title: Cervical spine fracture patterns predictive of blunt vertebral artery injury.
abstract: BACKGROUND
  Aggressive screening for blunt cerebrovascular injury (BCVI) has uncovered an astonishing incidence of vertebral artery injuries (VAIs) and associated stroke rate. Stroke incidence is reduced with early recognition and prompt anticoagulation. Because of the proximity of the cervical spine and vertebral arteries, we queried whether all patients with cervical spine fractures required arteriography to rule out VAI.
  
  
  METHODS
  Four-vessel cerebrovascular angiography remains the standard screening test for patients at risk for BCVI. Patients undergoing angiographic screening for blunt cerebrovascular injuries have been prospectively followed at our regional trauma center since January 1990; however, in January 1996, we began aggressive screening based on injury patterns.
  
  
  RESULTS
  Ninety-two patients with vertebral artery injuries were identified during the study period from January 1996 to June 2002. Two patients with vertebral injuries had minor cervical fractures, a C6 body fracture and a C7 spinous process/laminar fracture; both underwent diagnostic angiography for injury mechanism. Of the 21 patients without cervical spine fracture, angiographic screening for BCVI was performed for neurologic symptoms (11 patients), basilar skull fracture (6 patients), or severe facial fractures (4 patients). Cervical spine fracture was the sole indication for VAI in 69 patients. The fracture patterns were subluxations in 38 patients (55%) or extension of the fracture through the foramen transversarium in 18 patients (26%). The remaining injuries (18%) were located in the upper cervical spine: isolated C1 arch in eight patients and C2/3 body fractures in five patients.
  
  
  CONCLUSIONS
  Blunt vertebral artery injury is associated with complex cervical spine fractures involving subluxation, extension into the foramen transversarium, or upper C1 to C3 fractures. Routine screening should incorporate these findings to maximize yield while limiting the use of invasive procedures.
authors: Department of Surgery, Denver Health Medical Center and University of Colorado Health Sciences Center, 777 Bannock Street, Denver, CO 80204, USA. clay.cothren@dhha.org
authors: C Clay
authors: CC
authors: Cothren
authors: Ernest E
authors: EE
authors: Moore
authors: Walter L
authors: WL
authors: Biffl
authors: David J
authors: DJ
authors: Ciesla
authors: Charles E
authors: CE
authors: Ray
authors: Jeffrey L
authors: JL
authors: Johnson
authors: John B
authors: JB
authors: Moore
authors: Jon M
authors: JM
authors: Burch
mesh_terms: D000328:Adult; D002533:Cerebral Angiography; D002574:Cervical Vertebrae / Q000293:injuries*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008297:Male; D016103:Spinal Fractures / Q000209:etiology; D020521:Stroke / Q000453:epidemiology; D014193:Trauma Centers; D014711:Vertebral Artery / Q000293:injuries*; D014949:Wounds, Nonpenetrating / Q000145:classification* / Q000209:etiology