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CC BY-NC-ND 4.0 · Asian J Neurosurg 2020; 15(03): 644-647
DOI: 10.4103/ajns.AJNS_45_20
Original Article

Incidence and outcome analysis of vertebral artery injury in posttraumatic cervical spine

Tushar Rathod
Department of Orthopaedics, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra
,
Vinayak Garje
Department of Orthopaedics, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra
,
Nandan Marathe
Department of Orthopaedics, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra
,
Shubranshu Mohanty
Department of Orthopaedics, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra
,
Chetan Shende
Department of Orthopaedics, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra
,
Abhinav Jogani
Department of Orthopaedics, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra
,
Abhinav Srivastava
Department of Orthopaedics, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra
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Objective: Vertebral artery injury (VAI) after cervical spine trauma often remains undiagnosed. Despite various clinical studies suggesting simultaneous occurrence of VAI with cervical spine trauma, guidelines regarding screening and management of posttraumatic VAI are yet to be formulated. The primary objective of the current study was to formulate a low-cost screening protocol for posttraumatic VAI, thereby reducing the incidence of missed VAI in developing countries. Materials and Methods: This was a single-center prospective study performed on 61 patients using plain magnetic resonance imaging (MRI) as a screening tool to assess the frequency of VAI and routine X-ray to detect morphological fracture patterns associated with the VAI in posttraumatic cervical spine cases. If the MRI study showed any evidence of vascular disruption, then further investigation in the form of computed tomography angiography was done to confirm the diagnosis. Results: This study showed the incidence of VAI was 14.75% (9/61). Of 61 patients, 16 had supraaxial, and 45 patients sustained subaxial cervical spine fractures. In the cohort of nine cases of VAI, eight patients had subaxial cervical spine injuries, of which seven were due to flexion-distraction injury. C5–C6 flexion-distraction injury was most commonly associated with VAI (4 cases). Of the nine cases, five succumbed to injury (mortality 55.55%), and 19 patients from the non-VAI group succumbed to injury (mortality 36.53%). From surviving four cases with VAI, two had improvement in the American Spinal Injury Association scale by Grade 1. Conclusion: VAI in cervical spine trauma is an underrecognized phenomenon. Plain MRI axial imaging sequence can be an instrumental low-cost screening tool in resource-deficient parts of the world. VAI has tendency to occur with high-velocity trauma like bi-facetal dislocation, which has a high mortality and poor neurological recovery.

Key-words:

Cervical spine - computed tomography angiography - vertebral artery injury

Financial support and sponsorship

Nil.




Publication History

Received: 17 March 2020

Accepted: 14 April 2020

Article published online:
16 August 2022

© 2020. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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