Vertebral Artery Injury with Coinciding Unstable Cervical Spine Trauma: Mechanisms, Evidence-based Management, and Treatment Options

Intraoperative surveillance of the vertebral artery using indocyanine green angiography and Doppler sonography in craniovertebral junction surgeries

“…1,37 This variation occurs not only because the incidence of significant complications declines with the increase in the surgeon's experience, but also because the VA's status and related complications may be changed by certain pathologic conditions such as a tumor, trauma, congenital anomaly, and infection. 2,6,9,10,15,[38][39][40] In the present study, the control and monitoring groups differed in terms of pathology and VAI risk. We performed ICG angiography and Doppler sonography only for patients with a high risk of VAI.…”

Implications of Vertebral Artery Blunt Injury to Cervical Spine Trauma Treatment: Short Narrative Review of the Literature Based on Four Cases

“…Nonetheless, while outcomes have overall significantly improved and mortality or strokes rates have dropped, clinical recommendations remain at low or moderate level of evidence at best with regards to imaging build-up and BCVI treatment regimens [1,11,12]. Moreover, clinical questions regarding the implications of BCVI on treatment of underlying or concomitant cervical spine trauma have only recently been touched [12,13]. Among others, treating surgeon has to often manage cervical spine trauma stabilization [14] against anticoagulation treatment for VAI, leading to delay of definite operative treatment, or evaluate intervention for the vascular injury [13].…”

“…Moreover, clinical questions regarding the implications of BCVI on treatment of underlying or concomitant cervical spine trauma have only recently been touched [12,13]. Among others, treating surgeon has to often manage cervical spine trauma stabilization [14] against anticoagulation treatment for VAI, leading to delay of definite operative treatment, or evaluate intervention for the vascular injury [13]. In the context of this clinical discussion, we hereby present four patient cases with VAI due to BCVI that were treated in our department.…”

“…Endovascular treatment is to be considered in failure of conservative, possibly in pseudoaneurysms and in active extravasation, while operative treatment of BCVI is generally uncommon [6,10,12]. As a consequence, operative treatment of concomitant and underlying spinal trauma is subject to a difficult decision process that needs to take into account the patient neurological status and the urgency of decompression and stabilization against the degree of vascular injury and the need for early antithrombotic and possibly anticoagulant treatment [13]. As there is no clear evidence that cervical stabilization may actually positively affect the course of VAI [13], in cases where the patient neurology and cervical trauma permits, it can be considered safe to delay the definitive operative treatment until the stroke high risk period had passed.…”

“…As a consequence, operative treatment of concomitant and underlying spinal trauma is subject to a difficult decision process that needs to take into account the patient neurological status and the urgency of decompression and stabilization against the degree of vascular injury and the need for early antithrombotic and possibly anticoagulant treatment [13]. As there is no clear evidence that cervical stabilization may actually positively affect the course of VAI [13], in cases where the patient neurology and cervical trauma permits, it can be considered safe to delay the definitive operative treatment until the stroke high risk period had passed. In our cases we demonstrate that initial management with LMWH possibly allows for a safe compromise during the diagnostic build-up and waiting period, regardless of final decision to operate or not.…”