Humans ; Neck Injuries ; therapy ; Vertebral Artery ; injuries ; Vertebrobasilar Insufficiency

STUDY DESIGN: A retrospective study. OBJECTIVES: This study was performed by probing vertebral artery injuries and their radiologic characteristics in cervical spine fractures, and analyzing MRI findings of vascular injuries. SUMMARY OF LITERATURE REVIEW: Vertebral artery injuries are found relatively often in cervical spine fractures. MATERIALS AND METHODS: We evaluated 57 cases of cervical spine fractures that occurred beginning in June 2011 and ending in February 2003. The characteristics of each fracture were evaluated using conventional radiographs, CT, and MRI. The presence of a vertebral artery injury was based on the absence of signal void in multilevel transverse foramens. RESULTS: Twelve out of the 57 cases (21.1%) were found to have unilateral vertebral artery injuries. Clinically, impairment in cerebral circulation was not found. We found no statistical correlation between the signal change in the spinal cord and in the vertebral artery injury (P=0.424). We noted fractures of transverse processes in 7 cases, 6 of which showed vertebral artery injuries. Thus, the transverse process facture was associated with t vertebral artery injury (P=0.000). There seemed to be no relationship between the vertebral artery injury and each of following: fracture level (P=0.416), fracture type (P=0.723) and severity of soft tissue injury (P=0.195). CONCLUSIONS: Unilateral vertebral artery injuries were frequently found in the cervical spine fractures. And of all radiographic factors associated with vertebral artery injury, only the presence of transverse process fracture was statistically significant. Absence of signal void at multi-section MR images is considered to be a useful guide to commence additional vascular evaluation.
Retrospective Studies ; Soft Tissue Injuries ; Spinal Cord ; Spine ; Vascular System Injuries ; Vertebral Artery

Blunt vertebral artery injury occurs frequently in forensic practice. However, injuries of the vertebral artery are easily ignored or overlooked because of its relatively deep location. Through literatures review, this paper finds that the manners of blunt vertebral artery injury are varied and one or more injury mechanisms may be involved simultaneously. Patients often undergo immediate or delayed cerebral apoplexy as well as compression and injury of surrounding structures, due to direct injury or secondary aneurysm or dissection, resulting in disability or death. Diseases such as, vertebral atherosclerosis and dysplasia can increase the disability and death risk and the difficulty of forensic identification. In forensic identification, the details of the case should be considered. For cases of suspected vertebral artery injury, in addition to routine examination of intracranial segment, attention should be paid to the examination of extracranial segment. If conditions permit, angiography can be used prior to or during the autopsy to improve the identification efficiency and accuracy of opinions.
Autopsy ; Craniocerebral Trauma ; Forensic Medicine ; Humans ; Neck Injuries ; Vertebral Artery/injuries*

vertebral artery is detected. We performed the embolization of the vertebral artery with coils and manual removal of the foreign body without any complication was followed.]]>
Angiography ; Fires ; Foreign Bodies ; Hematoma ; Hemorrhage ; Incidence ; Neck ; Shock ; Vascular System Injuries ; Vertebral Artery ; Wounds and Injuries

Vertebrobasilar junction entrapment due to a clivus fracture is a rare clinical observation. The present case report describes a 54-yr-old man who sustained a major craniofacial injury. The patient displayed a stuporous mental state (Glasgow Coma Scale [GCS]=8) and left hemiparesis (Grade 3). The initial computed tomography (CT) scan revealed a right subdural hemorrhage in the frontotemporal region, with a midline shift and longitudinal clival fracture. A decompressive craniectomy with removal of the hematoma was performed. Two days after surgery, a follow-up CT scan showed cerebellar and brain stem infarction, and a CT angiogram revealed occlusion of the left vertebral artery and entrapment of vertebrobasilar junction by the clival fracture. A decompressive suboccipital craniectomy was performed and the patient gradually recovered. This appears to be a rare case of traumatic vertebrobasilar junction entrapment due to a longitudinal clival fracture, including a cerebellar infarction caused by a left vertebral artery occlusion. A literature review is provided.
Basilar Artery/*injuries ; Humans ; Male ; Middle Aged ; Skull Fractures/*complications/radiography ; Tomography, X-Ray Computed ; Vertebral Artery/*injuries

