Bilateral Vertebral Artery Occlusion After Cervical Spine Fracture Dislocation

Strickland, Ben A.; Lewis, Courtney S; Pham, Martin H.

doi:10.1016/j.wneu.2019.01.033

Cited by 10 publications

(7 citation statements)

References 20 publications

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“…It is usually caused by the overextension of the vertebral artery between the adjacent transverse foramina due to overflexion or overextension of the neck. 5,6) There is no consensus concerning which intervertebral segment is likely to cause complications by VAI, 3,6,11) but among our patients, no VAI was observed in two C6/7 cases, which may have been due to high mobility of the vertebral artery and high interferential action for shear stress at C6/7 compared with the other intervertebral segments. Although we were unable to find reports on the VAI complication rates of unilateral and bilateral dislocation in our patients, it was noted in two of four patients with unilateral dislocation, suggesting an influence of torsion of the vertebral artery.…”

Section: Discussionmentioning

confidence: 58%

“…5) However, even unilateral development causes serious sequelae or death when a scattering thrombus causes basilar artery occlusion (BAO). 7,8,9,12) On the contrary, even in bilateral VAO, when BAO is absent, symptoms are mild because of collateral circulation in rare cases 5,8) ; therefore, avoiding embolism of the cerebral major arteries, including BAO, may be the most important factor for the reduction of dislocation in patients with VAO. Thus, we searched for reports on treatment before the reduction of dislocation in patients with VAO.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] Moreover, 7%-20% of cervical spine injury patients develop vertebral artery occlusion (VAO) as a result of VAI. 4,5) On the contrary, cervical spine fracture is noted in 70% or more VAI cases. 6) VAI complication rate with facet dislocation, subluxation, and fracture of the transverse foramen were reported in 80%, 75%, and 46% of cases, respectively.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation for Vertebral Artery Injury with Cervical Dislocated Fracture and Optimal Treatment before Reduction

Suga

Mitome-Mishima

Yoshida

et al. 2022

JNET

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Objective: Cervical dislocated fractures frequently cause vertebral artery injury (VAI), which, in turn, propagates the thrombus at the site of injury. Cerebral embolism due to a thrombus after the reduction of dislocation leads to a poorer neurological outcome. Therefore, we investigated the outcome of treatment for cervical dislocated fractures and the usefulness of parent artery occlusion (PAO) before reduction.Methods: Eight patients with cervical dislocated fractures with a locked facets treated at our hospital between January 2018 and December 2020 were evaluated. We retrospectively examined patient characteristics and clinical outcomes.Results: Among the eight patients, two were injured at C4/5, four at C5/6, and two at C6/7. All patients had locked facets.Four patients had bilateral dislocation, while the others had unilateral dislocation. Two patients with unilateral dislocation had ipsilateral vertebral artery occlusion (VAO), while the other six did not. Both patients with VAO underwent PAO to prevent cerebral embolism before reduction. The six patients who did not have VAI underwent reduction without preprocedural treatment. No cerebral ischemic complications were observed. One patient died due to paralysis of the respiratory muscles caused by spinal cord injury but the remaining seven recovered well. Conclusion:PAO before reduction for cervical dislocated fractures with VAO may be effective in preventing cerebral embolism after reduction.

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Evaluation for Vertebral Artery Injury with Cervical Dislocated Fracture and Optimal Treatment before Reduction

Suga

Mitome-Mishima

Yoshida

et al. 2022

JNET

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“…Another study done by Giacobetti et al found 19.7% (n = 61) VAI in their patients [ 9 ]. A study done by Strickland et al showed the patient did not have any cranial symptoms despite his bilateral VAI [ 10 ]. Of the 68 patients with a confirmed cervical spine fracture, five (7.35%) were diagnosed with VAI in another study by Sheppard et al [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Vertebral Artery Injury in Cervical Spine Fracture Dislocation: An Observational Study in a Tertiary Care Center

