Abstract
Introduction and Aims: Vertebral artery patency is not routinely documented in cervical fractures and dislocations. The incidence of vertebral artery injuries following cervical trauma is unknown, as they are rarely symptomatic. Vertebrobasilar insufficiency may be catastrophic and such vascular occlusion should be identified and treated early.
Method: One hundred and eighteen patients who sustained fractures and dislocations of the cervical spine between January 1996 and February 2001 were evaluated and subjected to MRI (magnetic resonance imaging) and MRA (magnetic resonance angiography). The average age was 34 years and there were 30 females. Seventy patients had unifacet dislocations, 10 burst fractures and 38 bifacetal dislocations. Forty-five patients had neurological deficit. Seven patients died within the first six weeks of injury. Reduction and surgical fusion were performed on 115 patients. None of the patients had signs/symptoms of vertebrobasilar ischaemia. MRA was repeated in six patients three years post-injury.
Results: Vertebral artery injury was diagnosed in 20 patients (23.6 %) – one patient had bilateral injury. Diagnosis was based on the loss of normal flow void on MRI and confirmed on MRA. Twelve patients with vascular compromise had unifacetal dislocations, two had burst fractures and six bifacetal dislocations. Thrombosis was present in 13 patients, three patients had intimal tears and five dissections (one patient with bilateral injury). The patient with bilateral injury also had significant neurological deficit (frankel C), confusion that resolved in 24 hours and evidence of cerebellar infarct. She had no symptoms of vertebrobasilar insufficiency and recovered full neurological function. Repeat MRA in six patients showed no evidence of recanalisation.
Conclusion: VAI was more common in unifacet dislocations, emphasising the effect of a rotation force predisposing to vascular injury. We recommend early diagnosis of vertebrobasilar insufficiency. Future anterior cervical surgery in patients with VAI should be undertaken with caution.
These abstracts were prepared by Editorial Secretary, George Sikorski. Correspondence should be addressed to Australian Orthopaedic Association, Ground Floor, The William Bland Centre, 229 Macquarie Street, Sydney, NSW 2000, Australia.
One or more of the authors are receiving or have received material benefits or support from a commercial source.
