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

Trauma of bone and soft tissues in South American mummies—New cases provide further insight into violence and lethal outcome

There exist numerous reports on violence in South American populations which shed a particular light on life and living conditions in those historic communities. Most studies have been performed on collections of isolated skulls. Whole-body investigations especially on well-preserved mummified human remains are rare. In the present study we investigated three South American mummies predating the Colonial Spanish period. The “Marburg” man lived between 996 and 1147 CE and was buried in typical burial bundle. The analysis of the textiles, ceramics and fishing tools associated with his naturally mummified body suggests that he most likely originated from the Arica region in Northern Chile and was possibly part of a fishing community. The “Delémont” natural mummies belong to an adult male and an adult female, respectively. The mummies, the textiles and grave goods were investigated. The ceramics suggest a provenance from the Arequipa region, supposing that all the artifacts were originally associated with the two mummies. The Delémont male mummy is ¹⁴C dated between 902 and 994 CE and the “Delémont” female mummy ¹⁴C dated between 1224 and 1282 CE. All mummies underwent Multidetector Computed Tomography which showed evidence of trauma, some of which were interpreted as evidence of interpersonal violence. An interdisciplinary approach was applied with the particular intention to identify trauma sequels and to evaluate their paleo-forensic potential. Evidence of violence was identified in the two male individuals. Our study provides evidence that the interdisciplinary investigation of well-preserved human remains may detect much more frequent traces of intentional trauma than previously thought. Particularly, trauma against the body may not be identified in studies on skulls alone, and trauma residues of internal organs/soft tissues will only be seen in mummies. We therefore add further evidence of two cases of (lethal) trauma in pre-colonial South-American male individuals.

Vertebral artery dissection in acute cervical spine trauma

Objective:

The aim of this study was to study mechanism, risk factors, and prognosis of patients with vertebral artery dissection (VAD) from acute cervical spine trauma (CST).

Methods:

A total of 149 consecutive patients were chosen from 2014 to 2019 from our institute data base, and their records were retrospectively studied. Morphology of fracture and subluxation were studied in detail with respect to the presence or absence of VAD.

Results:

Patients were divided in subsets of axial spine injury and subaxial spine injury. Subgroup and group analysis was performed and computerized tomography angiogram, MR angiogram and T1/T2 axial scans were studied to identify VAD, an incidence of 14.1% was found. Patients having infarcts in posterior circulation were also identified.

Conclusion:

There is a significant contribution of biomechanics of CST and evolution of VAD. This is an important consideration to prevent significant morbidity and mortality. Hence, a diagnostic algorithm which can be applied in any hospital setup is the need of the hour.

Evaluation for Vertebral Artery Injury with Cervical Dislocated Fracture and Optimal Treatment before Reduction

Objective

Cervical dislocated fractures frequently cause vertebral artery injury (VAI), which, in turn, propagates the thrombus at the site of injury. Cerebral embolism due to a thrombus after the reduction of dislocation leads to a poorer neurological outcome. Therefore, we investigated the outcome of treatment for cervical dislocated fractures and the usefulness of parent artery occlusion (PAO) before reduction.

Methods

Eight patients with cervical dislocated fractures with a locked facets treated at our hospital between January 2018 and December 2020 were evaluated. We retrospectively examined patient characteristics and clinical outcomes.

Results

Among the eight patients, two were injured at C4/5, four at C5/6, and two at C6/7. All patients had locked facets. Four patients had bilateral dislocation, while the others had unilateral dislocation. Two patients with unilateral dislocation had ipsilateral vertebral artery occlusion (VAO), while the other six did not. Both patients with VAO underwent PAO to prevent cerebral embolism before reduction. The six patients who did not have VAI underwent reduction without preprocedural treatment. No cerebral ischemic complications were observed. One patient died due to paralysis of the respiratory muscles caused by spinal cord injury but the remaining seven recovered well.

Conclusion

PAO before reduction for cervical dislocated fractures with VAO may be effective in preventing cerebral embolism after reduction.