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Devi B, Gupta R, Siroya H, Bhat D, Shukla D, Pruthi N. Vertebral artery dissection in acute cervical spine trauma. J Craniovertebr Junction Spine 2022; 13:27-37. [PMID: 35386245 PMCID: PMC8978858 DOI: 10.4103/jcvjs.jcvjs_3_22] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 01/09/2022] [Indexed: 12/05/2022] Open
Abstract
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.
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Extensive brain infarctions from bilateral vertebral artery injury because of cervical hyperextension injury: A case report. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Merrill S, Clifton W, Valero-Moreno F, Damon A, Rahmathulla G. Vertebral Artery Injury with Coinciding Unstable Cervical Spine Trauma: Mechanisms, Evidence-based Management, and Treatment Options. Cureus 2020; 12:e7225. [PMID: 32274283 PMCID: PMC7141798 DOI: 10.7759/cureus.7225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Unstable traumatic cervical spine fracture is a commonly encountered neurosurgical issue. Concomitant vertebral artery injuries present a challenge in surgical decision-making regarding the timing and order of surgical intervention with respect to endovascular intervention and internal fixation of the unstable fracture. Currently, there are no studies that have specifically examined stroke rate or outcomes for patients who have vertebral artery injuries and unstable cervical spine fractures with respect to temporal treatment course. The purpose of this paper is to review the current evidence for the standards of diagnosis and management of vertebral artery injuries with coinciding unstable cervical spine injuries and propose an evidence-based algorithm for workup and treatment.
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Affiliation(s)
- Sarah Merrill
- Neurological Surgery, Mayo Clinic Alix School of Medicine, Scottsdale, USA
| | | | | | - Aaron Damon
- Neurological Surgery, Mayo Clinic, Jacksonville, USA
| | - Gazanfar Rahmathulla
- Neurological Surgery, University of Florida College of Medicine, Gainesville, USA
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Strickland B, Lewis CS, Pham MH. Bilateral Vertebral Artery Occlusion After Cervical Spine Fracture Dislocation. World Neurosurg 2019; 124:304-309. [PMID: 30684719 DOI: 10.1016/j.wneu.2019.01.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 01/03/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Vertebral artery injury is known to potentially occur in conjunction with blunt cervical spine trauma. Rarely, these injuries present bilaterally as complete occlusions. Twelve cases of bilateral vertebral artery occlusions after closed cervical spine trauma have been described in the reported data, nearly all of which demonstrated signs and symptoms of vertebrobasilar insufficiency and ischemia. CASE DESCRIPTION Our patient presented after a traumatic C5-C6 flexion-distraction injury that had resulted in bilateral locked facets and spinal cord injury and bilateral vertebral artery occlusions at the V1 segment. However, our patient did not show any cranial symptoms despite his neurovascular injury. CONCLUSIONS We present our patient's case as a rare illustration of a bilateral vertebral artery occlusion after blunt cervical spine trauma without clinical vertebrobasilar ischemic sequelae.
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Her Y, Kang SH, Abdullaev I, Kim N. Delayed Infarction of Medullar and Cerebellum 3 Months after Vertebral Artery Injury with C1-2 Fracture: Case Report. Korean J Neurotrauma 2017; 13:29-33. [PMID: 28512615 PMCID: PMC5432446 DOI: 10.13004/kjnt.2017.13.1.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 04/10/2017] [Accepted: 04/10/2017] [Indexed: 11/25/2022] Open
Abstract
The clinical manifestations of vertebral artery (VA) injury (VAI) after cervical trauma range from asymptomatic to fatal cerebral infarction. Thrombotic occlusion and embolization to the distal arteries can cause cerebellar and brain stem infarction within days after trauma. We report a 64-year-old man who underwent arthrodesis surgery for C1 and C2 fractures. He had left VAI at the C2 transverse foramen site but was asymptomatic. The patient experiences brainstem and cerebellar infarction 3 months after injury to the VA, and we are here to discuss the treatment of VAI after cervical trauma.
