Gonzalo F. Del Rio Montesinos Abstract Title : Unveiling the Risks: A Deep Dive into Vertebral Artery Injuries Post Cervical Disc Arthroplasty Background Cervical Disc Arthroplasty (CDA) treats cervical disc degeneration and spinal compression, offering a high success rate and improved neck disability index. During CDA, the vertebral artery (VA), a major blood vessel branching from the subclavian artery, is at risk. This courses the transverse foramen of C2-C6 vertebrae, exits at C2, and enters the skull via the foramen magnum. Injuries are often due to anatomical variations, though rare, can cause severe complications. The objective of this narrative review is to analyze variables such as Normal Anatomy, FDA-approved Devices, increase CDA, the prevalence of VAI in the anterior approach, case reports regarding the injury, preventative measures, and treatment were considered.

Methods The articles chosen were from June 30th, 2000, to June 30th, 2024, and sourced from PubMed, Science Direct, and Web of Science. The keywords were cervical, cervical disc, vertebral artery, vertebral artery injury, disc arthroplasty, and degenerative disc.

Results Extensive literature exists regarding the anatomic variations such as a 7.6% occurrence among 250 individuals. The anterior approach of CDA has a 0.4% occurrence of VAI. Pre-operative MRI and post-operative advanced imaging techniques such as MRI must be implemented with more frequency to determine artery course and health outcomes. Physician experience has significant effects upon possible injuries. Surgeons with < 300 procedure experience had a 0.33% possibility of injuring the artery and those with > 300 had 0.06%. CDA has been implemented in Europe since the 1960s however it wasn’t until 2007 where the FDA approved the first CDA device for the USA. Among 11 FDA-approved devices, eight reported blood loss, two Vascular Intra op, and one cerebrovascular bleeding, however no device indicated to have a VAI as a complication. Two case reports were found regarding VAI following CDA. In VAI, a stent has 97% success rate, however one must consider long term re-stenting and symptom reappearance. Two case reports regarding VAI following CDA indicated the lack of literature of the injury and the possible complication when approaching the procedure. In the years 2007-2013 there has been a nonlinear 190% increase in the use of CDA, exponentially replacing anterior cervical fusion and one must consider that this continuous implementation will bring about increased case reports regarding complications.

Conclusion VAI must be considered when approaching a CDA due the higher prevalence of these procedures being implemented. Anatomic variations, Physician Experience, preventative and treatment management are factors to consider in VAI.