Original Research

The pattern and prevalence of vertebral artery injury in patients with cervical spine fractures

Farzanah Ismail, Silas Motsitsi, Nausheen Khan, Inger Fabris-Rotelli
South African Journal of Radiology | Vol 17, No 2 | a243 | DOI: https://doi.org/10.4102/sajr.v17i2.243 | © 2013 Farzanah Ismail, Silas Motsitsi, Nausheen Khan, Inger Fabris-Rotelli | This work is licensed under CC Attribution 4.0
Submitted: 24 February 2013 | Published: 11 June 2013

About the author(s)

Farzanah Ismail, Department of Radiology, University of Pretoria, South Africa
Silas Motsitsi, Department of Orthopaedic Surgery, Kalafong Hospital, Pretoria, South Africa
Nausheen Khan, Department of Radiology, Kalafong Hospital, Pretoria, South Africa
Inger Fabris-Rotelli, Department of Statistics, University of Pretoria, South Africa


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Abstract

Aim: It is not uncommon for vertebral artery injury to occur when there are fractures through the transverse foraminae of the first to the sixth vertebral bodies. Other important risk factors for vertebral artery injury include facet joint dislocations and fractures of the first to the third cervical vertebral bodies. The aim of this study was to determine the pattern and prevalence of vertebral artery injury on CT angiography (CTA) in patients with cervical spine fractures.

Method: A retrospective review of patients who had undergone CTA of the vertebral arteries was undertaken. Reports were reviewed to determine which patients met the inclusion criteria of having had both cervical spine fractures and CTA of the vertebral arteries. Images of patients who met the inclusion criteria were analysed by a radiologist.

Results: The prevalence of vertebral artery injury was 33%. Four out of the 11 patients who had vertebral artery injury, had post-traumatic spasm of the artery, with associated thrombosis or occlusion of the vessel. In terms of blunt carotid vertebral injury (BCVI) grading, most of the patients sustained grade IV injuries. Four patients who had vertebral artery injury had fractures of the upper cervical vertebrae, i.e. C1 to C3. Fifteen transverse process fractures were associated with vertebral artery injury. No vertebral artery injury was detected in patients who had facet joint subluxations.

Conclusion: Patients with transverse process fractures of the cervical spine and upper cervical vertebral body fractures should undergo CTA to exclude vertebral artery injury.


Keywords

Vertebral artery injury; Spinal injury; Computed Tomography Angiography

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