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Affiliation(s)
- Yunsuk Her
- Department of Neurosurgery, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon, Korea
| | - Suk Hyung Kang
- Department of Neurosurgery, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon, Korea
| | - Ilhom Abdullaev
- Department of Neurosurgery, Multi-Profiled Medical Center of Khorezm, Khorezm, Uzbekistan
| | - Noah Kim
- Asia Pacific International School, Seoul, Korea
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Zhang Z, Wang H, Mu Z. Vertebral Artery Occlusion and Recanalization After Cervical Facet Dislocation. World Neurosurg 2016; 95:190-196. [DOI: 10.1016/j.wneu.2016.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 07/31/2016] [Accepted: 08/01/2016] [Indexed: 11/25/2022]
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Kyrylenko M, Karadas E, Pienaar SJ, Fialka C. Survival without Neurological Impairment After Complete Dislocation of the C7 Vertebral Body: A Case Report. JBJS Case Connect 2015; 5:e100. [PMID: 29252806 DOI: 10.2106/jbjs.cc.o.00038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We report a case of a forty-one-year-old woman who sustained a C7/T1 fracture-dislocation due to a vehicle rollover accident. Despite complete dislocation of the C7 vertebral body, no subsequent injury-related neurological deficit occurred. After the initial survey, injury evaluation with computed tomography and magnetic resonance imaging was performed. Immediate open reduction and internal fixation included anterior plating and interbody arthrodesis from C6 to T1 with an iliac crest bone graft. The patient was discharged home ten days postoperatively. Sufficient osseous consolidation was confirmed after two months. CONCLUSION Immediate surgical treatment in this case resulted in an excellent short-term clinical outcome. Other treatment alternatives are discussed.
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Nakao Y, Terai H. Distal embolic brain infarction due to recanalization of asymptomatic vertebral artery occlusion resulting from cervical spine injury: a case report. J Chiropr Med 2014; 13:266-72. [PMID: 25435840 DOI: 10.1016/j.jcm.2014.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 08/19/2014] [Accepted: 08/23/2014] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The purpose of this case report is to describe a patient with brain infarction due to recanalization of an occluded vertebral artery (VA) following closed reduction and open fixation of cervical spinal dislocation and to discuss the management of asymptomatic VA injuries associated with spine trauma. CLINICAL FEATURES A 41-year-old Asian man experienced a C4-5 distractive-flexion injury manifesting with quadriplegia and anesthesia below the C3 cord level (including phrenic nerve paralysis), and bowel and bladder dysfunction. Magnetic resonance angiography and computed tomography angiography showed left extracranial VA (V2) occlusion and a patent contralateral VA. INTERVENTION AND OUTCOME The patient was observed without antiplatelet and/or anticoagulation therapy and underwent open reduction and internal fusion of C4/5 and tracheostomy 8 hours after the injury. After surgery, supraspinal symptoms such as left horizontal nystagmus and left homonymous hemianopsia led to cranial computed tomography and magnetic resonance imaging, which showed left-side cerebellar infarction in the posterior inferior cerebellar artery territory and right-side posterior cerebral artery infarction. Magnetic resonance angiography and computed tomography angiography demonstrated patent bilateral VA (but hypoplastic right VA) and occluded right posterior cerebral artery. The injured VA was treated conservatively, and there were no other ischemic complications. CONCLUSION The management of asymptomatic VA injury is controversial, with several treatment options available, including observation alone, antiplatelet therapy, anticoagulation therapy, or invasive intervention. Although there are some reports described where management with observation alone seems safe, serious attention should be given to the VA injury caused by cervical spine trauma.
