PICA injury secondary to anterior odontoid screw fixation: Case report of an exceptional complication

Abstract

Background: Odontoid fracture is a common injury in the upper cervical spine that can sometimes be managed by anterior odontoid screw fixation.

Case description: We report the first case of iatrogenic postero-inferior cerebellar artery (PICA) injury while performing anterior odontoid screw fixation for a type II odontoid fracture in a 22-year-old man. Fisher grade 4 subarachnoid hemorrhage secondary to iatrogenic pseudoaneurysm formation was managed by the endovascular neuroradiologist. Odontoid fracture was then managed posteriorly using Harm's technique. Postoperative 12-month follow-up revealed good clinical and radiological results. CT scan showed fusion. Complete exclusion of the pseudo aneurysm with a mild stroke in the inferior left cerebellar hemisphere were noted on the MRI. There were no cerebellar ataxia or swallowing disorders.

Conclusion: To the best of our knowledge, this is the first case report of iatrogenic PICA injury in anterior odontoid screw fixation. The patient was well managed in our institution within a multidisciplinary team. We recommend that surgical management of odontoid fractures should be performed in expert centres.

Keywords: Anterior fixation; Complication; Iatrogenic; Odontoid fracture; PICA injury; Pseudoaneurysm.