Injury of the cervical spine associated with carotid and vertebral artery occlusion: case report and literature review

Unilateral and bilateral vertebral artery dissection following motor vehicle injury—Two cases and a mini-review

“…High-energy impacts that tend to cause cervical spine fractures most often result in lesions of the segment lying in the vertebral canal, in particular at the level of C5-C6 [5,21,37]. C1 vertebral body fractures, C2 (HangemanÕs) fractures, C5 burst fractures, fracture dislocations of C4 on C5 and of C5 on C6, facet joint fractures or dislocations, transverse process fractures, and lateral cervical spine dislocations have all been associated with VAD [16,17,31]. The finding of bone fragments in the vertebral canal by CT/MRI has been associated with a high predictive value for VAD [39].…”

“…Revascularization procedures such as surgical or endovascular thromboembolectomy have also been described. Successful thrombolysis using streptokinase has been reported [8,12,21,31,32].…”

Unilateral and bilateral vertebral artery dissection following motor vehicle injury—Two cases and a mini-review

“…High-energy impacts that tend to cause cervical spine fractures most often result in lesions of the segment lying in the vertebral canal, in particular at the level of C5-C6 [5,21,37]. C1 vertebral body fractures, C2 (HangemanÕs) fractures, C5 burst fractures, fracture dislocations of C4 on C5 and of C5 on C6, facet joint fractures or dislocations, transverse process fractures, and lateral cervical spine dislocations have all been associated with VAD [16,17,31]. The finding of bone fragments in the vertebral canal by CT/MRI has been associated with a high predictive value for VAD [39].…”

Traumatic, high-cervical, coronal-plane spondyloptosis with unilateral vertebral artery occlusion: treatment using a prophylactic arterial bypass graft, open reduction, and instrumented segmental fusion

“…39 This cautionary report highlights the importance of studying vascular anatomy closely in spondyloptosis, which can otherwise cause mobilization of a thrombus or propagation of dissection leading to catastrophic posterior circulation ischemia. 8,10,19,23,26,29,32,33,40 Vertebral artery injury is a rare but well recognized catastrophic iatrogenic complication of cervical spine surgery with a reported incidence of 0.3%-0.5%. 6,7,13,14,25,28,30 In the case presented in this report, the left VA was at risk during the exposure, osteotomies, and bone reduction for 2 reasons: 1) proximity of the artery to the partially autofused C2-3 vertebral bodies with potential for injury during osteotomy; and 2) anticipated significant alteration in its course that would occur with successful realignment, placing the vessel at risk for shear injury or kinking during translation.…”

“…Iatrogenic VA injury during cervical spine surgery has been documented to produce fistulas, late hemorrhages, pseudoaneurysm, thrombosis, and death. 8,10,19,23,26,29,32,33,40 Common techniques to reduce the risk of VA injury include the following: 1) partial excision of the longus colli muscle, allowing exposure of the uncinate processes and transverse processes; 2) careful uncectomy and removal of lateral osteophytes followed by uncovertebral joint resection up to the depth of the floor of the transverse foramen cephalad and caudal to the transverse process; 3) exposure large enough for proximal and distal control of the VA should inadvertent arterial injury be encountered while working on the fusion mass; and 4) use of neuronavigation and Doppler probe ultrasonography to more clearly identify the vessel near the fu sion mass.…”