Vertebral artery injury in cervical spine trauma

Parbhoo, A. H.; Govender, S.; Corr, Peter

doi:10.1016/s0020-1383(00)00232-1

Cited by 67 publications

(30 citation statements)

References 20 publications

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“…Although some reports have indicated that management with observation alone seems safe, serious attention should be paid to a potential ischemic event due to VA injury caused by cervical spine trauma. For patients with cervical spine injuries who need immediate fixation, the help of an interventionist may be advised [25][26][27][28][29] .…”

Section: Resultsmentioning

confidence: 99%

Distal Embolic Brain Infarction Due to Recanalization of Asymptomatic Vertebral Artery Occlusion Resulting From Cervical Spine Injury: A Case Report

Nakao

Terai

2014

Journal of Chiropractic Medicine

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Objective: The purpose of this case report is to describe a patient with brain infarction due to recanalization of an occluded vertebral artery (VA) following closed reduction and open fixation of cervical spinal dislocation and to discuss the management of asymptomatic VA injuries associated with spine trauma. Clinical Features: A 41-year-old Asian man experienced a C4-5 distractive-flexion injury manifesting with quadriplegia and anesthesia below the C3 cord level (including phrenic nerve paralysis), and bowel and bladder dysfunction. Magnetic resonance angiography and computed tomography angiography showed left extracranial VA (V2) occlusion and a patent contralateral VA. Intervention and Outcome: The patient was observed without antiplatelet and/or anticoagulation therapy and underwent open reduction and internal fusion of C4/5 and tracheostomy 8 hours after the injury. After surgery, supraspinal symptoms such as left horizontal nystagmus and left homonymous hemianopsia led to cranial computed tomography and magnetic resonance imaging, which showed left-side cerebellar infarction in the posterior inferior cerebellar artery territory and right-side posterior cerebral artery infarction. Magnetic resonance angiography and computed tomography angiography demonstrated patent bilateral VA (but hypoplastic right VA) and occluded right posterior cerebral artery. The injured VA was treated conservatively, and there were no other ischemic complications. Conclusion: The management of asymptomatic VA injury is controversial, with several treatment options available, including observation alone, antiplatelet therapy, anticoagulation therapy, or invasive intervention. Although there are some reports described where management with observation alone seems safe, serious attention should be given to the VA injury caused by cervical spine trauma.

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Section: Resultsmentioning

confidence: 99%

Distal Embolic Brain Infarction Due to Recanalization of Asymptomatic Vertebral Artery Occlusion Resulting From Cervical Spine Injury: A Case Report

Nakao

Terai

2014

Journal of Chiropractic Medicine

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“…Data from the 1980s estimated TVAI to account for 3-19% of all cervical vascular injuries [8]. These figures have increased as the use of screening has increased detection rates, with recent series finding VAI in 17.2-25.5% in blunt cervical spine trauma [9][10][11][12][13].…”

Section: Epidemiologymentioning

confidence: 99%

Blunt traumatic vertebral artery injury: a clinical review

et al. 2011

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Blunt traumatic vertebral injury (TVAI) is frequently associated with head and neck injury and is being detected with increasing frequency due to improved imaging of the trauma patient. In a few cases, it can lead to potentially fatal posterior circulation ischaemia There is debate in the literature regarding whether TVAI should be actively screened for and, if so, how. Management of TVAI may be conservative, medical (antiplatelet agents or anticoagulation), endovascular or open surgery. We review the literature concerning the mechanisms and presentation of TVAI following blunt injury and the current screening recommendations. Management strategies proposed are based on the radiological grade and clinical severity of TVAI, where high-grade symptomatic injuries and highgrade injuries in patients where anticoagulation is contraindicated are treated endovascularly and asymptomatic or low-grade injuries are managed with anticoagulation where it is not contraindicated. Follow-up is via CT angiography to assess for resolution of the injury.

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“…In the trauma literature, there are several reported cases of symptomatic vertebral and basilar artery thrombosis, with and without surgical reduction of cervical spine injury. 8,10,23,26,27,31,34,39,43,44 Once a patient develops a symptomatic basilar artery occlusion, the prognosis is generally ominous, although a case report of successful mechanical and pharmacological thrombolysis does exist in the literature. 37 …”

Section: Role Of Prophylactic Arterial Graftingmentioning

confidence: 99%

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

Manjila¹,

Chowdhry²,

Bambakidis³

et al. 2014

SPI

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The authors present a case of traumatic, complete, high cervical spine injury in a patient with gradual worsening deformity and neck pain while in rigid cervical collar immobilization, ultimately resulting in coronal-plane spondyloptosis. Due to the extent of lateral displacement of the spinal elements, preoperative evaluation included catheter angiography, which revealed complete right vertebral artery (VA) occlusion. A prophylactic arterial bypass graft from the right occipital artery to the extradural right VA was fashioned to augment posterior circulation blood supply prior to reduction and circumferential instrumented fusion. Following surgery, the patient was able to participate in an aggressive rehabilitation program allowing early mobilization, and he ceased to be ventilator-dependent following implantation of a diaphragmatic pacer. The authors review factors leading to progression of this type of injury and suggest technical pearls as well as highlight specific management pitfalls, including operative risks.

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Vertebral artery injury in cervical spine trauma

Cited by 67 publications

References 20 publications

Distal Embolic Brain Infarction Due to Recanalization of Asymptomatic Vertebral Artery Occlusion Resulting From Cervical Spine Injury: A Case Report

Distal Embolic Brain Infarction Due to Recanalization of Asymptomatic Vertebral Artery Occlusion Resulting From Cervical Spine Injury: A Case Report

Blunt traumatic vertebral artery injury: a clinical review

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

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