Vertebral artery injury in patients with isolated transverse process fractures.
We sought to assess the rate of CTA-diagnosed vertebral artery injury in patients with isolated transverse process fractures, with and without extension into the transverse foramen, in the blunt-trauma population served by our hospital. We queried our universities trauma registry between January 2009 and July 2014 for ICD-9 codes pertaining to cervical spine fractures. Of 330 patients identified, 45 patients had fractures limited to the transverse process and were selected for the study population. For each patient identified, demographics, injury mechanism, imaging reports, angiography findings, and treatments were recorded. In total, 69 fractures were identified in 45 patients. Of the 45 patients, 15 (33%) had transverse process fractures at multiple cervical levels. 23/45 (51%) patients had at least one fracture extending into TF. Four patients with transverse process fractures and one patient without transverse process fractures were diagnosed with vertebral artery injury by CT angiogram (17.4% vs. 4.5%, p=0.35). The number of transverse process fractures in patients with VAI was greater than those without VAI (3.0 vs. 1.4, p<0.001). None of the 30 patients with any one-level TPF (with or without extension into TF) was diagnosed with VAI (p=0.003). None of 17 patients with isolated C7-level TPFs were diagnosed with VAI (p=0.15). The incidence of cervical VAI was greater in patients with multiple-level TPFs than in patients with single-level TPFs. While patients with a single, isolated TPF have a low probability of VAI, patients with numerous TPF fractures may benefit from CTA.
Department of Neurological Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA. Electronic address: phil.alan.bonney@gmail.com.
Phillip A
PA
Bonney
Department of Neurological Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA. Electronic address: joshua-burks@ouhsc.edu.
Joshua D
JD
Burks
Department of Neurological Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA. Electronic address: Andrew-conner@ouhsc.edu.
Andrew K
AK
Conner
Department of Neurological Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA. Electronic address: chad-glenn@ouhsc.edu.
Chad A
CA
Glenn
Department of Neurological Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA. Electronic address: cordell-baker@ouhsc.edu.
Cordell M
CM
Baker
Department of Neurological Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA. Electronic address: ahmed-cheema@ouhsc.edu.
Ahmed A
AA
Cheema
Department of Neurological Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
Jacob B
JB
Archer
Department of Neurological Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA. Electronic address: bryan-buster@ouhsc.edu.
Bryan E
BE
Buster
Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA. Electronic address: roxie-albrecht@ouhsc.edu.
Roxie M
RM
Albrecht
Department of Neurological Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA. Electronic address: Bradley-bohnstedt@ouhsc.edu.
Bradley N
BN
Bohnstedt
D000328:Adult; D000368:Aged; D000792:Angiography; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019838:Neck Injuries / Q000000981:diagnostic imaging* / Q000453:epidemiology; D016103:Spinal Fractures / Q000000981:diagnostic imaging* / Q000453:epidemiology; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000293:injuries*
Arterial injury; CT angiogram; Transverse process fracture; Trauma; Vertebral artery