Delayed subarachnoid hemorrhage following failed odontoid screw fixation.

Department

Neurosurgery

Document Type

Article

Abstract

Iatrogenic vascular injury is a rare but potentially devastating complication of cervical spine instrumentation. The authors report on a patient who developed an anterior spinal artery pseudoaneurysm associated with delayed subarachnoid hemorrhage after undergoing odontoid screw placement 14 months earlier. This 86-year-old man presented with spontaneous subarachnoid hemorrhage (Fisher Grade 4) and full motor strength on neurological examination. Imaging demonstrated pseudarthrosis of the odontoid process, extension of the odontoid screw beyond the posterior cortex of the dens, and a pseudoaneurysm arising from an adjacent branch of the anterior spinal artery. Due to the aneurysm's location and lack of active extravasation, endovascular treatment was not attempted. Posterior C1-2 fusion was performed to treat radiographic and clinical instability of the C1-2 joint. Postoperatively, the patient's motor function remained intact. Almost all cases of vascular injury related to cervical spine instrumentation are recognized at surgery. To the authors' knowledge, this is the first report of delayed vascular injury following an uncomplicated cervical fixation. This case further suggests that the risk of this phenomenon may be elevated in cases of failed fusion.

Medical Subject Headings

Aged, 80 and over; Bone Screws; Cerebral Angiography; Fracture Fixation, Internal; Fractures, Bone; Humans; Internal Fixators; Male; Odontoid Process; Subarachnoid Hemorrhage; Treatment Outcome

Publication Date

6-1-2011

Publication Title

Journal of neurosurgery. Spine

ISSN

1547-5646

Volume

14

Issue

6

First Page

715

Last Page

718

PubMed ID

21395399

Digital Object Identifier (DOI)

10.3171/2011.1.SPINE10561

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