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Affiliation(s)
- Yaoki Nakao
- Attending Physician, Daiyukai General Hospital, Ichinomiya, Japan
| | - Hiroshi Terai
- Attending Physician, Daiyukai General Hospital, Ichinomiya, Japan
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Nakao Y, Terai H. Embolic brain infarction related to posttraumatic occlusion of vertebral artery resulting from cervical spine injury: a case report. J Med Case Rep 2014; 8:344. [PMID: 25316102 PMCID: PMC4205778 DOI: 10.1186/1752-1947-8-344] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 08/06/2014] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The frequency of vertebrobasilar ischemia in patients with cervical spine trauma had been regarded as low in many published papers. However, some case reports have described cervical spine injury associated with blunt vertebral artery injury. Many aspects of the management of vertebral artery injuries still remain controversial, including the screening criteria, the diagnostic modality, and the optimal treatment for various lesions. The case of a patient who had a brain infarction due to recanalization of his occluded vertebral artery following open reduction of cervical spinal dislocation is presented here. CASE PRESENTATION A 41-year-old Asian man presented with C4 to C5 distractive flexion injury manifesting with quadriplegia and anesthesia below his C3 cord level (including phrenic nerve paralysis), and bowel and bladder dysfunction. Magnetic resonance angiography and computed tomography angiography showed left extracranial vertebral artery occlusion and patent contralateral vertebral artery. He was observed without antiplatelet and/or anticoagulation therapy, and underwent surgery (open reduction and internal fusion of C4 to C5, and tracheostomy) 8 hours after the injury. After surgery, supraspinal symptoms such as left horizontal nystagmus and left homonymous hemianopsia led to cranial computed tomography and magnetic resonance imaging, which showed left-side cerebellar infarction in his posterior inferior cerebellar artery territory and right-side posterior cerebral artery infarction. Magnetic resonance angiography and computed tomography angiography demonstrated patent bilateral vertebral artery (but hypoplastic right vertebral artery) and occluded right posterior cerebral artery. His injured vertebral artery was treated conservatively, which did not cause any other ischemic complications. CONCLUSIONS The management of asymptomatic vertebral artery injury is controversial with several treatment options available, including observation alone, antiplatelet therapy, anticoagulation therapy, or invasive intervention. Although there are some reports in which management with observation alone is described as safe, we should pay serious attention to the vertebral artery injury caused by cervical spine trauma.
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Affiliation(s)
- Yaoki Nakao
- Department of Emergency Medicine, Daiyukai General Hospital, 1-9-9, Sakura, Ichinomiya 491-8551, Japan.
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Jang D, Kim C, Lee SJ, Kim J. Delayed Brain Infarction due to Bilateral Vertebral Artery Occlusion Which Occurred 5 Days after Cervical Trauma. J Korean Neurosurg Soc 2014; 56:141-5. [PMID: 25328652 PMCID: PMC4200362 DOI: 10.3340/jkns.2014.56.2.141] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 06/26/2014] [Accepted: 08/16/2014] [Indexed: 11/27/2022] Open
Abstract
Vertebral artery (VA) injuries usually accompany cervical trauma. Although these injuries are commonly asymptomatic, some result in vertebrobasilar infarction. The symptoms of VA occlusion have been reported to usually manifest within 24 hours after trauma. The symptoms of bilateral VA occlusions seem to be more severe and seem to occur with shorter latencies than those of unilateral occlusions. A 48-year-old man had a C3-4 fracture-dislocation with spinal cord compression that resulted from a traffic accident. After surgery, his initial quadriparesis gradually improved. However, he complained of sudden headache and dizziness on the 5th postoperative day. His motor weakness was abruptly aggravated. Radiologic evaluation revealed an infarction in the occipital lobe and cerebellum. Cerebral angiography revealed complete bilateral VA occlusion. We administered anticoagulation therapy. After 6 months, his weakness had only partially improved. This case demonstrates that delayed infarction due to bilateral VA occlusion can occur at latencies as long as 5 days. Thus, we recommend that patients with cervical traumas that may be accompanied by bilateral VA occlusion should be closely observed for longer than 5 days.
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Affiliation(s)
- Donghwan Jang
- Department of Neurosurgery, Kangwon National University Hospital, Chuncheon, Korea
| | - Choonghyo Kim
- Department of Neurosurgery, Kangwon National University Hospital, Chuncheon, Korea
| | - Seung Jin Lee
- Department of Neurosurgery, Kangwon National University Hospital, Chuncheon, Korea
| | - Jiha Kim
- Department of Neurosurgery, Kangwon National University Hospital, Chuncheon, Korea
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O’Shaughnessy J, Grenier JM, Stern PJ. A delayed diagnosis of bilateral facet dislocation of the cervical spine: a case report. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2014; 58:45-51. [PMID: 24587496 PMCID: PMC3924504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To review the case of a patient suffering from bilateral facet dislocation of the cervical spine. CLINICAL FEATURES A 53-year-old male was involved in a car accident and was transported to the hospital. Cervical radiographs were taken at the emergency department and interpreted as normal. Four days later, he consulted a chiropractor where radiographs of the cervical spine were repeated. The examination revealed bilateral cervical facet joint dislocation at C5-C6 as well as a fracture involving the spinous process and laminae of C6. INTERVENTION AND OUTCOME The patient was referred to the hospital and underwent surgery. CONCLUSION Patients involved in motor vehicle accidents often consult chiropractors for neck pain treatment. A high index of suspicion due to significant history and physical examination findings should guide the clinician in determining the need for reviewing the initial radiographs (if taken and available) or request repeat studies, regardless of the initial imaging status.
