Traumatic vertebral artery injuries in the geriatric population: a retrospective cohort study

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Traumatic vertebral artery injuries (TVAIs) are a common finding in cervical spine trauma and can predispose patients to posterior circulation infarction. While extensive research has been conducted regarding the management and criteria for imaging in patients with suspected blunt vascular injury, little research has been conducted highlighting these injuries in the geriatric population.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>The authors performed a retrospective review of all patients evaluated at a level 1 trauma center and found to have TVAIs between January 1, 2010, and January 1, 2018. Biometric, clinical, and imaging data were obtained from a trauma registry database. Patients were divided into 2 groups on the basis of age, a geriatric group (age ≥ 65 years) and an adult group (age 18 to &lt; 65 years). Variables evaluated included type of trauma, mortality, Injury Severity Score (ISS), and ICU length of stay. The Student t-test was used for continuous variables, and Pearson’s chi-square test was used for categorical variables.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Of the 2698 of patients identified with traumatic cervical spine injuries, 103 patients demonstrated evidence of TVAI. Of these patients, 69 were &lt; 65 and 34 were ≥ 65 years old at the time of their trauma. There was no difference in the incidence of TVAIs between the 2 groups. The ICU length of stay (4.71 vs 4.32 days, p &gt; 0.05), hospital length of stay (10.71 vs 10.72 days, p &gt; 0.05), and the ISS (21.50 vs 21.32, p &gt; 0.05) did not differ significantly between the 2 groups. Mortality was significantly higher in the geriatric group, occurring in 9 of 34 patients (26.5%) compared with only 3 of 69 patients (4.4%) in the adult group (p &lt; 0.001). Ground-level falls were the most common inciting event in the geriatric group (44% vs 14.5%, p &lt; 0.001), whereas motor vehicle accidents were the most common etiology in the younger population (72.5% vs 38.2%, p &lt; 0.001). Incidence of ischemic stroke did not vary significantly between the 2 groups (p &gt; 0.05).</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>TVAI in the older adult population is associated with a significantly greater risk of mortality than in the younger adult population, despite the 2 groups having similar ISSs. Additionally, low-velocity mechanisms of injury, such as ground-level falls, are a greater risk factor for acquired TVAI in older adults than in younger adults, in whom it is a significantly less common etiology.</jats:p></jats:sec>

Blunt cerebrovascular injury in the geriatric population

“…Prior work by Page and Josiah describes traumatic vertebral artery injuries in the geriatric population. 8 The differences in patient selection and arterial inclusion between their study and ours expand the understanding of geriatric BCVI. To identify patients, the authors of the previous study cross-referenced all traumatic cervical spine injuries with patients found to have a vertebral artery injury.…”

“…Of these injury mechanisms, the most common causes of BCVIs in adults were motor vehicle accidents, whereas geriatric patients more commonly presented due to falls from standing height. 7,8 With the population of both the United States and the international community aging rapidly, and 1 in every 5 people expected to be older than 65 years by 2030, 9 special attention should be given to the geriatric population.…”

“…Page and Josiah demonstrated that mortality specifically following vertebral artery injuries was significantly higher in the geriatric age group than in the general population. 8 Additional studies have shown that institutions often miss BCVI in the geriatric population, but even when screened appropriately, detection of the injury does change management of the patient's injuries. 7 Still, a more thorough evaluation of the geriatric population is needed.…”

Vertebral Artery Injury with Coinciding Unstable Cervical Spine Trauma: Mechanisms, Evidence-based Management, and Treatment Options

“…Rarely, medical procedures requiring hyperextension of the neck, such as esophagogastroduodenoscopy, have been reported to result in VA dissection [27]. Significant VAI is more likely to occur in patients less than 65 years of age than in younger patients with the same injury severity score [7].…”

“…Segment II travels through the subaxial transverse foramina to C2. Segment III courses posterolaterally in a tortuous course from the transverse foramen of C2 to the posterior arch of C1, which renders it particularly vulnerable to stretch and rotational injuries [6,7]. Segment IV crosses the dura at the foramen magnum and runs superiorly to meet the proximal basilar artery.…”