Vertebral artery injury associated with cervical spine fracture dislocation

A 76-year-old man presented to the emergency department after a fall. Paraplegia, ataxia, and slurred speech were observed at presentation. Computed tomography scan of the cervical spine showed C6–C7 fracture dislocation. Fracture and dislocation of the anterosuperior part of the C7 vertebra, bilateral lamina fracture of the C6 vertebra, grade 3 spondylolisthesis, and posttraumatic severe spinal canal stenosis at the C6–C7 levels were observed (Fig. 1). Bilateral facet dislocation with locked facets at this level was seen. Magnetic resonance imaging additionally showed spinal cord injury due to severe compression and narrowing at this level (Fig. 2). C6–C7 intervertebral disc injury was seen. T1- and T2-weighted images showed absence of normal flow void in the left vertebral artery compatible with vertebral artery injury. Magnetic resonance angiography revealed occlusion and traumatic dissection of the V2 segment of the left vertebral artery. Spinal stabilization surgery was performed. Cervical spine fractures, facet joint dislocations, and transverse foramen fractures are closely associated with vertebral artery injury. Dissection and occlusion are the most common injury patterns and the second segment is frequently involved [ [1] Inamasu J. Guiot B.H. Vertebral artery injury after blunt cervical trauma: an update. Surg Neurol. 2006; 65: 238-246 Abstract Full Text Full Text PDF PubMed Scopus (71) Google Scholar ]. Vertebral artery injury should be kept in mind while evaluating patients with cervical spine trauma. Fig. 2Sagittal (A, B) and axial (C) T2-weighted magnetic resonance images show spinal cord injury (black arrow) caused by compression, posttraumatic severe spinal canal stenosis, C6–C7 intervertebral disc injury, dislocated locked facet joint (white arrow), and absence of normal flow void in the V2 segment of the left vertebral artery (red arrows). Magnetic resonance angiography image (D) shows non-opacification of the left vertebral artery segment (red dashed arrow) and the normal right vertebral artery (blue arrows). View Large Image Figure Viewer Download Hi-res image