Vertebral Arteriovenous Fistula: A Rare Complication Following Transpedicular Occipitocervical Fixation in a Patient with Atlantoaxial Dislocation

Abstract

Vertebral arteriovenous fistula (AVF), a complication of a vertebral artery injury (VAI), is a rare but serious complication of upper cervical spine fixation surgery. We report a case of a 59-year-old female patient who had a vertebral AVF following transpedicular occipitocervical fixation surgery. Endovascular embolization of the AVF was successfully performed using ethylene vinyl alcohol. From this case we learned that preoperative evaluation of the course of the vertebral artery is necessary, and vertebral artery embolism is an effective and safe method to treat vertebral AVF after proof of a patent second vertebral artery.

Keywords

vertebral arteriovenous fistula - vertebral artery injury - cervical spine - fixation

• References

• 1 Grabowski G, Cornett CA, Kang JD. Esophageal and vertebral artery injuries during complex cervical spine surgery—avoidance and management. Orthop Clin North Am 2012; 43 (01) 63-74 , viii
• 2 Elliott RE, Tanweer O, Boah A. , et al. Comparison of screw malposition and vertebral artery injury of C2 pedicle and transarticular screws: meta-analysis and review of the literature. J Spinal Disord Tech 2014; 27 (06) 305-315
• 3 Lunardini DJ, Eskander MS, Even JL. , et al. Vertebral artery injuries in cervical spine surgery. Spine J 2014; 14 (08) 1520-1525
• 4 Takagaki H, Nishimura S, Onda J. , et al. Vertebral arteriovenous fistula as a complication of atlantoaxial transarticular screw fixation—case report [in Japanese]. Brain Nerve 2008; 60 (03) 291-294
• 5 Yang Y, Liu H, Ma L, Zeng J, Song Y, Xie X. Sudden cerebral infarction after interventional vertebral artery embolism for vertebral artery injury during removal of C1-C2 pedicle screw fixation: a case report. Int J Clin Exp Med 2015; 8 (09) 16803-16807
• 6 Miyata M, Neo M, Ito H. , et al. Is rheumatoid arthritis a risk factor for a high-riding vertebral artery?. Spine 2008; 33 (18) 2007-2011
• 7 Innocenzi G, Bistazzoni S, D'Ercole M. , et al. Does navigation improve pedicle screw placement accuracy? Comparison between navigated and non-navigated percutaneous and open fixations. Acta Neurochir Suppl (Wien) 2017; 124: 289-295