Document Detail


Vertebral artery injury after cervical spine trauma: a prospective study.
MedLine Citation:
PMID:  12518258     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Vertebral artery (VA) -injury is rarely symptomatic and can therefore easily be overlooked. However, thromboembolic complications may result in permanent morbidity or mortality due to brainstem ischemia and infarction. In this prospective study a standardized protocol for the diagnosis and management of VA-injury following blunt cervical spine trauma with subluxation or fractures affecting the transverse foramen was evaluated. METHODS: During a 48 months period 31 (12 female, 19 male; mean age 44.2 years) of 119 patients with blunt cervical spine trauma were suspicious for VA-injury and subjected to a predefined radiological work-up. Selective digital subtraction angiography (DSA) was performed at admission in 31 patients. For comparison magnetic resonance angiography (MRA) was added within 2 days in 7 patients. RESULTS: The incidence of VA injury detected by DSA (n = 5) was 4% in all types of blunt cervical spinal injury, 16% in cases suspicious for VA injury, i.e. cases with mono- or bifacet dislocation and/or cases with fractures extending into the transverse foramen. Unilateral VA-stenosis was found in 4 and VA-occlusion in one patients. In one case a VA-stenosis by an intimal flap after transverse foramen fracture was detected by DSA but not by MRA. In 2 patients with VA injury headache occurred without signs of vertebro-basilar insufficiency. All 5 patients with VA-injury were treated with anticoagulation without complications or side effects. 14 of 31 patients which had DSA/MRA had unstable spine conditions and were treated surgically within 4 days after admission. CONCLUSION: The subgroup of patients with dislocation or fracture related stenosis of the transverse foramen should undergo early angiography for establishment of anticoagulation to prevent thromboembolic complications. It appears that the radiological diagnosis of VA-insufficiency is more sensitive than clinical findings, which rarely indicate VA-insufficiency. In this series one VA injury was overlooked with MRA.
Authors:
T Kral; C Schaller; H Urbach; J Schramm
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Zentralblatt für Neurochirurgie     Volume:  63     ISSN:  0044-4251     ISO Abbreviation:  Zentralbl. Neurochir.     Publication Date:  2002  
Date Detail:
Created Date:  2003-01-08     Completed Date:  2003-03-25     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0413646     Medline TA:  Zentralbl Neurochir     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  153-8     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, University of Bonn, Medical Center, Germany. Thomas.Kral@ukb.uni-bonn.de
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Angiography, Digital Subtraction
Anticoagulants / therapeutic use
Female
Heparin / therapeutic use
Humans
Magnetic Resonance Angiography
Male
Middle Aged
Prospective Studies
Spinal Cord Injuries / complications*,  diagnosis,  pathology
Treatment Outcome
Vertebral Artery / injuries*,  pathology
Wounds, Nonpenetrating / complications,  diagnosis
Chemical
Reg. No./Substance:
0/Anticoagulants; 9005-49-6/Heparin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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