Vertebral artery occlusion after acute cervical spine trauma.
METHODS
A retrospective study of vertebral artery injury diagnosed during the last 6 years in our institution.


OBJECTIVE
To determine the clinical and radiologic features of vertebral artery injury.


BACKGROUND
Extracranial occlusion of the vertebral artery associated with cervical spine fracture is uncommon and can cause serious and even fatal neurologic deficit due to back lifting and cerebellar infarction. Magnetic resonance imaging and magnetic resonance angiography are extremely helpful in the examination of acute injuries of the cervical spine.


METHODS
Magnetic resonance imaging and magnetic resonance angiography were performed at the time of injury.


RESULTS
The authors reviewed six patients with cervical spine fractures who were diagnosed with a unilateral occlusion of the vertebral artery by means of magnetic resonance imaging/magnetic resonance angiography. One patient had signs of vertebrobasilar insufficiency and another with complete cord lesion had cerebellar and back lifting infarctions. Surgical anterior spinal fusion was performed in five patients, and one was treated by traction and orthosis. At the time of discharge, five patients had no vertebrobasilar symptoms, and the patient who experienced vertebrobasilar territory infarctions showed no progression of the neurologic damage.


CONCLUSIONS
Vertebral artery injury should be suspected in cervical trauma patients with facet joint dislocation or transverse foramen fracture. Magnetic resonance imaging/magnetic resonance angiography is a helpful test to rule out vascular injury. Vertebral artery injury affects the extracranial segment at the same level as the cervical fracture. This is a retrospective review that did not permit drawing conclusions about the effects of early surgical stabilization in the treatment of cervical spine injuries with associated vertebral artery injury; however, surgical stabilization may avoid propagation and embolization of the clot located at the site of the lesion.
Veras
L M
LM
Department of Orthopedic Surgery and MR Unit (Department of Radiology), Vall d'Hebron University Hospital, Barcelona, Spain. luima@codetel.net.do
Pedraza-Gutiérrez
S
S
Castellanos
J
J
Capellades
J
J
Casamitjana
J
J
Rovira-Cañellas
A
A
D000293:Adolescent; D000328:Adult; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000150:complications / Q000000981:diagnostic imaging*; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000293:injuries; D014715:Vertebrobasilar Insufficiency / Q000000981:diagnostic imaging* / Q000209:etiology