Vertebral artery injury during cervical discectomy and fusion in a patient with bilateral anomalous arteries in the disc space: Case report

Objective: Our goal was to increase the safety of anterior cervical discectomy, a routine surgery performed by neurosurgeons worldwide, in the face of vertebral artery (VA) anomalies. Clinical presentation: A 59-year-old woman had an intraoperative injury of the left VA during elective anterior cervical discectomy and fusion from C3 to 7. Retrospective analysis of her magnetic resonance images showed bilateral anomalous VAs. Intervention postoperatively, a pseudoaneurysm developed that was subsequently coiled. The patient underwent embolization of the pseudoaneurysm and sacrifice of the parent vessel by endovascular neurosurgical techniques. She had no neurological sequelae but did have some difficulty swallowing. Conclusion: Radiologists, neuroradiologists, and surgeons should note the location and course of the VA in their routine evaluation of cervical magnetic resonance images. Neuroradiologists should alert surgeons to the possibility of anomalous VAs that are at risk of injury during surgery. Ultimately, it remains the responsibility of the surgeon to carefully review the images, assess for vascular anomalies, and plan the surgery accordingly.