Hasan,

Sangondimath,

Alam

et al. 2024

Cureus

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Background: The incidence of traumatic vertebral artery injury (VAI) associated with cervical spine trauma varies widely in published trauma series. The primary aim of this study was to determine the incidence of traumatic VAI in patients who suffered cervical spine injuries by means of routine magnetic resonance imaging, and the secondary objective was to identify any associations with injury mechanism, level of injury, and neurologic injury severity. Materials and methods: A retrospective review was conducted on 96 patients who suffered cervical spine fracture dislocation with or without an associated spinal cord injury (SCI) in Indian Spinal Injuries Center (ISIC), New Delhi, India from January 2013 to April 2023. Cervical magnetic resonance imaging (MRI) was used to diagnose VAI. Patient’s age, sex, cervical injury level, mechanism of injury, neurologic level of injury, association with foraminal fracture, facet dislocation, and clinical sequelae of vertebral artery injury were analyzed. Results: In this study, of 96 patients who met the inclusion criteria, 18 patients (18.75%) had VAI on the MRI study. Thirteen (72.22%) of the eighteen patients had right-sided injuries, four (22.22%) had left-sided injuries, and one (5.55%) had bilateral injuries. There was an associated SCI in every VAI patient. VAI was significantly more common in patients who had ASIA A (61%, n = 11) and ASIA B (22%, n = 4) injuries, and no VAI was noted in neurologically intact patients (p<0.001). The incidence of VAI was higher in the flexion distraction type of injury (n = 12, 66%). The most commonly involved cervical spine injury level was C5-C6 (27%, n = 5), followed by 22% (n = 4) at C4-C5 and C6-C7 levels. About 27.8% (n = 5) of VAI was associated with foraminal fractures, and 72% (n = 13) of VAI was associated with facet dislocations, of which 44% (n = 8) were bifacetal and 28% (n = 5) were unifacetal dislocations. On clinical symptoms, only one (5.56%) patient had a headache, and 17 (94.4%) had no clinical features due to VAI. Conclusion: The incidence of traumatic vertebral artery disease is not very uncommon and requires careful and meticulous screening and management. Otherwise, complications like pseudoaneurysm, neurologic deficit, late-onset hemorrhage, infarction, and death can happen. Mostly, it is associated with high-velocity injuries and neurological injuries. MRI can be used as a good screening tool, which can be aided by a CT angiogram or digital subtraction angiography for confirmation. Proper pre-operative evaluation of vascular injury in cervical spine fracture dislocation is very important for patient counseling, patient management, and surgical planning.

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“…Although bilateral VA occlusions due to C2 fracture have been reported,[2] alternating VA occlusions are rare. Two explanations for these in our patient could be considered.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound can detect alternating vertebral artery occlusions due to hangman fracture

Ohara

Sato

Mitsumura

et al. 2020

Neurology & Clinical Neurosc

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An 89-year-old woman fell from bed and hit her head on the floor.An immediately diagnosed C2 fracture was not indicated for surgery and was conservatively managed with a Philadelphia collar. Ten days later, she was transferred to our hospital with a sudden consciousness disturbance. Upon arrival, the patient was confused and had a Glasgow Coma Scale (GCS) score of 9 (E4V1M4) and a National Institutes of Health Stroke Scale score of 19. Magnetic resonance imaging (MRI) revealed hyperacute ischemic lesions in the bilateral cerebellar hemispheres, and MR angiography (MRA) showed occlusion of the left vertebral artery (VA) (Figure 1A). After intravenous thrombolysis, carotid ultrasonography (CUS) showed bilateral antegrade VA blood flow. On day 2, her consciousness score improved to a GCS of 14. Follow-up MRI revealed left VA recanalization and new right VA occlusion (Figure 1B). On day 3, MRI revealed right VA recanalization and left VA occlusion again (Figure 1C-1). CUS demonstrated normal flow of right VA, and left VA occlusion before branching into the posterior inferior cerebellar artery [1] (Figure 1C-2). Transcranial color flow imaging (TCCFI) showed retrograde left

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Bilateral Vertebral Artery Occlusion After Cervical Spine Fracture Dislocation

Cited by 10 publications

References 20 publications

Evaluation for Vertebral Artery Injury with Cervical Dislocated Fracture and Optimal Treatment before Reduction

Evaluation for Vertebral Artery Injury with Cervical Dislocated Fracture and Optimal Treatment before Reduction

Vertebral Artery Injury in Cervical Spine Fracture Dislocation: An Observational Study in a Tertiary Care Center

Ultrasound can detect alternating vertebral artery occlusions due to hangman fracture

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