Abstract:Objective:
The aim of this study was to study mechanism, risk factors, and prognosis of patients with vertebral artery dissection (VAD) from acute cervical spine trauma (CST).
Methods:
A total of 149 consecutive patients were chosen from 2014 to 2019 from our institute data base, and their records were retrospectively studied. Morphology of fracture and subluxation were studied in detail with respect to the presence or absence of VAD.
Results:
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“…Overall characteristics of injury included occlusion (40/82 (48.8%)), dissection (34/82 (41.5%)), stenosis (4/82 (4.9%)), occlusive-dissection (2/82 (2.4%)), and compression (2/82 (2.4%)). One study was only concerned with VA dissections secondary to injury, Gupta et al 16 noted an incidence of VA dissection of 14.1% (21/149).Figure 5.Grades of VAI. VA: vertebral artery.…”
Study design Systematic Review Objectives Vertebral Artery Injury (VAI) is a potentially serious complication of cervical spine fractures. As many patients can be asymptomatic at the time of injury, the identification and diagnosis of VAI can often prove difficult. Due to the high rates of morbidity and mortality associated with VAI, high clinical suspicion is paramount. The purpose of this review is to elucidate incidence, diagnosis, treatment and outcomes of VAI associated with cervical spine injuries. Methods A systematic search of electronic databases was performed using ‘PUBMED’, ‘EMBASE’,‘Medline (OVID)’, and ‘Web of Science, for articles pertaining to traumatic cervical fractures with associated VAI. Results 24 studies were included in this systematic review. Data was included from 48 744 patients. In regards to the demographics of the focus groups that highlighted information on VAI, the mean average age was 46.6 (32.1-62.6). 75.1% (169/225) were male and 24.9% (56/225) were female. Overall incidence of VAI was 596/11 479 (5.19%). 190/420 (45.2%) of patients with VAI had fractures involving the transverse foramina. The right vertebral artery was the most commonly injured 114/234 (48.7%). V3 was the most common section injured (16/36 (44.4%)). Grade I was the most common (103/218 (47.2%)) injury noted. Collective acute hospital mortality rate was 32/226 (14.2%), ranging from 0-26.2% across studies. Conclusion VAI secondary to cervical spine trauma has a notable incidence and high associated mortality rates. The current available literature is limited by a low quality of evidence. In order to optimise diagnostic protocols and treatment strategies, in addition to reducing mortality rates associated with VAI, robust quantitative and qualitative studies are needed.
“…Overall characteristics of injury included occlusion (40/82 (48.8%)), dissection (34/82 (41.5%)), stenosis (4/82 (4.9%)), occlusive-dissection (2/82 (2.4%)), and compression (2/82 (2.4%)). One study was only concerned with VA dissections secondary to injury, Gupta et al 16 noted an incidence of VA dissection of 14.1% (21/149).Figure 5.Grades of VAI. VA: vertebral artery.…”
Study design Systematic Review Objectives Vertebral Artery Injury (VAI) is a potentially serious complication of cervical spine fractures. As many patients can be asymptomatic at the time of injury, the identification and diagnosis of VAI can often prove difficult. Due to the high rates of morbidity and mortality associated with VAI, high clinical suspicion is paramount. The purpose of this review is to elucidate incidence, diagnosis, treatment and outcomes of VAI associated with cervical spine injuries. Methods A systematic search of electronic databases was performed using ‘PUBMED’, ‘EMBASE’,‘Medline (OVID)’, and ‘Web of Science, for articles pertaining to traumatic cervical fractures with associated VAI. Results 24 studies were included in this systematic review. Data was included from 48 744 patients. In regards to the demographics of the focus groups that highlighted information on VAI, the mean average age was 46.6 (32.1-62.6). 75.1% (169/225) were male and 24.9% (56/225) were female. Overall incidence of VAI was 596/11 479 (5.19%). 190/420 (45.2%) of patients with VAI had fractures involving the transverse foramina. The right vertebral artery was the most commonly injured 114/234 (48.7%). V3 was the most common section injured (16/36 (44.4%)). Grade I was the most common (103/218 (47.2%)) injury noted. Collective acute hospital mortality rate was 32/226 (14.2%), ranging from 0-26.2% across studies. Conclusion VAI secondary to cervical spine trauma has a notable incidence and high associated mortality rates. The current available literature is limited by a low quality of evidence. In order to optimise diagnostic protocols and treatment strategies, in addition to reducing mortality rates associated with VAI, robust quantitative and qualitative studies are needed.
“…Transection of the spinal cord in the cervical region of the spine caused by traumatic dislocation is an injury that often leads to death, especially when it is a spinal cord injury in the upper cervical spine because of respiratory impairment and vascular lesions. Gupta showed the flexion/distraction injury is associated with vertebral artery injury [ 7 ], and on the other hand Biffl did not find a significant pattern in the mechanism of injury or the level of cervical spine injury associated with injury to the vertebral artery [ 8 ]. Spinal cord injuries caused by luxation and/or dislocation of the cervical spine, at the level C3-C7 vertebra, lead to motor and sensory paralysis below the level of the injury and sphincter dysfunction [ 9 ].…”
We present the case of rare extreme dislocation of subaxial cervical spine, which was challenging regarding type and time of surgery. A 22-year-old patient was injured in a traffic accident, from very beginning with signs of spinal shock. Severe traumatic C6/C7 dislocation with resulting transection of the spinal cord was diagnosed with MDCT imaging. The main dilemmas regarding the surgical treatment of this injury referred to the timing of surgery and the choice of surgical approach. We decided to perform posterior surgery at first stage. Postoperative her condition get worsening and on the 16th postoperative day came to the fatal outcome. Despite all the available protocols, in our case, the decision had to be made on the basis of individual multidisciplinary assessment, bearing in mind the mechanism of the injury and the clinical presentation of the injured patient.
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