Antiplatelet versus Anticoagulation for Asymptomatic Patients with Vertebral Artery Injury during Anterior Cervical Surgery-Two Case Reports and Review of Literature

Vertebral Artery Injury (VAI) while performing cervical spinal reconstruction surgery is rare, but it can lead to catastrophic events. Treatment for this injury with regard to antiplatelet versus anticoagulation therapy is controversial. The purpose of this report is to discuss two cases of VAI that occurred during the performance of cervical reconstruction surgery and provide a guideline based on a literature review about whether to use anticoagulant or antiplatelet therapy for treatment of asymptomatic VAI. In case 1, iatrogenic injury occurred to the left C5 vertebral artery (VA) during high speed burr removal of an osteophyte on the left C5/6 uncovertebral joint, resulting in VAI. This patient was treated with Heparin resulting in respiratory complication. Case 2 encountered VAI while using the kerrison rongeur to perform a right sided C5/6 foraminotomy. Antiplatelet therapy was administered. Fourteen publications relevant to Antiplatelet versus Anticoagulation treatment were reviewed. Anticoagulation has similar results to antiplatelet therapy. Studies are limited; there were no common guidelines or parameters concerning the utilization of Antiplatelets versus Anticoagulants. Anticoagulation achieved similar results as Antiplatelet therapy; based on the limited relevant data, the superiority of one treatment over the other cannot be concluded in VAI after cervical spinal reconstruction surgery.