Abstract

Background: Blunt vertebral artery injury (VAI) is uncommon, but it can cause neurologic deficits. Early diagnosis and treatment before the onset of neurological sequelae are important. The Advanced Trauma Life Support^® (ATLS) program has published screening criteria for VAI. The major treatments of VAI are anticoagulation therapy and endovascular therapy, but the management of VAI remains controversial.
Methods: We retrospectively investigated the patients with blunt cervical spine injury treated at the trauma and critical care center in Osaka City University Hospital and analyzed the efficiency of the ATLS screening criteria and the treatment of VAI.
Results: One hundred fourteen patients were diagnosed as having cervical spine injury. Contrast-enhanced whole-body computed tomography was performed in 82 patients, and 13 patients were diagnosed as having VAI. Among the 114 patients, 73 patients met the ATLS screening criteria for investigating VAI, and 12 of the 13 (92.3%) VAI patients met the ATLS screening criteria. Among these 13 patients, antithrombotic therapy was performed in 9 patients but was not performed in the other 4 patients due to other injuries. Seven patients required urgent surgery. Prophylactic coiling to completely occlude the injured vertebral artery was performed before the operation or reduction in 4 patients. Two of the 13 VAI patients showed subsequent cerebellar infarction; both of them was not received antithrombotic therapy and had bilateral VAIs.
Conclusion: ATLS screening criteria have high sensitivity for the diagnosis of VAI. Bilateral VAI and no antithrombotic therapy are risk factors for subsequent cerebellar infarction. Coiling of the obstructed vertebral artery might be effective in preventing infarction, but a randomized controlled study would be required to evaluate the efficacy of this endovascular treatment.