THE INCIDENCE OF VERTEBRAL ARTERY INJURY AFTER MIDCERVICAL SPINE FRACTURE OR SUBLUXATION

TWENTY-SIX PATIENTS WITH blunt trauma of the cervical spine, producing a subluxation from a ''locked'' or ''perched'' facet, facet destructi on with evidence of instability, or a fracture involving the foramen t ransversarium, underwent preoperative vertebral angiography to determi ne the incidence of vertebral artery injury. The cervical spine injury in all the patients was deemed unstable and in need of surgical stabi lization. Spinal cord injury was present in one-half of the patients s tudied. Vertebral artery injury was identified angiographically in 12 patients (46%). Occlusion of the vertebral artery near its origin or a t the level of the spinal injury was identified in nine patients. An i ntimal flap, arterial dissection, and a pseudoaneurysm were identified in the remaining three patients. The injury involved the left vertebr al artery in all but three patients. In none of the patients did the v ertebral artery injury clearly result in neurological dysfunction or o ther sequelae. After cervical spine fracture or dislocation, vertebral artery injury is more prevalent than commonly believed. The possibili ty of vertebral artery injury should be considered during the establis hment of clinical management schemes for blunt trauma of the cervical spine.