Ayesha Waheed Presents VeRTIAL at the 11th Annual Safety in Spine Surgery Summit

SCOLI Principal Research Fellow Ayesha Waheed, MBBS, took the stage at the 11th Annual Safety in Spine Surgery Summit in New York City to present VeRTIAL: The Vertebral Artery Injury Assessment Lifeline, a perioperative algorithm for the prevention, recognition, and management of iatrogenic vertebral artery injury (VAI) in cervical spine surgery.

Vertebral artery injury is among the most feared complications in cervical spine surgery: rare, but with the potential for catastrophic bleeding, stroke, and death. VeRTIAL distills that high-stakes scenario into a single, shared framework that the whole operating room team can follow, from preoperative planning through the moment of crisis and into recovery.

One framework, three phases, two pathways

Rather than treating VAI as an unpredictable emergency, VeRTIAL organizes the response into three clear phases:

• Anticipate (Preoperative). Stratify risk on CT/MRI, and add CTA/MRA and intraoperative navigation for high-risk cases.
• Rescue (Intraoperative). Apply approach-specific control and a single, well-rehearsed escalation ladder.
• Surveil (Postoperative). Mandate vascular imaging and serial follow-up.

A key insight of the algorithm is that anterior and posterior injuries are not the same emergency: each follows its own rescue pathway, with a dedicated escalation ladder that moves from local control through to definitive management. Giving the team a common language and a single ladder to climb, rather than improvising under pressure, is what turns a rare catastrophe into a manageable, drilled response.

VeRTIAL maps vertebral artery injury onto three phases (Anticipate, Rescue, and Surveil), with separate rescue pathways for anterior and posterior injuries.

A team effort

VeRTIAL is the product of a broad, multi-institutional collaboration. Alongside Ayesha Waheed, the work was authored by Ricardo J. Fernández-de-Thomas, MD; Armani Manov, BS; Serhat Aydin, MD; David T. Fernandes-Cabral, MD; Prateek Agarwal, MD; Rick Sasso, MD; Raj Swaroop Lavadi, MD; Bradley A. Gross, MD; Michael J. Lang, MD; Thomas J. Buell, MD; James Harrop, MD; D. Kojo Hamilton, MD; and Nitin Agarwal, MD.

In closing her talk, Ayesha credited her mentors, Dr. D. Kojo Hamilton and Dr. Ricardo J. Fernández-de-Thomas, noting that “the vision and standards behind this work are theirs as much as mine.”

About the Safety in Spine Surgery Summit

The Safety in Spine Surgery Summit is the flagship meeting of the Safety in Spine Surgery Project (S3P), founded by Michael Vitale, MD, MPH. Each year it convenes leading adult and pediatric spine surgeons, anesthesiologists, neuromonitoring specialists, and the broader OR team to build consensus best practices that reduce complications and improve patient outcomes. The summit is designed so that attendees leave with insights they can apply in their own practice right away.

The 11th Annual Safety in Spine Surgery Summit convened the full operating-room team to advance fieldwide best practices.

Presenting VeRTIAL on this stage places SCOLI’s work at the center of the field’s ongoing effort to make spine surgery safer, turning a rare and dangerous complication into something every team can anticipate, rescue from, and surveil for.