Abstracts

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E1125. Disaster aVERTed: What Does the Spine Surgeon Need to Know?
Authors
  1. Amy Condos; Naval Medical Readiness and Training Command San Diego
  2. John Vigilante; Naval Medical Readiness and Training Command San Diego
  3. Daniel Hawley; Naval Medical Readiness and Training Command San Diego
  4. Aaron Cho; Naval Medical Readiness and Training Command San Diego
  5. Michael Cathey; Naval Medical Readiness and Training Command San Diego
Background
Vertebral artery injury (VAI) is the most common vascular injury in cervical spine surgery due to its variable course and proximity to areas of instrumentation. While VAI is rare, with the incidence ranging from 0.08%-0.5%, the potential consequences can be catastrophic leading to bleeding, neurological damage or death. Therefore, it is essential for radiologists to evaluate more than disc and arthritic degeneration on preoperative imaging, with the intent of helping to prevent complications from spine surgery.

Educational Goals / Teaching Points
The purpose of this exhibit is to: - Review cervical vascular anatomy, emphasizing the surgically important vascular anomalies using a case-based approach - Assist viewers to prospectively add value to the pre-operative imaging evaluation beyond disc and arthritic degeneration

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
We will briefly review the normal vascular anatomy of the cervical spine, and then present cases highlighting surgically important vascular anomalies. Abbreviated review of normal vascular anatomy, Surgically Important Vascular Anomalies of the Cervical Spine, Aberrant Origin of the Vertebral Artery, Aberrant Course of the Vertebral Artery, High Riding Vertebral Artery, High Entrance of the Vertebral Artery, Duplicated Vertebral Artery, Hypoplastic Vertebral Artery, Fenestrated Vertebral Artery, Vertebral Artery Loop Formation/Tortuous VA, Retropharyngeal course of the Carotid Artery, Aberrant Right Subclavian Artery, Occult Internal Carotid Artery Stenosis, Fibromuscular Dysplasia

Conclusion
Vascular complications in cervical spine surgery are rare, but they have the potential to cause permanent neurological damage or even death. Vertebral artery injury is the most common vascular injury in spine surgery and most commonly occurs in posterior upper cervical spine instrumentation and anterior corpectomy. Radiologists can add value to the preoperative imaging evaluation beyond arthritic and disc degeneration by being aware of cervical vascular anatomy and anomalies. By drawing attention to these findings, the radiologist can potentially aid the surgeon in preventing catastrophic injury.