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

Abstract

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.

Degenerative Cervical Spondylosis: A Cause of Vertigo?

“…The importance of analyzing the VA in various pathologies of the cervical spine is being increasingly recognized in current literature. 19 A multi centric study with a larger sample size and inclusion of non-spondylotic control group will further validate our findings of the pathophysiological association between CS and vertigo.…”

CT Scan in Subaxial Cervical Facet Injury: Is It Enough for Decision-Making?

“… 8 However, Rathod et al in a recent study incluiding 45 patients with subaxial cervical spine fracture concluded that vertebral artery injury in cervical spine trauma is an underrecognized phenomenon and MRI can be an instrumental low-cost screening tool in resource-deficient parts of the world. 9 Thus, studies investigating the real need and the impact of further radiological evaluation on patient outcomes in context of facet fracture are necessary.…”

Prospective Randomized Control Pilot Study to Compare the Role of Injection Cerebrolysin in Operated cases of Degenerative Cervical Myelopathy

“…The efficacy of treatment over shorter period needs to be analyzed. We believe that the sex ratio may have been influenced by the current social determinants in the country where the study was conducted and gender roles which are still in vogue 29 . A study addressing some of these limitations and investigating a 10-days Cerebrolysin schedule is underway with initial results expected during 2021 (IRB approval number—EC/BYC/22112020/DRPD).…”

“…We believe that the sex ratio may have been influenced by the current social determinants in the country where the study was conducted and gender roles which are still in vogue. 29 A study addressing some of these limitations and investigating a 10-days Cerebrolysin schedule is underway with initial results expected during 2021 (IRB approval number-EC/ BYC/22112020/DRPD). Further studies on Cerebrolysin in other spine pathologies including dorsal myelopathy and SCI will further establish its efficacy as a neuroprotective agent in spinal pathologies.…”