Delayed Cerebellar Infarction more than One Year after Posterior Cervical Fixation Treated with Parent Artery Occlusion: A Case Report

Abstract

Vertebral artery (VA) injury is a possible complication of posterior cervical fixation; however, this injury rarely develops long after surgery. Herein, we report a case of cerebellar infarction which developed one year and four months after this operation. A 67-year-old man with a history of cervical spondylosis treated with posterior fixation at another hospital in March 2020 visited our hospital upon experiencing astasia in July 2021. Neurological findings revealed consciousness disorder (JCS 3), conjugate deviation to the left, dysarthria, right facial paralysis, and right limb ataxia. The National Institute of Health Stroke Scale was 15. Head magnetic resonance imaging and computed tomography (CT) revealed massive infarction in the right cerebellar hemisphere and vermis. Contrast-enhanced CT showed aberrant progression of the right C2 screw into the transverse foramen, causing injury to the VA. On day 4 of admission, stenosis was observed on digital subtraction angiography of the VA. We performed coil embolization of the parent artery to prevent repetition of infarction. The patient recovered well and was discharged with a modified Rankin Scale score of 2. This case indicates that VA injury after posterior cervical fixation can develop in the remote period following surgery. Although no clear evidence has yet been established, we suggest that parent artery embolization is both safe and useful.