The Incidence of Vertebral Artery Injury in Cervical Spine Surgery

Abstract

Study DesignRetrospective Cohort Study ObjectiveThe purpose of this study is to identify the incidence of vertebral artery injuries (VAI) in patients undergoing cervical spine procedures for degenerative pathologies. Summary of Background DataPreviously reported estimates of VAI during cervical spine surgery relied upon self-reported survey studies and retrospective cohorts which may not be reflective of national averages. The largest study to date reports an incidence of 0.07%; however, significant variation exists between different cervical spine procedures. MethodsA national insurance database was used to access patient data from 2010-2020, who underwent Anterior Cervical Discectomy and Fusion (ACDF), Anterior Corpectomy, Posterior Cervical Fusion (C3-C7), or C1-C2 posterior fusions for degenerative pathologies. Patients who experienced a vertebral artery injury were identified and frequencies for the different procedures were compared. ResultsA total of 224,326 patients were included in this study and the overall incidence of VAI across all procedures was found to be 0.03%. The highest incidence of VAI was estimated in C1-C2 posterior fusion (0.12-1.10%). The number of VAI cases post anterior corpectomy, ACDF, and posterior fusion were 14 (0.06), 43 (0.02) and 26 (0.01) patients respectively. ConclusionsThis is the largest study to date that provides frequencies of vertebral artery injuries in patients undergoing cervical spine surgery in the United States. Our finding of 0.03% is lower than previously reported estimates but significant variability exists between procedures which is important to counsel patients when discussing risks of surgery.