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Evaluation for Vertebral Artery Injury with Cervical Dislocated Fracture and Optimal Treatment before Reduction
Yasuo Suga1,2, Yumiko Mitome-Mishima1,2, Kensaku Yoshida1,2
1Department of Neurosurgery, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan.
Insights
Parent artery occlusion (PAO) before reduction may prevent cerebral embolism in patients with cervical dislocated fractures and vertebral artery injury (VAI). This approach shows promise for improving neurological outcomes after fracture reduction.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Vascular Surgery
Background:
- Cervical dislocated fractures often lead to vertebral artery injury (VAI).
- Thrombus formation at the injury site can cause cerebral embolism, worsening neurological outcomes after fracture reduction.
- Effective management strategies are crucial to mitigate these risks.
Purpose of the Study:
- To evaluate treatment outcomes for cervical dislocated fractures.
- To assess the utility of parent artery occlusion (PAO) prior to reduction in preventing cerebral embolism.
Main Methods:
- Retrospective analysis of eight patients with cervical dislocated fractures and locked facets (2018-2020).
- Evaluation of patient characteristics and clinical outcomes.
- Comparison of outcomes with and without pre-reduction PAO in cases of VAI.
Main Results:
- Eight patients with locked facets (C4/5, C5/6, C6/7) were analyzed.
- Two patients with unilateral dislocation had ipsilateral vertebral artery occlusion (VAO) and underwent PAO; no cerebral embolism occurred.
- Six patients without VAI underwent reduction without pre-procedural treatment; no cerebral ischemic complications were observed.
Conclusions:
- Parent artery occlusion (PAO) before reduction appears effective in preventing cerebral embolism in cervical dislocated fractures with vertebral artery injury (VAI).
- This strategy may improve neurological outcomes in affected patients.
Objective:
Cervical dislocated fractures frequently cause vertebral artery injury (VAI), which, in turn, propagates the thrombus at the site of injury. Cerebral embolism due to a thrombus after the reduction of dislocation leads to a poorer neurological outcome. Therefore, we investigated the outcome of treatment for cervical dislocated fractures and the usefulness of parent artery occlusion (PAO) before reduction.
Methods:
Eight patients with cervical dislocated fractures with a locked facets treated at our hospital between January 2018 and December 2020 were evaluated. We retrospectively examined patient characteristics and clinical outcomes.
Results:
Among the eight patients, two were injured at C4/5, four at C5/6, and two at C6/7. All patients had locked facets. Four patients had bilateral dislocation, while the others had unilateral dislocation. Two patients with unilateral dislocation had ipsilateral vertebral artery occlusion (VAO), while the other six did not. Both patients with VAO underwent PAO to prevent cerebral embolism before reduction. The six patients who did not have VAI underwent reduction without preprocedural treatment. No cerebral ischemic complications were observed. One patient died due to paralysis of the respiratory muscles caused by spinal cord injury but the remaining seven recovered well.
Conclusion:
PAO before reduction for cervical dislocated fractures with VAO may be effective in preventing cerebral embolism after reduction.
