Gonzalo Del Rio Montesinos, BS
Lancelot Benn, MD
Christopher P. Bellaire, MD
Addisu Mesfin, MD
Universidad Central del Caribe (UCC)
MedStar Georgetown University School of Medicine
Nth Dimensions
MedStar Orthopedic Institute, MedStar Washington Hospital Center
Introduction
Cervical disc arthroplasty (CDA) is an increasingly utilized surgical intervention for cervical disc degeneration, aimed at preserving motion and reducing disability. However, vertebral artery injury (VAI) is a rare but serious complication, often linked to anatomical variations and surgical technique. Despite the increasing adoption of CDA, limited literature exists on the incidence, risk factors, and prevention of VAI. This review synthesizes current data on anatomical risk factors, FDA-approved devices, documented VAI cases, and mitigation strategies.
Methods
A narrative review was conducted using PubMed, Science Direct, and Web of Science for articles published between June 30, 2000, and June 30, 2024. Keywords included cervical, cervical disc, vertebral artery, vertebral artery injury, disc arthroplasty, and degenerative disc. Studies focusing on VAI incidence, risk factors, and surgical outcomes were analyzed.
Results
Anatomical variations in the vertebral artery occur in 7.6% of the population, posing a potential risk during CDA. The anterior surgical approach has a 0.4% incidence of VAI, reinforcing the necessity of pre- and post-operative MRI for risk assessment. Surgeon experience significantly influences VAI risk, with those performing fewer than 300 procedures reporting a 0.33% incidence, compared to 0.06% for more experienced surgeons. Although CDA has been performed in Europe since the 1960s and FDA-approved in the U.S. since 2007, no FDA-approved device reports VAI as a complication. Only two published case reports document VAI post-CDA, indicating a gap in clinical literature. The growing adoption of CDA, with a 190% increase from 2007 to 2013, underscores the need for further research.
Conclusion
Although rare, VAI during CDA is a critical complication that warrants further study. Surgeon expertise, anatomical considerations, and imaging protocols are essential for risk mitigation. Given the rapid adoption of CDA, further research is necessary to optimize safety, refine techniques, and establish evidence-based guidelines for preoperative assessment and intraoperative precautions.
