Risk Factors and Precipitating Neck Movements Causing Vertebrobasilar Artery Dissection After Cervical Trauma and Spinal Manipulation

Abstract

The literature does not assist in the identification of the offending mechanical trauma, neck movement, or type of manipulation precipitating vertebrobasilar artery dissection or the identification of the patient at risk. Thus, given the current status of the literature, it is impossible to advise patients or physicians about how to avoid vertebrobasilar artery dissection when considering cervical manipulation or about specific sports or exercises that result in neck movement or trauma.

Blunt vertebral vascular injury in trauma patients: ATLS® recommendations and review of current evidence

“…Hyperextension injury has been found to be significantly associated with TVAI in particular (15). The most common cause of injury is major trauma sustained during road traffic accidents (16,17). Trivial trauma and spinal manipulation are also recognised modes of injury (16).…”

“…The most common cause of injury is major trauma sustained during road traffic accidents (16,17). Trivial trauma and spinal manipulation are also recognised modes of injury (16). Such trauma can culminate in numerous pathologies including dissection, thrombosis, aneurysms, pseudoaneurysms, arteriovenous fistula formation, transection or vasospasm (18,19).…”

The effect of end-range cervical rotation on vertebral and internal carotid arterial blood flow and cerebral inflow: A sub analysis of an MRI study

“…A velocity encoding value of 100 cm/s was used. The selected imaging plane was at the level of the C1 vertebra and atlas loop of the VA, this being the site of most reported manipulative injuries of the VA (Frisoni and Anzola 1991, Hurwitz, Aker et al 1996, Haldeman, Kohlbeck et al 1999). …”

Blunt traumatic vertebral artery injury: a clinical review

“…The risk of spontaneous vertebral artery dissection is also known to be increased in connective tissue disorders. Minor or seemingly innocuous supraclavicular trauma may also precipitate TVAI in such patients [22]. The pathophysiology of TVAI includes occlusion, dissection, thrombo-embolism, intimal damage, pseudoaneurysm, rupture, arteriovenous fistula and transection [3,9,23].…”