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Clinical Features and Treatment Strategy of Vertebral Artery Injury Associated with Cervical Spine Trauma Yuichi FUJITA 1,2 , Hideo AIHARA 2 , Hiroaki NAGASHIMA 2 , Akitsugu MORISHITA 2 , Kenji AOKI 3 , Hiroyuki TAKAYAMA 3 , Toshihiko HARADA 3 , Yoshiki TOHMA 4 , Yoshie HARA 5 , Eiji KOHMURA 1 1Department of Neurosurgery, Kobe University Graduate School of Medicine 2Department of Neurosurgery, Hyogo Prefectural Kakogawa Medical Center 3Department of Orthopedic Surgery, Hyogo Prefectural Kakogawa Medical Center 4Department of Emergency Medicine, Hyogo Prefectural Kakogawa Medical Center 5Department of Neurosurgery, Hyogo Emergency Medical Center and Kobe Red Cross Hospital Keyword: vertebral artery injury , cervical spine trauma , stroke , endovascular therapy , anticoagulant therapy pp.663-671
Published Date 2018/8/10
DOI https://doi.org/10.11477/mf.1436203791
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 OBJECTIVE:Vertebral artery injury(VAI)associated with cervical spine trauma has the potential to cause catastrophic vertebrobasilar stroke. However, there are no well-defined treatment recommendations for VAI. The purpose of this study was to identify an effective treatment strategy for VAI following cervical spine trauma.

 METHODS:Ninety-seven patients with blunt cervical spine trauma were treated at Hyogo Prefectural Kakogawa Medical Center between January 2013 and September 2017. Of these patients, 49 underwent computed tomographic angiography or magnetic resonance angiography for evaluation of the vertebral artery. Eighteen patients(36.7%)had a diagnosis of VAI. We retrospectively analyzed the clinical features, treatment, and outcomes in these 18 patients.

 RESULTS:Seven patients(38.9%)had bilateral VAI, 16(88.9%)had cervical dislocation, and 2(11.1%)had transverse process fractures extending into the transverse foramen. Surgical reduction was performed in 14 patients. Five patients with either bilateral or unilateral occlusion underwent parent artery occlusion before reduction. There were no complications after this procedure. Two patients with bilateral VAI had a stroke before treatment. There were no infarctions in the distribution of the vertebrobasilar artery after intervention. The perioperative stroke rate was relatively good, and almost all Glasgow Outcome Scale scores were related to the degree of spinal cord injury.

 CONCLUSIONS:Aggressive screening for VAI is important in patients with cervical spine trauma in order to ensure adequate treatment. Although the treatment strategy described here could yield good results, it may require modification according to the needs of the individual patient.


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電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院

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