Cervical fracture patterns associated with blunt cerebrovascular injures when utilizing computed tomographic angiography: a systematic review and meta-analysis

Du, Peter Z; Barton, Dane; Bridge, Nathaniel; Ganapathy, Venkatanarayanan

doi:10.1016/j.spinee.2022.05.009

Cited by 5 publications

(4 citation statements)

References 43 publications

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“…One study showed there was no statistically significant association between combined C4−C7 fractures and BCVI. 21 Vertebral artery injuries had the highest associated stroke rate of any injury type at 27.6% (vs 20.1% in carotid injury). Assessing the mortality rate, carotid artery injuries had a slightly higher rate of 12.6% versus 9.7% in vertebral injuries.…”

Section: Resultsmentioning

confidence: 90%

“…Regarding the association of BCVI with cervical spine fractures, the studies showed a statistical significance between BCVI and C1−C3 fractures, 2-level fractures, subluxation/dislocations, transverse foramen fractures, and facet fractures. One study showed there was no statistically significant association between combined C4−C7 fractures and BCVI 21 …”

Section: Resultsmentioning

confidence: 99%

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Pediatric Blunt Cerebrovascular Injuries

El Tawil,

Nemeth,

Al Sawafi

2023

Pediatr Emer Care

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The low incidence of blunt cerebrovascular injury (BCVI) reported in pediatric studies (<1%) might be related to an underreporting due to both the absence of current screening guidelines and the use of inadequate imaging techniques. This research is a review of the literature limited to the last 5 years (2017-2022) about the approach and management of BCVI in pediatrics. The strongest predictors for BCVI were the presence of basal skull fracture, cervical spine fracture, intracranial hemorrhage, Glasgow Coma Scale score less than 8, mandible fracture, and injury severity score more than 15. Vertebral artery injuries had the highest associated stroke rate of any injury type at 27.6% (vs 20.1% in carotid injury). The sensitivity of the well-established screening guidelines of BCVI varies when applied to the pediatric population (Utah score -36%, 17%, Eastern Association for the Surgery of Trauma (EAST) guideline -17%, and Denver criteria -2%). A recent metaanalysis of 8 studies comparing early computed tomographic angiogram (CTA) to digital subtraction angiography for BCVI detection in adult trauma patients demonstrated high variability in the sensitivity and specificity of CTA across centers. Overall, CTA was found to have a high specificity but low sensitivity for BCVI. The role of antithrombotic as well as the type and duration of therapy remain controversial. Studies suggest that systemic heparinization and antiplatelet therapy are equally effective.

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Section: Resultsmentioning

confidence: 90%

Section: Resultsmentioning

confidence: 99%

Pediatric Blunt Cerebrovascular Injuries

El Tawil,

Nemeth,

Al Sawafi

2023

Pediatr Emer Care

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“…9 A recent study reported combined C0-C3 fractures were associated with an increased risk of VAI. 10 Therefore, early diagnosis and prophylactic treatment are essential for traumatic VAI.…”

Section: Discussionmentioning

confidence: 99%

“…The literature suggests a 71% prevalence of VAI in patients with cervical spine injury and 18% in those with C2 fractures 9 . A recent study reported combined C0‐C3 fractures were associated with an increased risk of VAI 10 . Therefore, early diagnosis and prophylactic treatment are essential for traumatic VAI.…”

Section: Discussionmentioning

confidence: 99%

Vertebral artery injury following combination Jefferson fracture of C1 and Type II odontoid fracture: A case report

Meng,

Zhang,

Song

et al. 2024

Clinical Case Reports

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Key Clinical MessageTraumatic posterior atlantoaxial dislocation combined with Jefferson fracture and odontoid process fracture with vertebral artery injury is rare. The management of such injury raises controversial issues and is still open to debate. A 74‐year‐old Chinese male presented with sustained neck pain and stiffness after falling from height. The patient was neurologically intact. Preoperative radiographs demonstrated a Jefferson burst fracture with a posterior dislocation of the atlantoaxial joints and odontoid process Anderson and D'alonzo type II fracture. A computed tomography angiography (CTA) showed an occluded left vertebral artery. Coil embolization in the proximal portion of the occluded vertebral artery was performed to prevent further cerebral infarction due to distal embolization of the thrombus. Then a second stage occipito‐cervical fusion was performed to reconstruct cervical spine stability. A systematic screening of blunt trauma vertebral artery injuries through CTA is required when dealing with upper cervical fracture. For cases with vertebral artery occlusion secondary to cervical spine injury, endovascular treatment preceding cervical spine surgery is a feasible and a safe treatment.

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