| ObjectVertebral artery injury by closed cervical spine trauma after blunt injury, such as motor vehicle accident and fall, has been reported. This problem, which can also occur after whiplash injury, therapeutic neck manipulation and minimal trauma, has been described in the literature. In the past, the literature describing the association between closed cervical spine trauma and vertebral artery injury contains mainly isolated case reports and few clinical series. Some scholars believe that vertebral artery injuries associated with closed cervical spine trauma are rare because the vertebral artery is deeply situated in the neck and is normally well protected by soft tissue and bone. The quantity of the literatures has been increasing along with the technological development of vascular examination in recent years. We gradually recognize that vertebral artery injuries after closed cervical spine trauma are often underdiagnosed or misdiagnosed, sometimes the diagnosis may be delayed after the patient has developed irrevocable major central nervous system neurological deficits, because of lack of symptomatology, without specific signs in conventional imaging documentsand the risks of conventional angiography. Vertebral artery injury is clinically important and may cause serious or even fatal neurological deficit because the vertebral artery supplies important blood flow to the cerebellum, brain stem, medulla and spinal cord. We know that prompt diagnosis and early institution of treatment are essential if the patient is to have any chance for functional neurological recovery. All of the above require us, especial clinical physicians, to take this kind of injury seriously and study it further. Recently developing Magnetic resonance angiography (MRA) presents an excellent, rapid, noninvasive alternative for confirming vascular occlusion or damage and is the diagnostic study of choice. We utilized MRA to further determine the incidence of vertebral artery injury and possible correlative factors after acute closed cervical spine trauma, to observe the clinical signs and symptoms, to assess the clinical consequences and to explore the methods of early diagnosing vertebral artery injury.Material and MethodsThis research was accomplished at the Imaging Laboratory of Orthopaedic Institute and the Department of Orthopaedic Surgery of the Second Affiliated Hospital, Medical School of Zhejiang University.1. During the 18-month period from August 2000 to February 2002, 46 patients admitted to the Second Affiliated Hospital of Medical School of Zhejiang University for closed cervical spine trauma were examined with MRA of the neck arteries and magnetic resonance imaging (MRI) of the cervical spine to evaluate both vertebral arteries as soon as clinically possible. 35 patients with plain radiographic evidence of obvious cervicalfracture or dislocation were selected to undergo computed tomography (CT) at the corresponding segments. The MRA findings, combined with that of X-ray films, MRI, CT and the clinical records, were comprehensively analyzed. There were 42 male and 4 female patients, with an average age of 45.6 years (range, 19-85 years). The cause of trauma was a fall from high place in 18 patients, automobile accidents in 14 patients, a tumble in 9 patients, a pound in 2 patients and others in 3 patients. The average interval between trauma and examining MRA is 40.3 hours (range, 5-360 hours).2. In the series, there were 34 patients with cervical spine fracture and/or dislocation, 3 patients with unstable cervical spine and 9 patients with cervical spinal cord injury but no radiographic abnormality; 11 patients with locked facet dislocation (bilateral 5, unilateral 6); 22 patients with flexion injury, 17 patients with extension injury and 7 patients with vertical compression injury; 14 patients with complete spinal cord injury, 19 patients with incomplete spinal cord injury and 13 patients with no spinal cord injury; 8 patients with upper cervical spine (C,C2) injury and 38 pati...
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