Vertebral artery dissection following a posterior cervical foraminotomy

Abstract

Vertebral artery dissection following a posterior cervical foraminotomy with rhizolysis of the subaxial spine has not been described before. A 46-year-old lady underwent the procedure for a left C6 radiculopathy with a focal disc herniation with no intraoperative complications. Seven hours post-operatively, she developed a right homonymous hemianopia, thalamic dysphasia, gait and memory impairment. Imaging demonstrated an occlusion to the left vertebral artery from C7/T1 to C4 with a dissection flap noted at the inferior margin. This was further complicated with thrombosis of the dissected artery and subsequent emboli causing acute posterior circulation infarctions. Given that the dissection occurred at the level of the surgery, an indirect surgical cause is likely. We hypothesize that the vibration transmitted via bone from the high-speed drill led to arterial injury and dissection.