Screening via CT angiogram after traumatic cervical spine fractures: narrowing imaging to improve cost effectiveness. Experience of a Level I trauma center

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>Screening for vertebral artery injury (VAI) following cervical spine fractures is routinely performed across trauma centers in North America. From 2002 to 2007, the total number of neck CT angiography (CTA) studies performed in the Medicare population after trauma increased from 9796 to 115,021. In the era of cost-effective medical care, the authors aimed to evaluate the utility of CTA screening in detecting VAI and reduce chances of posterior circulation strokes after traumatic cervical spine fractures.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>A retrospective review of all patients presenting with cervical spine fractures to Northeast Ohio’s Level I trauma institution from 2002 to 2012 was performed.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>There was a total of 1717 cervical spine fractures in patients presenting to Northeast Ohio’s Level I trauma institution between 2002 and 2012. CTA screening was performed in 732 patients, and 51 patients (0.7%) were found to have a VAI. Fracture patterns with increased odds of VAI were C-1 and C-2 combined fractures, transverse foramen fractures, and subluxation of adjacent vertebral levels. Ten posterior circulation strokes were identified in this patient population (0.6%) and found in only 4 of 51 cases of VAI (7.8%). High-risk fractures defined by Denver Criteria, VAI, and antiplatelet treatment of VAI were not independent predictors of stroke.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Cost-effective screening must be reevaluated in the setting of blunt cervical spine fractures on a case-by-case basis. Further prospective studies must be performed to elucidate the utility of screening for VAI and posterior circulation stroke prevention, if identified.</jats:p></jats:sec>

Treatment of Axis Ring Fractures: Recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU)

“…A conventional angiography, a CT angiography (CTA), or magnetic resonance imaging (MRI) angiography are potential tools used to detect a vascular lesion or an anatomical anomaly (eg, high riding artery). 10 - 12 …”

Cervical Computed Tomography Angiography Rarely Leads to Intervention in Patients With Cervical Spine Fractures

“…They found CTAs ordered off protocol had a very low likelihood of having a VAI, the incidence of CTA changing the surgical intervention of the patient was likewise low (1 of 126, 0.8%), and C1-C3 spine injuries have an increased association with VAI. Similarly, in a retrospective study ranging 10 years and encompassing 732 patients, Lockwood et al 20 found that C1 and C2 fractures along with those involving the foramen transversarium and subluxation injuries, were associated with an increased risk of VAI. Additionally, they found that only 7.8% (4 of 51) of these VAIs and 0.6% (10 of 732) of all CTAs conducted, ended up with a posterior stroke.…”

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

“…However, given the cost and inherent procedural risks, screening DSA has largely been replaced by CTA or MR angiography 16. CTA has been found to be between 97.7% and 100% sensitive in screening for blunt traumatic cerebrovascular injury in both retrospective17 and prospective series 18.…”