Vertebral artery injury may occur following blunt trauma to the cervical spine and can produce severe neurological deficit. We report upon two patients having vertebral artery injury following blunt trauma to the cervical spine. The first one developed a cerebellar infarct and the second cervical cord ischemia. The possibility of vertebral artery injury should be considered in patients with cervical spine injury, especially in those having a subluxation or fracture of the facet joint. Early signs of vertebral artery injury may be silent. Non-invasive techniques, such as magnetic resonance angiography should be utilized in such cases.
Humans ; Ischemia ; Magnetic Resonance Angiography ; Spine* ; Vascular System Injuries ; Vertebral Artery* ; Wounds, Nonpenetrating ; Zygapophyseal Joint

OBJECTIVE: To identify the accuracy and efficiency of the computed tomographic (CT)-based navigation system on upper cervical instrumentation, particularly C1 lateral mass and C2 pedicle screw fixation compared to previous reports. METHODS: Between May 2005 and March 2014, 25 patients underwent upper cervical instrumentation via a CT-based navigation system. Seven patients were excluded, while 18 patients were involved. There were 13 males and five females; resulting in four degenerative cervical diseases and 14 trauma cases. A CT-based navigation system and lateral fluoroscopy were used during the screw instrumentation procedure. Among the 58 screws inserted as C1-2 screws fixation, their precise positions were evaluated by postoperative CT scans and classified into three categories : in-pedicle, non-critical breach, and critical breach. RESULTS: Postoperatively, the precise positions of the C1-2 screws fixation were 81.1% (47/58), and 8.6% (5/58) were of non-critical breach, while 10.3% (6/58) were of critical breach. Most (5/6, 83.3%) of the critical breaches and all of non-critical breaches were observed in the C2 pedicle screws and there was only one case of a critical breach among the C1 lateral mass screws. There were three complications (two vertebral artery occlusions and a deep wound infection), but no postoperative instrument-related neurological deteriorations were seen, even in the critical breach cases. CONCLUSION: Although CT-based navigation systems can result in a more precise procedure, there are still some problems at the upper cervical spine levels, where the anatomy is highly variable. Even though there were no catastrophic complications, more experience are needed for safer procedure.
Cervical Vertebrae ; Female ; Fluoroscopy ; Humans ; Male ; Spine* ; Tomography, X-Ray Computed ; Vertebral Artery ; Wounds and Injuries

We present a case of posterior atlantoaxial screw-rod fixation in a patient with an aberrant vertebral artery (VA) course combined with bilateral high-riding VA. An aberrant VA which courses below the posterior arch of the atlas (C1) that does not pass through the C1 transverse foramen and without an osseous anomaly is rare. However, it is important to consider an abnormal course of the VA both preoperatively and intraoperatively in order to avoid critical vascular injuries in procedures which require exposure or control of the VA, such as the far-lateral approach and spinal operations.
Atlanto-Axial Joint ; Bone Screws ; Humans ; Vascular System Injuries ; Vertebral Artery

Adult ; Brain Hemorrhage, Traumatic ; diagnosis ; etiology ; Humans ; Male ; Neck Injuries ; complications ; diagnosis ; Vertebral Artery

Injury to vertebral vessel is not usually associated with neurologic deficit and a lot of such injuries have not been recognized. Also, vertebral artery injuries are the least common arterial injuries because of their deep location in a bony canal. The incidence of vertebral artery injury occurring in penetration wound of the neck varies from 1.0% in gunshot wounds to 7.4% in stab wounds. But even vertebral artery injuries in penetration wound of the neck rarely results in cerebellar infarction. Authors experienced a case of cerebellar infarction induced by post-vertebral artery injury in penetration wound of the neck with hypoplastic contralateral verterbral artery. We thus report with a review of the related literature.
Arteries ; Cerebellum ; Incidence ; Infarction* ; Neck ; Neurologic Manifestations ; Vertebral Artery* ; Wounds and Injuries ; Wounds, Gunshot ; Wounds, Stab