Vertebral Artery Injury in Cervical Spine Fractures: A Cohort Study and Review of the Literature
Abstract
ABSTRACT BACKGROUND The risk of vertebral artery injury (VAI) secondary to cervical spine fracture is increasingly recognised in the literature. The aim of this study was to determine the incidence of VAI amongst patients presenting to the Royal Victoria Hospital (Northern Ireland’s regional trauma centre with emergency surgical spinal services) with acute cervical spine fractures, and to identify fracture patterns associated with the highest risk of VAI. METHODS A retrospective review of 1,894 computed tomography (CT) reports of patients who underwent imaging of their cervical spine and/or vertebral arteries over a 12-month period, from June 2018 to June 2019, was conducted. RESULTS Sixty-eight patients (3.59%) with a confirmed cervical spine fracture were identified. These patients had an age range of 18-97 years and included 39 males (57.4%) and 29 females (42.6%). The fractures were then classified according to the AOSpine Cervical Spine Fracture Classification. Of the 68 patients with a confirmed cervical spine fracture, five (7.35%) were diagnosed with VAI, all involving fractures of their upper cervical spine. Two involved fractures extending into the transverse foramen, two involved subluxation of the vertebrae and one involved both. In all five cases, these fractures resulted from high- energy injuries. Regarding management, the patients with VAI in this study were either monitored and given no specific treatment or treated medically with antiplatelet therapy. None…
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