Analysis of Cervical Angiograms in Cervical Spine Trauma Patients, Does it Make a Difference?

Retrospective review.

To evaluate computed tomography angiogram (CTA) use for diagnosing blunt vertebral artery injury (BVAI) at a single institution, to assess the incidence of BVAI in the studied population, and determine if diagnosis affected care. We also wanted to evaluate if testing and treatment resulted in complications.

BVAI is an example of a previously underdiagnosed injury. Ease of CTA has simplified vertebral artery evaluation. Injury to the vertebral or carotid arteries is diagnosed in approximately 0.1% of blunt trauma patients when there is high clinical suspicion, or when symptoms of central nervous system damage are apparent on initial examination. Routine screening of asymptomatic patients increases the incidence to approximately 1%.

After IRB approval, the hospital trauma registry identified patients aged 18-89 presenting with cervical spine fracture from 2006 to 2011. A retrospective review of charts was completed. Data collection included demographic data, fracture pattern, and neurological findings. The indications for and the results of CTA was also reviewed. The type of treatment and any complications were recorded.

A total of 637 charts reviewed. A total of 108 subjects underwent CTA/magnetic resonance angiography; 15 diagnosed with VAI injury. Four received treatment. There were no complications from imaging or treatment of BVAI. Eight subjects without CTA evaluation presented with symptoms potentially related to injury on arrival. Three had neurological decline, although none were eligible for treatment. No routine diagnostic/treatment protocol for vertebral arteries was found at our institution.

Although neurological sequelae after VAI can be devastating, routine screening after cervical spine fracture may not be warranted. Beside cost, our study suggests it is rarely associated with symptoms, and the asymptomatic patient rarely receives treatment due to concomitant injuries. Our study reinforces the need for further research to establish protocols so that patient-appropriate, cost-effective evaluation and treatment can be provided.