Management and Outcomes of Patients Undergoing Surgery for Traumatic Cervical Fracture-subluxation Associated With an Asymptomatic Vertebral Artery Injury

Abstract

Retrospective clinical series. To evaluate the management and outcomes of patients with unilateral, asymptomatic vertebral artery occlusion (VAO) undergoing surgery for cervical fractures associated with subluxation. The management of VAO is controversial with several treatment options available, including observation alone, antiplatelet therapy, or anticoagulation therapy. A chart review inclusive of the years 2004 to 2006 was performed to include patients who presented after nonpenetrating trauma with cervical fracture associated with subluxation requiring surgery. An associated asymptomatic VAO was also required for inclusion. Eight patients were identified. Seven patients were male and the mean age was 26.8 years. Six patients suffered an associated spinal cord injury. Three patients underwent closed reduction before surgical stabilization. Five patients underwent open reduction with stabilization. No patient received treatment for VAO before reduction. Postoperative treatment for VAO was variable, with 5 of 8 patients undergoing observation alone. The remaining 3 patients were treated with aspirin therapy, although 1 patient received heparin intravenously for 1 day. None of the patients experienced an ischemic complication. Reduction of a fracture, whether closed or open, without treatment of an associated asymptomatic VAO seems safe. Postoperative management of VAO consisting of either observation alone or aspirin therapy also seems to be a safe option.