Clinical outcome after vertebral artery injury following blunt cervical spine trauma

Abstract

Objective: Imaging after blunt cervical trauma is being used increasingly to screen patients for injury of the vertebral artery (VA). There are no guidelines for imaging of the VA for nonpenetrating cervical trauma. The purpose of this study was to determine the effect of VA injury on clinical outcome after blunt cervical trauma.

Methods: Sixty-six patients who underwent computed tomographic angiography (CTA) and magnetic resonance angiography (MRA) after blunt cervical trauma were reviewed. Medical records were reviewed for clinical status, including the presence of a neurologic deficit or pain related to spine or vascular injury. Any suggested brain injury was evaluated with diffusion-weighted MR imaging. Both clinical and radiographic data were analyzed to determine the incidence of VA abnormalities and their association with clinical outcome.

Results: VA abnormalities were present in 19.7% of cases. Two patients had symptomatic brain sequelae from VA injury. There was no significant association between VA abnormalities and the presence of symptoms and/or cervical spine fractures at presentation. The presence of a fracture and neurologic symptoms at presentation predicted a significantly worse outcome at a mean follow-up of 5 months. However, the presence of VA abnormalities did not predict a worse clinical outcome.

Conclusions: The clinical outcome of patients with blunt cervical trauma was not associated with the presence of VA abnormalities. Given the rare but potentially devastating consequences of a VA injury, however, screening may still be worthwhile.

Keywords: Angiography; CTA; Cervical spine; Computer tomographic angiography; DW MRI; Diffusion-weighted magnetic resonance imaging; Imaging; MRA; MRI; Magnetic resonance angiography; Magnetic resonance imaging; Modified Rankin Scale; Trauma; VA; Vertebral artery; Vertebral artery injury; mRS.