anatomical relations.