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Affiliation(s)
- Julie O’Shaughnessy
- Full time professor, Département de chiropratique, Université du Québec à Trois-Rivières (UQTR), Trois-Rivières, Québec, Canada
| | - Julie-Marthe Grenier
- Full time professor, Département de chiropratique, Université du Québec à Trois-Rivières (UQTR), Trois-Rivières, Québec, Canada
| | - Paula J. Stern
- Director, CMCC Graduate Studies program, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
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Mimata Y, Murakami H, Sato K, Suzuki Y. Bilateral cerebellar and brain stem infarction resulting from vertebral artery injury following cervical trauma without radiographic damage of the spinal column: a case report. Skeletal Radiol 2014; 43:99-105. [PMID: 24061492 DOI: 10.1007/s00256-013-1722-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 08/21/2013] [Accepted: 08/23/2013] [Indexed: 02/02/2023]
Abstract
Vertebral artery injury can be a complication of cervical spine injury. Although most cases are asymptomatic, the rare case progresses to severe neurological impairment and fatal outcomes. We experienced a case of bilateral cerebellar and brain stem infarction with fatal outcome resulting from vertebral artery injury associated with cervical spine trauma. A 69-year-old male was admitted to our hospital because of tetraplegia after falling down the stairs and hitting his head on the floor. Marked bony damage of the cervical spine was not apparent on radiographs and CT scans, so the injury was initially considered to be a cervical cord injury without bony damage. However, an intensity change in the intervertebral disc at C5/C6, and a ventral epidural hematoma were observed on MRI. A CT angiogram of the neck showed the right vertebral artery was completely occluded at the C4 level of the spine. Forty-eight hours after injury, the patient lapsed into drowsy consciousness. The cranial CT scan showed a massive low-density area in the bilateral cerebellar hemispheres and brain stem. Anticoagulation was initiated after a diagnosis of the right vertebral artery injury, but the patient developed bilateral cerebellar and brain stem infarction. The patient's brain herniation progressed and the patient died 52 h after injury. We considered that not only anticoagulation but also treatment for thrombosis would have been needed to prevent cranial embolism. We fully realize that early and appropriate treatment are essential to improve the treatment results, and constructing a medical system with a team of orthopedists, radiologists, and neurosurgeons is also very important.
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Affiliation(s)
- Yoshikuni Mimata
- Department of Orthopaedic Surgery, Iwate Prefectural Chubu Hospital, 17-10 Murasakino, Kitakami, 024-8507, Japan,
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Manjila S, Chowdhry SA, Bambakidis NC, Hart DJ. Traumatic, high-cervical, coronal-plane spondyloptosis with unilateral vertebral artery occlusion: treatment using a prophylactic arterial bypass graft, open reduction, and instrumented segmental fusion. J Neurosurg Spine 2013; 20:183-90. [PMID: 24286529 DOI: 10.3171/2013.10.spine13115] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors present a case of traumatic, complete, high cervical spine injury in a patient with gradual worsening deformity and neck pain while in rigid cervical collar immobilization, ultimately resulting in coronal-plane spondyloptosis. Due to the extent of lateral displacement of the spinal elements, preoperative evaluation included catheter angiography, which revealed complete right vertebral artery (VA) occlusion. A prophylactic arterial bypass graft from the right occipital artery to the extradural right VA was fashioned to augment posterior circulation blood supply prior to reduction and circumferential instrumented fusion. Following surgery, the patient was able to participate in an aggressive rehabilitation program allowing early mobilization, and he ceased to be ventilator-dependent following implantation of a diaphragmatic pacer. The authors review factors leading to progression of this type of injury and suggest technical pearls as well as highlight specific management pitfalls, including operative risks.
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Affiliation(s)
- Sunil Manjila
- Department of Neurological Surgery, University Hospitals Case Medical Center, Cleveland, Ohio
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