Home  |  About  |  Contact  |  Join MCACS  Donate to MCACS
Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons
57th Annual Meeting Abstracts


Poster 15

Abstract Title

Independent Predictors of Vertebral Artery Injury Secondary to Cervical Spine Trauma

 

Author Block

Darren R. Lebl, MD1, George Velmahos, MD2, Umesh Metkar, MD3, Kirkham B, Wood, MD2, Christopher M. Bono, MD1, Mitchel B. Harris, MD1

1Harvard Medical School, Boston, MA Brigham and Women's Hospital, Boston, MA 2Massachusetts General Hospital, Boston, MA 3Beth Israel Deaconess Medical Center, Boston, MA

 

Abstract Body

Background: The majority of vertebral artery injuries (VAIs) in the blunt trauma patient occur in association with cervical spine injury. There is no universally agreed upon protocol for screening and treatment of cervical spine injury related VAI.

Methods: Retrospective review of prospectively collected data from AmericanCollege of Surgeons (ACS) trauma registries at three level 1 centers was performed over a 3-year period. All patients with a blunt cervical spine injury identified by CT were included. Logistic regression analysis of independent predictors for VAI and neurologic events was performed.

Results: 253 patients (21%) of the 1,204 patients with cervical spine injuries were underwent screening for VAI by CTA. 42 patients (3.5%) were diagnosed with VAI, unilateral in 38 (3.1%) and bilateral in 4 (0.3%). Fracture displacement into the transverse foramen ≥ 1mm (OR=3.7, 95% confidence interval [1.32 10.2]; p<.01), basilar skull fracture (OR=5.2, 95% confidence interval [2.07-13.0]; p<.001), occipitocervical dissociation (p<.001), and seronegative spondyloarthopathy (AS or DISH) (OR=8.0, 95% confidence interval [1.30 49.7]; p<.03) were independently predictive of VAI. Facet subluxation or dislocation (OR=9.0, 95% C.I. [1.51 - 53.7]; p<.02) and the diagnosis of AS or DISH (OR=40.7, 95% confidence interval [5.3 314.0]; p<.001) were predictive of neurological events secondary to VAI. A contraindication to treatment was present in 100 (40%) of screened patients. Stroke-rate was 6/42 (14%) and stroke-related mortality rate was 2/42 (4.8%). Conclusion: Identification of polytrauma patients at highest risk for clinically significant VAI may minimize potentially harmful additional radiation exposure and costly diagnostic examinations.

 

 Home | About | Contact