Vertebral artery injury during anterior cervical vertebral surgery caused by transverse foramen malformation-appendix: case report and literature review

One male patient at 59 years old of age was diagnosed as cervical myelopathy for unsteady gait and stiff lower limbs, followed by cervical 3/4 and 5/6 discectomy plus bone grafting and internal fixation, when processing the superior endplate of left cervical 4 disk, a large number of arterial bleeding occurred, which was stopped by packing method, and followed by continued cervical discectomy plus internal fixation. This patient was followed up for five years, the left vertebral artery was blocked, while no significant vascular injury-associated complication occurred, nor the symptoms of spinal cord further aggravated. We believed that the missed-diagnosed transverse foramen malformation before surgery led to the occurrence of almost catastrophic intraoperative bleeding, which might be ignored by the vast majority of clinicians and imaging physicians in preoperative routine magnetic resonance imaging (MRI) examination, therefore, paying high attention to this situation, as well as preoperative vertebral CT scanning or vertebral artery angiography would be essential.