Contemporary outcomes of vertebral artery injury

Alterman, Daniel M.; Heidel, R Eric; Daley, Brian; Grandas, Oscar H.; Stevens, Scott L.; Goldman, Mitchell H.; Freeman, Michael B.

doi:10.1016/j.jvs.2012.09.006

Cited by 41 publications

(33 citation statements)

References 14 publications

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“…In this regards, the efficacious results with aspirin have innumerous advocates. [22] These findings support that both the fracture pattern described above and facet dislocations are a strong indicator of potential BVAI. As CT angiography has shown a 99% accuracy compared with conventional angiography in the identification of such injuries, these studies are likely responsible for the recent marked increase in detection of BVAI and should be used in the screening for all patients with this pattern of atlanto-axial injury.…”

Section: Discussionsupporting

confidence: 72%

Unilateral atlanto-axial fractures in near side impact collisions: An under recognized entity in cervical trauma

Lozen

Pace

Yoganandan

et al. 2014

J Craniovert Jun Spine

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Objective:Nearside impact collisions presenting with lateral mass fractures of atlanto-axial vertebrae contralateral to the impact site represents a rare fracture pattern that does not correlate with previously described injury mechanism. We describe our clinical experience with such fractures and propose a novel description of biomechanical forces involved in this unique injury pattern. The findings serve to alert clinicians to potentially serious consequences of associated unrecognized and untreated vertebral artery injury.Material and Methods:In addition to describing our clinical experience with three of these fractures, a review of Crash Injury Research and Engineering Network (CIREN) database was conducted to further characterize such fractures. A descriptive analysis of three recent lateral mass fractures of the atlanto-axial segment is coupled with a review of the CIREN database. A total of 4047 collisions were screened for unilateral fractures of atlas or axis. Information was screened for side of impact and data regarding impact velocity, occupant injuries and use of restraints.Results:Following screening of unilateral fractures of atlas and axis for direct side impacts, 41 fractures were identified. Cross referencing these cases for occurrence contralateral to side of impact identified four such fractures. Including our recent clinical experience, seven injuries were identified: Five C1 and two C2 fractures. Velocity ranged from 14 to 43 km/h. Two associated vertebral artery injuries were identified.Conclusions:Complexity of the atlanto-axial complex is responsible for a sequence of events that define load application in side impacts. This study demonstrates the vulnerability of vertebral artery to injury under unique translational forces and supports the use or routine screening for vascular injury. Diminished sensitivity of plain radiography in identifying these injuries suggests that computerized tomography should be used in all patients wherein a similar pattern of injury is suspected.

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Section: Discussionsupporting

confidence: 72%

Unilateral atlanto-axial fractures in near side impact collisions: An under recognized entity in cervical trauma

Lozen

Pace

Yoganandan

et al. 2014

J Craniovert Jun Spine

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“…As posterior circulation ischemia may occur, consensus recommendations include early screening for cerebrovascular injury following blunt trauma, provided that no contraindication for IV contrast exists and the patient is sufficiently medically stable to undergo imaging 2 19. Prospective studies have repeatedly demonstrated the utility of early initiation of systemic heparin or antiplatelet therapy in reducing the risk of stroke after a blunt cerebrovascular injury 9 21–24.…”

Section: Discussionmentioning

confidence: 99%

Temporary vertebral artery occlusion after C3 fracture dislocation injury and spontaneous resolution following reduction and instrumented fusion: case report and literature review

Yaeger

Kellner

Hickman

et al. 2016

J NeuroIntervent Surg

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Vertebral artery injuries as a result of blunt trauma can result in vertebrobasilar strokes. Typical treatment of such an injury includes early anticoagulation to prevent cerebral ischemic events due to vessel occlusion or embolism. We present a case of cervical fracture-dislocation injury and compression/occlusion of the right vertebral artery, which spontaneously resolved following surgical reduction and fusion. Postoperative cerebral angiography showed no evidence of vertebral artery stenosis, and systemic anticoagulation was discontinued. This case shows that vertebral artery occlusion can resolve spontaneously after fracture reduction, and cerebral angiography should play a role in assessing these complicated traumatic injuries.

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“…It lies anterior to the intervertebral foramen between the C-6 and C-7 and then enters the lateral mass of the C-7 transverse process. 1 The C-7 nerve emerges at this level. Preparation of the passage from the intervertebral foramen to the retroesophageal space requires us to traverse deep to the scalenus anterior muscle and through the longus colli muscle.…”

Section: Complications Arising From the Creation Of The Retroesophagementioning

confidence: 93%

Complications of contralateral C-7 transfer through the modified prespinal route for repairing brachial plexus root avulsion injury: a retrospective study of 425 patients

Wang

Zhao

et al. 2015

JNS

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obJect In this report, the authors review complications related to the modified prespinal route in contralateral C-7 transfer for repairing brachial plexus nerve root avulsion injury and suggest a prevention strategy. methods A retrospective, nonselected amalgamation of every case of modified contralateral C-7 transfer through the prespinal route was undertaken. The study population comprised 425 patients treated between February 2002 and August 2009. The patients were managed according to a standardized protocol by one senior professor. The surgical complications were grouped into one of the following categories: those associated with tunnel making through the prespinal route, those related to the dissection and transection of the contralateral C-7 nerve root, and those that occurred in the postoperative period. results The study population included 379 male and 46 female patients whose average age was 21 years (range 3 months to 56 years). A total of 401 patients were diagnosed with traumatic brachial plexus injury, the leading cause of which was motor vehicle accident, and 24 patients were diagnosed with obstetrical brachial plexus palsy. The contralateral C-7 nerve root was cut at the proximal side of the division portion of the middle trunk in 15 cases and sectioned at the distal end of the anterior and posterior divisions in 410 cases. The overall incidence of complications was 5.4% (23 of 425). Complications associated with making a prespinal tunnel occurred in 12 cases, including severe bleeding due to vertebral artery injury during the procedure in 2 cases (0.47%), temporary recurrent laryngeal nerve palsy in 5 cases (1.18%), pain and numbness in the donor upper extremity during swallowing in 4 cases (0.94%), and dyspnea caused by thrombosis of the brainstem 42 hours postoperatively in 1 case (0.24%); this last patient died 38 days after the operation. Complications related to exploration and transection of the contralateral C-7 nerve root occurred in 11 cases, including deficiency in extensor strength of the fingers and thumb in 4 cases (0.94%) due to injury to the posterior division of the lower trunk, unbearable pain on the donor upper extremity in 3 cases (0.71%), Horner's syndrome in 2 children (0.47%) who suffered birth palsy, a section of C-6 nerve root mistaken as C-7 in l case (0.24%), and atrophy of the sternocostal part of the pectoralis major in 1 case (0.24%). coNclusioNs The most serious complications of using the modified prespinal route in contralateral C-7 transfer were vertebral artery laceration and injury to the posterior division of the lower trunk. The prevention of such complications is necessary to popularize this surgical procedure and attain good long-term clinical results.

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Contemporary outcomes of vertebral artery injury

Cited by 41 publications

References 14 publications

Unilateral atlanto-axial fractures in near side impact collisions: An under recognized entity in cervical trauma

Unilateral atlanto-axial fractures in near side impact collisions: An under recognized entity in cervical trauma

Temporary vertebral artery occlusion after C3 fracture dislocation injury and spontaneous resolution following reduction and instrumented fusion: case report and literature review

Complications of contralateral C-7 transfer through the modified prespinal route for repairing brachial plexus root avulsion injury: a retrospective study of 425 patients

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