Cervical fracture patterns associated with vertebral artery injuries

Abstract

Background: Injury to the vertebral artery commonly occurs in the presence of traumatic cervical spine fractures. Data correlating incidence rates with specific fracture patterns remain unclear. Methods: We reviewed records of adult patients diagnosed with traumatic cervical spine fractures over a 10-year span. Subjects met at least one of the criteria: cervical vertebral subluxations (Pattern 1), fractures involving the transverse foramina (Pattern 2), fractures of C1-C3 (Pattern 3), and comminuted fractures in any segment of the cervical vertebra (Pattern 4). Results: Of the 119 patients included, 30 were diagnosed with vertebral artery injury (25.2%). The highest incidence was demonstrated in patients with the pattern combination of 1 and 2 only (n=3, 66.7%) and, 2 and 4 only (n=3, 66.7%). The next highest incidence was shown in patients with any combination including both pattern 2 and 4 (n=17, 41.1%). Patients with combination 1, 3, and 4 only (n=5, 40.0%), and with any combination including pattern 1 and 2 (n=10, 40.0%) had the third highest incidence. Conclusions: Our analysis demonstrated a high incidence of vertebral artery injury when the transverse foramina was involved and when any combination of three of the four high-risk patterns were involved in traumatic cervical fractures. These findings may be used to suspect vertebral artery injury in high likelihood injuries, reduce costly diagnostic testing, and guide providers to start treatment sooner.