Incidence of blunt cerebrovascular injury in low-risk cervical spine fractures

Am J Surg. 2011 Dec;202(6):684-8; discussion 688-9. doi: 10.1016/j.amjsurg.2011.06.033.


Background: It has been suggested that specific cervical spine fractures (CSfx) (location at upper cervical spine [CS], subluxation, or involvement of the transverse foramen) are predictive of blunt cerebrovascular injury (BCVI). We sought to determine the incidence of BCVI with CSfx in the absence of high-risk injury patterns.

Methods: We performed a retrospective study in patients with CSfx who underwent evaluation for BCVI. The presence of recognized CS risk factors for BCVI and other risk factors (Glasgow coma score ≤ 8, skull-based fracture, complex facial fractures, soft-tissue neck injury) were reviewed. Patients were divided into 2 groups based on the presence/absence of risk factors.

Results: A total of 260 patients had CSfx. When screened for high-risk pattern of injury for BCVI, 168 patients were identified and 13 had a BCVI (8%). The remaining 92 patients had isolated low CSfx (C4-C7) without other risk factors for BCVI. In this group, 2 patients were diagnosed with BCVI (2%). Failure to screen all patients with CSfx would have missed 2 of 15 BCVIs (13%).

Conclusions: We propose that all CS fracture patterns warrant screening for BCVI.

MeSH terms

  • Adolescent
  • Adult
  • Cerebral Angiography
  • Cerebrovascular Trauma / diagnosis
  • Cerebrovascular Trauma / epidemiology*
  • Cervical Vertebrae / diagnostic imaging
  • Cervical Vertebrae / injuries*
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Male
  • Multiple Trauma*
  • Prognosis
  • Retrospective Studies
  • Spinal Fractures / diagnosis*
  • Spinal Fractures / epidemiology
  • Time Factors
  • Tomography, X-Ray Computed
  • Trauma Severity Indices
  • United States / epidemiology
  • Vertebral Artery / diagnostic imaging
  • Vertebral Artery / injuries*
  • Wounds, Nonpenetrating / diagnosis
  • Wounds, Nonpenetrating / epidemiology*
  • Young Adult