Analysis of Vertebral Artery Injuries in Cervical Disc Arthroplasty

IF 2.3 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the National Medical Association Pub Date : 2025-09-01 DOI:10.1016/j.jnma.2025.08.056

Gonzalo F. Del Rio Montesinos BS, Lancelot Benn MD, Christopher P. Bellaire MD, Addisu Mesfin MD

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引用次数: 0

Abstract

Introduction

Cervical Disc Arthroplasty (CDA) treats cervical disc degeneration and spinal compression, offering a high success rate and improved neck disability index. During CDA, the vertebral artery (VA), a major blood vessel branching from the subclavian artery, is at risk. This courses the transverse foramen of C2-C6 vertebrae, exits at C2, and enters the skull via the foramen magnum. Injuries are often due to anatomical variations, though rare, can cause severe complications. The goal of this review is to analyze variables influence the incidence of vertebral artery injuries (VAI) such as Normal Anatomy, FDA-approved Devices, increase CDA, the prevalence of VAI in the anterior approach, case reports regarding the injury, preventative measures, and treatment were considered.

Methods

The articles chosen were from June 30th, 2000, to June 30th, 2024, and sourced from PubMed, Science Direct, and Web of Science. The articles inclusion and exclusion criteria were based on the qualitative and quantitative quality of the information sourced. We obtained the articles utilizing keywords such as cervical, cervical disc, vertebral artery, vertebral artery injury, disc arthroplasty, and degenerative disc. The risk of bias was obtained via the Robins-I V2 Tool for each individual article utilized. The synthesis of results was obtained via a meta-analysis of multiple articles.

Results

A total of 78 articles were analyzed, with 45 included in the systematic review. Anatomic variations of the vertebral artery occurred in 7.6% of 250 individuals, and the anterior approach of CDA had a 0.4% VAI occurrence. Surgeons with <300 procedures had a 0.33% risk of VAI, while those with >300 had 0.06%. FDA approved CDA in the U.S. in 2007, and among 11 approved devices, none reported VAI as a complication. Two case reports documented VAI post-CDA, highlighting limited literature. Stenting had a 97% success rate but required long-term monitoring. Between 2007-2013, CDA use increased 190%, replacing anterior cervical fusion. The risk of bias was low in intervention classification, outcome measurement, and result reporting but uncertain for confounding and missing data due to limited methodological details.

Conclusion

VAI risk in CDA necessitates careful consideration of anatomical variations, surgeon expertise, and robust preventive and treatment strategies. Increased usage underscores the need for more comprehensive research and reporting on potential complications.

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颈椎间盘置换术中椎动脉损伤的分析

颈椎间盘置换术（CDA）治疗颈椎间盘退变和脊柱压迫，成功率高，改善了颈部残疾指数。在CDA期间，椎动脉（VA）是锁骨下动脉分支的主要血管，处于危险之中。沿C2- c6椎体的横孔走行，在C2处退出，并通过枕骨大孔进入颅骨。损伤通常是由于解剖变异，虽然罕见，但会引起严重的并发症。本综述的目的是分析影响椎动脉损伤（VAI）发生率的变量，如正常解剖、fda批准的器械、增加的CDA、前路VAI的患病率、有关损伤的病例报告、预防措施和治疗。方法论文选取时间为2000年6月30日~ 2024年6月30日，文献来源为PubMed、Science Direct和Web of Science。文章的纳入和排除标准基于信息来源的定性和定量质量。我们以颈椎、颈椎间盘、椎动脉、椎动脉损伤、椎间盘成形术、退变性椎间盘等关键词获取相关文章。通过罗宾斯- i V2工具对所使用的每一篇文章进行偏倚风险评估。综合结果是通过多篇文章的荟萃分析得出的。结果共分析78篇文献，纳入系统评价45篇。250例患者中7.6%发生椎动脉解剖变异，CDA前路VAI发生率为0.4%。做过300次手术的外科医生发生VAI的风险为0.33%，而做过300次手术的外科医生发生VAI的风险为0.06%。FDA于2007年在美国批准了CDA，在11个批准的设备中，没有一个报告VAI是并发症。两例病例报告记录了cda后的VAI，突出了文献的局限性。支架置入术的成功率为97%，但需要长期监测。2007-2013年间，CDA的使用增加了190%，取代了颈椎前路融合术。干预分类、结果测量和结果报告的偏倚风险较低，但由于方法学细节有限，混淆和缺失数据的风险不确定。结论CDA的vai风险需要仔细考虑解剖变异，外科医生的专业知识，以及强有力的预防和治疗策略。使用量的增加强调了对潜在并发症进行更全面研究和报告的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the National Medical Association 医学-医学：内科

CiteScore

4.80

自引率

3.00%

发文量

139

审稿时长

98 days

期刊介绍： Journal of the National Medical Association, the official journal of the National Medical Association, is a peer-reviewed publication whose purpose is to address medical care disparities of persons of African descent. The Journal of the National Medical Association is focused on specialized clinical research activities related to the health problems of African Americans and other minority groups. Special emphasis is placed on the application of medical science to improve the healthcare of underserved populations both in the United States and abroad. The Journal has the following objectives: (1) to expand the base of original peer-reviewed literature and the quality of that research on the topic of minority health; (2) to provide greater dissemination of this research; (3) to offer appropriate and timely recognition of the significant contributions of physicians who serve these populations; and (4) to promote engagement by member and non-member physicians in the overall goals and objectives of the National Medical Association.