title: Vertebral artery injuries following cervical spine trauma: a prospective observational study.
abstract: OBJECTIVE
  The purpose of this study was to report on the incidence, diagnosis and clinical manifestation of VAI following cervical spine injuries observed in a prospective observational study with a standardized clinical and radiographical protocol.
  
  
  METHODS
  During a 16-year period, 69 (mean age: 43 ± 20.7 years; 25 female, 44 male) of 599 patients had cervical spine injury suspicious for VAI due to facet luxation and/or fractures extending into the transverse foramen. Diagnosis and management of these patients followed a previously published protocol (Kral in Zentralbl Neurochir 63:153-158, 2002). Digital subtraction angiography (DSA) was performed in all 69 patients. Injury grading of VAI was done according to Biffl et al. (Ann Surg 231:672-681, 2000). All patients with VAI were treated with anticoagulation (heparin followed by ASS) for 6 months.
  
  
  RESULTS
  In cases suspicious for VAI, the incidence of VAI detected by DSA was 27.5% (n = 19 of 69 patients). VAI Grade I occurred in 15.8%, Grade II in 26.3%, Grade IV in 52.6% and Grade V in 5.2%. Of 19 patients, 4 (21%) had clinical signs of vertebrobasilar ischemia. Two patients died in hospital after 4 and 21 days respectively. Of 69 patients, 33 (47.8%) with suspected VAI had unstable spine injuries and were treated surgically.
  
  
  CONCLUSIONS
  In patients with cervical spine fractures or dislocations crossing the course of the vertebral artery, VAI are relatively frequent and may be associated with significant morbidity and mortality. VAI were identified by DSA in 27.5%. Despite anticoagulation therapy, 5.8% became clinically symptomatic and 2.9% died due to cerebrovascular ischemia.
authors: Department of Neurosurgery, Rheinische Friedrich-Wilhelms Universität Bonn, Sigmund-Freud Str. 25, 53105 Bonn, Germany. camueller@ukaachen.de
authors: Christian-Andreas
authors: CA
authors: Mueller
authors: Inga
authors: I
authors: Peters
authors: Martin
authors: M
authors: Podlogar
authors: Attila
authors: A
authors: Kovacs
authors: Horst
authors: H
authors: Urbach
authors: Karl
authors: K
authors: Schaller
authors: Johannes
authors: J
authors: Schramm
authors: Thomas
authors: T
authors: Kral
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D002533:Cerebral Angiography; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013124:Spinal Injuries / Q000150:complications* / Q000000981:diagnostic imaging; D057772:Vascular System Injuries / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000293:injuries*; D014715:Vertebrobasilar Insufficiency / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology
chemical_list: D000925:Anticoagulants; D006493:Heparin