El-Hajj Victor Gabriel, Habashy Karl J, Cewe Paulina, Atallah Elias, Singh Aman, Fletcher-Sandersjöö Alexander, Bydon Mohamad, Fagerlund Michael, Jabbour Pascal, Gerdhem Paul, Elmi-Terander Adrian, Edström Erik
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm , Sweden.
Feinberg School of Medicine, Northwestern University, Chicago , Illinois , USA.
Neurosurgery. 2025 Apr 1;96(4):881-891. doi: 10.1227/neu.0000000000003173. Epub 2024 Sep 20.
Vertebral artery injury (VAI) because of traumatic subaxial cervical spine injury is a rare but potentially devastating condition as it could lead to stroke. The aim of this study was to examine the incidence, risk factors, outcomes, and radiographic predictors of VAI in patients surgically treated for subaxial cervical spine injuries at a tertiary care trauma center.
This is a retrospective population-based cohort study, including all patients surgically treated for traumatic subaxial cervical spine injuries at the study center between 2006 and 2018. Primary outcomes included mortality and morbidity after the injury. Propensity score matching, survival, univariable, and multivariable analyses were used to study the outcomes of interest.
Traumatic VAI primarily occurred after high-energy traumas such as motor vehicle accidents and falls from heights. The median age was 64.4 years (47.4-69.1), and 69% were male. In the cohort of patients with subaxial cervical injury, 54% had a spinal cord injury (SCI). In the subgroup with VAI, the frequency of SCI was 66% and a concomitant SCI and VAI were associated with a more severe American Spinal Cord Injury Association Impairment Scale grade ( P = .015). However, after accounting for age, sex, and associated injuries, VAI did not affect postoperative complications, short- or long-term outcomes, or mortality rates. Facet joint dislocation was a unique radiographic predictor of VAI (odds ratio 3.8 [CI 1.42-10.7], P = .009).
The findings suggest that clinical outcomes of patients with traumatic cervical spine injuries were not negatively affected by the presence of a VAI. Several radiographic factors were associated with VAI; however, only facet joint dislocation remained as an independent predictor of this injury.
创伤性下颈椎损伤所致椎动脉损伤（VAI）虽罕见，但可能造成毁灭性后果，因为它可能导致中风。本研究的目的是在一家三级创伤中心，调查接受手术治疗的下颈椎损伤患者中VAI的发生率、危险因素、预后及影像学预测指标。
这是一项基于人群的回顾性队列研究，纳入了2006年至2018年期间在研究中心接受手术治疗的所有创伤性下颈椎损伤患者。主要结局包括损伤后的死亡率和发病率。采用倾向评分匹配、生存分析、单变量和多变量分析来研究感兴趣的结局。
创伤性VAI主要发生在高能创伤后，如机动车事故和高处坠落。中位年龄为64.4岁（47.4 - 69.1岁），69%为男性。在下颈椎损伤患者队列中，54%有脊髓损伤（SCI）。在VAI亚组中，SCI的发生率为66%，同时存在SCI和VAI与更严重的美国脊髓损伤协会损伤量表分级相关（P = 0.015）。然而，在考虑年龄、性别和相关损伤后，VAI并不影响术后并发症、短期或长期结局或死亡率。小关节脱位是VAI的一个独特影像学预测指标（比值比3.8 [CI 1.
