Ashwin V. Asrani MD, Presenter: Nothing to Disclose

Rathachai Kaewlai MD, Abstract Co-Author: Nothing to Disclose

Joshua Goldstein MD, Abstract Co-Author: Consultant, Novo Nordisk AS Advisory Board, Novo Nordisk AS

Ramon Gilberto Gonzalez MD, PhD, Abstract Co-Author: Grant, Bayer AG (Berlex Inc)

Robert Arthur Novelline MD, Abstract Co-Author: Nothing to Disclose

Michael H. Lev MD, Abstract Co-Author: Speaker, General Electric Company Advisory Board, General Electric Company Research support, General Electric Company Speaker, Bracco Group Advisory Board, Bracco Group Advisory Board, CoAxia, Inc

To identify cervical spine fracture patterns strongly associated with arterial injury.

The imaging findings from 410 consecutive patients with acute cervical spine fracture presenting to our level 1 trauma center over a 2-year period were reviewed. For the subgroup who also received vascular imaging CT angiography (CTA) or MR angiography (MRA), the pattern of cervical vertebral spine fracture along with the status of the vertebral and carotid arteries were recorded. At our institution CTA has largely replaced direct catheter arteriography, which was not performed.

101/412 (24.5%) cervical spine fracture cases received both spine CT and concurrent CTA and/or MRA. 20/101 (19.8%) cases had vertebral artery injury (VAI). 17/20 (85%) had fractures of the lateral mass, 12/20 (60%) had fractures of the transverse foramina, 2/20 (10%) had dens fractures, 1/20 (5%) had occipital condylar fracture, and 1/20 (5%) had extension teardrop fracture. There was vertebral artery dissection/occlusion in 13/20 cases (65%) and narrowing in 7/20 cases (35%). Only 1 case of VAI had concurrent bilateral focal carotid artery dissection with a small pseudoaneurysm; the mechanism of injury had involved blunt carotid trauma. The 81 cases without vascular injury included 36 (44.4%) lateral mass (+/- facet) fractures, 35 (43.2%) transverse foramen fractures, 17 (20.9%) dens fractures, 15(18.5%) posterior element fractures, 8 (9.8%) vertebral body fractures and 3 (3.7%) extension teardrop fractures.

Vertebral artery injury is strongly associated with lateral mass and transverse foramen fractures. In such patients vascular imaging of the neck including CTA or MRA may be warranted. Carotid artery injury rarely occurs with cervical spine fractures.

Vertebral artery injury should be excluded with lateral mass and transverse foramen fractures of the cervical spine.

Asrani, A, Kaewlai, R, Goldstein, J, Gonzalez, R, Novelline, R, Lev, M, Cervical Spine Fractures of the Lateral Masses or Transverse Foramina Require CTA or MRA to Exclude Vertebral Artery Injury.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5007010.html