Delayed subarachnoid hemorrhage following failed odontoid screw fixation

Case report

Restricted access

Iatrogenic vascular injury is a rare but potentially devastating complication of cervical spine instrumentation. The authors report on a patient who developed an anterior spinal artery pseudoaneurysm associated with delayed subarachnoid hemorrhage after undergoing odontoid screw placement 14 months earlier. This 86-year-old man presented with spontaneous subarachnoid hemorrhage (Fisher Grade 4) and full motor strength on neurological examination. Imaging demonstrated pseudarthrosis of the odontoid process, extension of the odontoid screw beyond the posterior cortex of the dens, and a pseudoaneurysm arising from an adjacent branch of the anterior spinal artery. Due to the aneurysm's location and lack of active extravasation, endovascular treatment was not attempted. Posterior C1–2 fusion was performed to treat radiographic and clinical instability of the C1–2 joint. Postoperatively, the patient's motor function remained intact. Almost all cases of vascular injury related to cervical spine instrumentation are recognized at surgery. To the authors' knowledge, this is the first report of delayed vascular injury following an uncomplicated cervical fixation. This case further suggests that the risk of this phenomenon may be elevated in cases of failed fusion.

Abbreviations used in this paper: SAH = subarachnoid hemorrhage; VA = vertebral artery.
Article Information

Contributor Notes

Address correspondence to: Nicholas Theodore, M.D., c/o Neuroscience Publications, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, 350 West Thomas Raod, Phoenix, Arizona 85013. email: neuropub@chw.edu.Please include this information when citing this paper: published online March 11, 2011; DOI: 10.3171/2011.1.SPINE10561.
Headings
References
  • 1

    Daentzer DDeinsberger WBöker DK: Vertebral artery complications in anterior approaches to the cervical spine: report of two cases and review of literature. Surg Neurol 59:3003092003

    • Search Google Scholar
    • Export Citation
  • 2

    Fisher CMKistler JPDavis JM: Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 6:191980

    • Search Google Scholar
    • Export Citation
  • 3

    Inamasu JGuiot BH: Vascular injury and complication in neurosurgical spine surgery. Acta Neurochir (Wien) 148:3753872006

  • 4

    Neo MFujibayashi SMiyata MTakemoto MNakamura T: Vertebral artery injury during cervical spine surgery: a survey of more than 5600 operations. Spine 33:7797852008

    • Search Google Scholar
    • Export Citation
  • 5

    Prabhu VCFrance JCVoelker JLZoarski GH: Vertebral artery pseudoaneurysm complicating posterior C1–2 transarticular screw fixation: case report. Surg Neurol 55:29342001

    • Search Google Scholar
    • Export Citation
TrendMD
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 200 199 44
Full Text Views 66 56 0
PDF Downloads 110 67 0
EPUB Downloads 0 0 0
PubMed
Google Scholar