Rate and Characteristics of Vertebral Artery Injury Following C1-C2 Posterior Cervical Fusion: A Systematic Review and Meta-Analysis

Background: Intraoperative vascular injuries in the cervical spine are rare, but carry significant morbidity and mortality when they do occur. There is a need to better characterize the risk of vertebral artery injury (VAI) after posterior C1-C2 fusion. The aim of this study was to investigate the rate of VAI in patients undergoing posterior C1-C2 cervical fusion. Methods: An electronic database search was performed to identify studies that reported rates of VAI following posterior cervical fusion at C1-C2 level. Patient-specific risk factors, surgical indication, surgical technique, and other data were collected for each study. Forest plots were created to outline the pooled ratios of VAI in the literature. Results: Eleven studies with 773 patients were identified. Mean age of patients was 48.47 years (range, 6–78 years), and most patients were female (61.7%, n = 399). Trauma was the most frequent indication for surgery (18.8%, n = 146), followed by inflammatory processes affecting the vertebrae (13.2%, n = 102). The rate of VAI per patient was 2% (95% confidence interval = 1%–4%) among 773 patients, while injury rate per screw was 1% (95% confidence interval = 0%–2%) among 2238 screws placed. Conclusions: The rate of VAI after C1-C2 posterior cervical fusion was found to be 2% for each operated patient and 1% for each screw placed.