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  • CT angiography for evaluation of vertebral artery injury in cervical spine trauma: The University of Florida experience

    Final Number:

    John R. Bandela MD; Gregory J. Murad MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2012 Annual Meeting

    Introduction: Cervical spine trauma is a risk factor for vertebral artery (VA) injury and trauma patterns at greatest risk for VA injury remain unclear. The reported risk for stroke after VA injury can be as high as 20%. Since becoming a Level 1 Trauma Center in 2005, a significant number of cervical spine fractures have been treated at UF and screening for VA injury and has been highly physician dependent. We evaluated all CT angiograms (CTAs) done for VA injury in cervical spine trauma patients, the yield of these CTAs, fracture patterns that were more likely to result in VA injury, and outcomes from VA injury.

    Methods: The records of all trauma patients from 1/1/2005 to 3/31/2011 with a cervical spine fracture were evaluated to determine who underwent CTA for VA injury. These records were then examined to determine who suffered VA injury, and any treatment or sequelae from the injury. In addition, fracture patterns were evaluated to determine those more likely to result in VA injury.

    Results: 1091 patients with c-spine trauma were evaluated. 277 underwent CTAs to evaluate for VA injury. 59 of 277 (21%) had VA injury, of which 18 were treated with antiplatelet agent only (10) or anticoagulation (8). 7 patients died from injuries not related to VA injury. Of 52 survivors, none had neurological sequelae from VA injury. Mean follow-up was 210 days with a range from 6 days to 1170 days. C2 fractures, fracture dislocations, and C3-6 fractures with comminuted fractures of the transverse foramen were statistically significantly more likely to be associated with VA injury.

    Conclusions: We recommend the following spine fractures be screened for VA injury: Fracture-dislocation, C1 fracture, C2 fracture, C3-6 fracture with comminuted fracture of transverse foramen. This accounts for all VA injuries in our study from cervical spine trauma.

    Patient Care: This algorithm will result in decreased numbers of CT angiograms in patients with cervical spine injuries, but still have a high yield for vertebral artery injuries. This will reduce costs of medical care, and limit patient exposure to radiation and contrast dye.

    Learning Objectives: 1.)determine the outcomes of vertebral artery injury from cervical spine trauma 2.) determine who needs screening for vertebral artery injury after trauma

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