J Korean Soc Spine Surg.  2011 Sep;18(3):91-95.

Radiologic Characteristics of Vertebral Artery Injury in the Cervical Spine Fracture

• Ahn MW
• Kong BS
• Kim JR
• Shin JH

Abstract

STUDY DESIGN: A retrospective study.
OBJECTIVES
This study was performed by probing vertebral artery injuries and their radiologic characteristics in cervical spine fractures, and analyzing MRI findings of vascular injuries. SUMMARY OF LITERATURE REVIEW: Vertebral artery injuries are found relatively often in cervical spine fractures.
MATERIALS AND METHODS
We evaluated 57 cases of cervical spine fractures that occurred beginning in June 2011 and ending in February 2003. The characteristics of each fracture were evaluated using conventional radiographs, CT, and MRI. The presence of a vertebral artery injury was based on the absence of signal void in multilevel transverse foramens.
RESULTS
Twelve out of the 57 cases (21.1%) were found to have unilateral vertebral artery injuries. Clinically, impairment in cerebral circulation was not found. We found no statistical correlation between the signal change in the spinal cord and in the vertebral artery injury (P=0.424). We noted fractures of transverse processes in 7 cases, 6 of which showed vertebral artery injuries. Thus, the transverse process facture was associated with t vertebral artery injury (P=0.000). There seemed to be no relationship between the vertebral artery injury and each of following: fracture level (P=0.416), fracture type (P=0.723) and severity of soft tissue injury (P=0.195).
CONCLUSIONS
Unilateral vertebral artery injuries were frequently found in the cervical spine fractures. And of all radiographic factors associated with vertebral artery injury, only the presence of transverse process fracture was statistically significant. Absence of signal void at multi-section MR images is considered to be a useful guide to commence additional vascular evaluation.

Keyword

Vertebral artery injury; Cervical spine fracture; MRI

MeSH Terms

Retrospective Studies
Soft Tissue Injuries
Spinal Cord
Spine
Vascular System Injuries
Vertebral Artery

Reference

1. Hayes P, Gerlock AJ Jr, Cobb CA. Cervical spine trauma: a cause of vertebral artery injury. J Trauma. 1980; 20:904–5.

2. CARPENTER S. Injury of neck as cause of vertebral artery thrombosis. J Neurosurg. 1961; 18:849–53.

3. Schippinger G, Spork E, Obernosterer A, Seibert FJ, Schweighofer F. Injury of the cervical spine associated with carotid and vertebral artery occlusion: case report and literature review. Injury. 1997; 28:315–8.

4. Cothren CC, Moore EE, Biffl WL, et al. Cervical spine fracture patterns predictive of blunt vertebral artery injury. J Trauma. 2003; 55:811–3.

5. Biffl WL, Moore EE, Elliott JP, et al. The devastating potential of blunt vertebral arterial injuries. Ann Surg. 2000; 231:672–81.

6. Cheatham ML, Block EF, Nelson LD. Evaluation of acute mental status change in the nonhead injured trauma patient. Am Surg. 1998; 64:900–5.

7. Miller PR, Fabian TC, Bee TK, et al. Blunt cerebrovascular injuries: diagnosis and treatment. J Trauma. 2001; 51:279–86.

8. Miller PR, Fabian TC, Croce MA, et al. Prospective screening for blunt cerebrovascular injuries: analysis of diagnostic modalities and outcomes. Ann Surg. 2002; 236:386–93.

9. Bok AP, Peter JC. Carotid and vertebral artery occlusion after blunt cervical injury: the role of MR angiography in early diagnosis. J Trauma. 1996; 40:968–72.

10. Friedman D, Flanders A, Thomas C, Millar W. Vertebral artery injury after acute cervical spine trauma: rate of occurrence as detected by MR angiography and assessment of clinical consequences. AJR Am J Roentgenol. 1995; 164:443–7.

11. Taneichi H, Suda K, Kajino T, Kaneda K. Traumatically induced vertebral artery occlusion associated with cervical spine injuries: prospective study using magnetic resonance angiography. Spine (Phila Pa 1976). 2005; 30:1955–62.

12. Vaccaro AR, Klein GR, Flanders AE, Albert TJ, Balderston RA, Cotler JM. Longterm evaluation of vertebral artery injuries following cervical spine trauma using magnetic resonance angiography. Spine (Phila Pa 1976). 1998; 23:789–94.

13. Heary RF, Albert TJ, Ludwig SC, et al. Surgical anatomy of the vertebral arteries. Spine (Phila Pa 1976). 1996; 21:2074–80.

14. Schellinger PD, Schwab S, Krieger D, et al. Masking of vertebral artery dissection by severe trauma to the cervical spine. Spine (Phila Pa 1976). 2001; 26:314–9.

15. Inamasu J, Guiot BH. Vertebral artery injury after blunt cervical trauma: an update. Surg Neurol. 2006; 65:238–45.

16. Deen HG Jr, McGirr SJ. Vertebral artery injury associated with cervical spine fracture. Report of two cases. Spine (Phila Pa 1976). 1992; 17:230–4.

17. Oetgen ME, Lawrence BD, Yue JJ. Does the morphology of foramen transversarium fractures predict vertebral artery injuries? Spine (Phila Pa 1976). 2008; 33:E957–61.

18. Parent AD, Harkey HL, Touchstone DA, Smith EE, Smith RR. Lateral cervical spine dislocation and vertebral artery injury. Neurosurgery. 1992; 31:501–9.

19. Woodring JH, Lee C, Duncan V. Transverse process fractures of the cervical vertebrae: are they insignificant? J Trauma. 1993; 34:797–802.

20. Louw JA, Mafoyane NA, Small B, Neser CP. Occlusion of the vertebral artery in cervical spine dislocations. J Bone Joint Surg Br. 1990; 72:679–81.

21. Veras LM, Pedraza-Gutié rrez S, Castellanos J, Capellades J, Casamitjana J, Rovira-Cañ ellas A. Vertebral artery occlusion after acute cervical spine trauma. Spine (Phila Pa 1976). 2000; 25:1171–7.

22. Utter GH, Hollingworth W, Hallam DK, et al. Sixteen-slice CT angiography in patients with suspected blunt carotid and vertebral artery injuries. J Am Coll Surg. 2006; 203:838–48.

23. Friedman D, Flanders A, Thomas C, Millar W. Vertebral artery injury after acute cervical spine trauma: rate of occurrence as detected by MR angiography and assessment of clinical consequences. AJR Am J Roentgenol. 1995; 164:443–7.

24. Hiroshi T, Kota S, Tomomichi K, Kiyoshi K. Traumatically induced vertebral artery occlusion associated with cervical spine injuries: prospective study using magnetic resonance angiography. Spine (Phila Pa 1976). 2005; 30:1955–62.

25. Weller SJ, Rossitch E Jr, Malek AM. Detection of vertebral artery injury after cervical spine trauma using magnetic resonance angiography. J Trauma. 1999; 46:660–6.