The incidence of vertebral artery injury after midcervical spine fracture or subluxation.

Twenty-six patients with blunt trauma of the cervical spine, producing a subluxation from a "locked" or "perched" facet, facet destruction with evidence of instability, or a fracture involving the foramen transversarium, underwent preoperative vertebral angiography to determine the incidence of vertebral artery injury. The cervical spine injury in all the patients was deemed unstable and in need of surgical stabilization. Spinal cord injury was present in one-half of the patients studied. Vertebral artery injury was identified angiographically in 12 patients (46%). Occlusion of the vertebral artery near its origin or at the level of the spinal injury was identified in nine patients. An intimal flap, arterial dissection, and a pseudoaneurysm were identified in the remaining three patients. The injury involved the left vertebral artery in all but three patients. In none of the patients did the vertebral artery injury clearly result in neurological dysfunction or other sequelae. After cervical spine fracture or dislocation, vertebral artery injury is more prevalent than commonly believed. The possibility of vertebral artery injury should be considered during the establishment of clinical management schemes for blunt trauma of the cervical spine.