Vertebral Artery Caught in the Fracture Gap after Traumatic C2/3 Spondylolisthesis

Abstract

Background Context Patient with a C2 fracture and entrapment of the right vertebral artery in the fracture gap. Purpose Presentation of a case with follow-up until end of treatment. Study Design Case report. Methods A 25-year-old woman was brought into our emergency room after falling while riding a horse. She complained of pain in the cervical spine. Clinical examinations showed local tenderness at the upper cervical spine and painful impairment of the mobility of the neck, with no signs of neurological impairment. Radiological diagnostics revealed a traumatic C2/3 spondylolisthesis. A computer tomography (CT) angiographic scan showed a dislocation of the right vertebral artery into the fracture gap without injury to the artery. Open reduction and osteosynthesis were considered of too high risk. Therefore, we conducted fracture treatment with closed reduction and halo fixation. After removal of the halo fixator, the patient was given a soft cervical collar and was advised to rest for additional 6 weeks before beginning gradual activity. Results Conventional follow-up revealed osseous consolidation and a CT angiographic scan showed consistent blood flow to the artery. Conclusion Halo fixation was a safe and effective therapy strategy in the case of vertebral artery entrapment after traumatic C2 spondylolisthesis.

Vertebral arteriovenous fistule due to blunt neck trauma: case report

“…In one report, a patient’s vertebral artery was trapped between the broken lines after a hangman’s fracture. [ 11 ] In addition, angiographic examination is recommended with facet joint dislocation with or without fracture and type three odontoid fractures in terms of vertebral artery injury. [ 3 ] Our patient had C2-3 anterior dislocation due to a hangman’s fracture.…”

Intraoperative color-coded duplex ultrasound for safe surgical reduction of displaced hangman fractures in patients with atypical course of the vertebral artery: A case report of two patients

“…An atypical course of the vertebral artery, occurring in 2.3 up to 25.3% [1] , [2] , can be medically relevant in displaced Hangman fractures, especially if the artery course runs within the fracture gap of the isthmus of the second cervical vertebra (C2) [3] . During surgical reduction of the fracture, it can cause early to late complications such as entrapment, dissection, rupture and occlusion of the artery, potentially leading to transient ischemic attacks or ischemic strokes [3] , [4] .…”

“…An atypical course of the vertebral artery, occurring in 2.3 up to 25.3% [1] , [2] , can be medically relevant in displaced Hangman fractures, especially if the artery course runs within the fracture gap of the isthmus of the second cervical vertebra (C2) [3] . During surgical reduction of the fracture, it can cause early to late complications such as entrapment, dissection, rupture and occlusion of the artery, potentially leading to transient ischemic attacks or ischemic strokes [3] , [4] . Color-coded duplex ultrasound of the vertebral artery is a safe and noninvasive technique to investigate anatomical variations of vessel diameter, course, hemodynamics and morphology and is commonly used as a neurovascular diagnostic method [5] .…”