Treatment of Acute Vertebral Artery Injury (VAI)

Abstract

This chapter describes the acute management of vertebral artery injury during cervical spine surgery. Immediate provisional hemostasis should be achieved via tamponade using the left index finger. When this is not feasible, localized pressure should be applied using a few cottonoid pledgets and gauzes. Once provisional hemostasis is achieved, thorough preparation for the next steps should be carried out prior to removing the index finger or packing materials. Bleeding from the vertebral artery during pedicle screw insertion can be stopped by promptly placing a screw or using bone wax. When the artery is injured in an open space, there are three definitive management options depending on the severity of the injury and dominance of the injured artery: (1) adequate packing with local hemostatic agents in case provisional tamponade for a sufficient time stops bleeding permanently, (2) sacrifice of the injured artery by ligation, clipping, or endovascular coil occlusion, (3) direct suture or endovascular stent placement.