Objective: Vertebral artery injury (VAI) after cervical spine trauma often remains undiagnosed.
Despite various clinical studies suggesting simultaneous occurrence of VAI with cervical
spine trauma, guidelines regarding screening and management of posttraumatic VAI are
yet to be formulated. The primary objective of the current study was to formulate
a low-cost screening protocol for posttraumatic VAI, thereby reducing the incidence
of missed VAI in developing countries. Materials and Methods: This was a single-center prospective study performed on 61 patients using plain magnetic
resonance imaging (MRI) as a screening tool to assess the frequency of VAI and routine
X-ray to detect morphological fracture patterns associated with the VAI in posttraumatic
cervical spine cases. If the MRI study showed any evidence of vascular disruption,
then further investigation in the form of computed tomography angiography was done
to confirm the diagnosis. Results: This study showed the incidence of VAI was 14.75% (9/61). Of 61 patients, 16 had
supraaxial, and 45 patients sustained subaxial cervical spine fractures. In the cohort
of nine cases of VAI, eight patients had subaxial cervical spine injuries, of which
seven were due to flexion-distraction injury. C5–C6 flexion-distraction injury was
most commonly associated with VAI (4 cases). Of the nine cases, five succumbed to
injury (mortality 55.55%), and 19 patients from the non-VAI group succumbed to injury
(mortality 36.53%). From surviving four cases with VAI, two had improvement in the
American Spinal Injury Association scale by Grade 1. Conclusion: VAI in cervical spine trauma is an underrecognized phenomenon. Plain MRI axial imaging
sequence can be an instrumental low-cost screening tool in resource-deficient parts
of the world. VAI has tendency to occur with high-velocity trauma like bi-facetal
dislocation, which has a high mortality and poor neurological recovery.
Key-words:
Cervical spine - computed tomography angiography - vertebral artery injury
