Rathod Tushar, Garje Vinayak, Marathe Nandan, Mohanty Shubranshu, Shende Chetan, Jogani Abhinav, Srivastava Abhinav Kumar
Department of Orthopaedics, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra, India.
Department of Spine Services, Indian Spinal Injuries Centre, New Delhi, India.
Asian J Neurosurg. 2020 Aug 28;15(3):644-647. doi: 10.4103/ajns.AJNS_45_20. eCollection 2020 Jul-Sep.
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.
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.
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.
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.
颈椎创伤后椎动脉损伤（VAI）常未被诊断出来。尽管各种临床研究表明VAI与颈椎创伤同时发生，但关于创伤后VAI的筛查和管理指南尚未制定。本研究的主要目的是制定一种低成本的创伤后VAI筛查方案，从而降低发展中国家VAI漏诊的发生率。
这是一项单中心前瞻性研究，对61例患者进行了研究，使用普通磁共振成像（MRI）作为筛查工具来评估VAI的发生率，并使用常规X线检查来检测创伤后颈椎病例中与VAI相关的形态学骨折模式。如果MRI检查显示有任何血管中断的迹象，则以计算机断层血管造影的形式进行进一步检查以确诊。
本研究显示VAI的发生率为14.75%（9/61）。61例患者中，16例为轴上骨折，45例为轴下颈椎骨折。在9例VAI病例组中，8例患者有轴下颈椎损伤，其中7例是由于屈曲-牵张损伤。C5-C6屈曲-牵张损伤最常与VAI相关（4例）。9例病例中，5例死亡（死亡率55.55%），非VAI组的19例患者死亡（死亡率36.53%）。在4例存活的VAI病例中，2例美国脊髓损伤协会评分提高了1级。
颈椎创伤中的VAI是一种未被充分认识的现象。普通MRI轴位成像序列可以成为世界资源匮乏地区一种有用的低成本筛查工具。VAI倾向于与双侧关节突脱位等高速创伤同时发生，这种创伤死亡率高且神经功能恢复差。
