Giant delayed pseudo-aneurysm following screw placement in C1 lateral mass

We report the case of a patient who suffered iatrogenic vertebral artery injury (VAI) during a cervical spine posterior fixation procedure. The patient suffered massive bleeding and hemorrhagic shock at the time of screws placement in C1 lateral mass and C2 pedicle. The postoperative MRI and CT angiography showed a pseudoaneurysm 7.0 cm in diameter in the cervical spine. The iatrogenic VAI during posterior screw fixation is extremely rare. But, it can cause catastrophic consequences. We discuss the causes for the iatrogenic VAI and review the preventative measures and suitable management to avoid iatrogenic complications.