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Vertebral artery dissection in acute cervical spine trauma

Rahul Gupta1, Hardik Lalit Siroya1, Dhananjaya Ishwar Bhat2

  • 1Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.

Journal of Craniovertebral Junction & Spine
|April 7, 2022
PubMed

Insights

Acute cervical spine trauma (CST) significantly contributes to vertebral artery dissection (VAD). Understanding the biomechanics of CST is crucial for preventing VAD-related morbidity and mortality.

Area of Science:

  • Neurology
  • Orthopedic Surgery
  • Radiology

Background:

  • Vertebral artery dissection (VAD) is a significant cause of stroke, particularly in younger individuals.
  • Acute cervical spine trauma (CST) is an increasingly recognized risk factor for VAD.
  • The biomechanical interplay between CST and VAD requires further elucidation to improve patient outcomes.

Purpose of the Study:

  • To investigate the mechanism, risk factors, and prognosis of VAD in patients with acute CST.
  • To analyze the relationship between cervical spine injury morphology and the occurrence of VAD.
  • To identify predictors of posterior circulation infarcts in patients with VAD secondary to CST.

Main Methods:

  • Retrospective analysis of 149 consecutive patients with acute CST from 2014-2019.
  • Detailed morphological assessment of cervical spine fractures and subluxations.
  • Review of computerized tomography angiograms, MR angiograms, and axial CT scans to diagnose VAD and associated infarcts.

Main Results:

  • An overall incidence of 14.1% for VAD was identified in patients with acute CST.
  • Specific fracture and subluxation patterns were associated with an increased risk of VAD.
  • A subset of patients with VAD also exhibited infarcts in the posterior circulation.

Conclusions:

  • The biomechanics of CST play a significant role in the development of VAD.
  • Early identification and management of VAD in CST patients are critical to reduce morbidity and mortality.
  • Development of a standardized diagnostic algorithm for VAD in CST is warranted for widespread clinical application.
Abstract

Keywords:
Cervical spine traumainfarctsvertebral artery dissection

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