| BackgroundBlunt vertebral arterial injury has historically considered an uncommon event of relative insignificance. Recent reports have shown that this is not accurate. Biffl et all. reported an overall incidence of vertebral arterial injury (VIA) in blunt trauma victims of 0.53%, with a stroke rate of 25%, and founded stroke incidence is reduced with early recognition and prompt anticoagulation.The vertebral artery is prone to injury from cervical spine trauma because of the intimate relationship of its second segment to the bony structure of the spine. The vertebral artery injury has been reported in our previous study. ObjectivesThe aim of this project was three aspects,. First, to compare the advantages and disadvantages between CTA and MRA. Second, to elucidate the incidence of vertebral artery injury associated with low cervical spine fracture or subluxation and to determine the value of various factors in predicting the existence of a vertebral injury. Third, to evaluate the effect of vertebral artery injury on spine cord.material and MethodsIn the 36-month between August 2000 and August 2003, 60 patients admitted to the second affiliated hospital of zhejiang university for low cervical fracture or subluxition were examined with MRA and/or CTA, MRI, X-ray and CT of cervical spine. The study was divided into two stages. 30 patients were examined by MRA in the first stages between August 2000 and February 2002 ; 23 patients were performed by both MRA and CTA, 5 by MRA and 2 by CTA in the second stages between March 2002 and August 2003 .There were 53 male and 7 females patients, with an average age of 46.1 years (range, 18-85 years). The cause of injury was a fall in 27 patients, automobile accidents in 16 patients, assaults by falling objects in 8 patients, a tumble in 3 patients and others in 6 patients. The ASIA impairment scale was used to grade the degree of neurological impairment, type A in 25 patients, type B in 5 patients, type C in 8 patients, type D in 12 patients, type E in 10 patients. The types of cervical injury were flexion injury in 28 cases, vertical compression injury 13 cases and extension injury 19 cases.According to the outcome of X-ray and MRI, 60 patients were dividedinto two groups which were made up of cervical dislocation group in 32 patients and no cervical dislocation group in 28 patients. 23 patients had cervical foramen transversarium fractures.Magnetic resonance examinations were performed on a 1.0-T or 1. 5-T Magnetom. The MRA technique consisted of an two-dimensional time- of-fight sequence(2D TOP). A helical CT scanner used for 3D-CTA is Siemens Volume Zoom.Statistical analysis was performed using the SPSS 10.0 statistical software program. Categorical variables were compared using [chi]~ test where appropriate, grade variables were compared using U test where appropriate. Significance is set at p<0. 05. ResultsFindings on MRA were abnormal in 10 of 30 patients in the first stage, including 4 had one side vertebral artery occlusion, 4 had one side vertebral artery stenosis and 2 had bilateral vertebral artery stenosis. 7 patients had one side vertebral artery occlusion and 3 had unilateral vertebral artery stenosis on MRA, 7 patients had one side vertebral artery occlusion on CTA in the second stage. There was high concordance in the diagnosis of vertebral artery occlusion between CTA and MRA.As a total, eleven of the 60 patients evaluated for cervical trauma had an associated vertebral artery occlusion. 9 of 11 patients with vertebral artery injury had a foramen transversarium fracture, and 14 of the 50 patients with no vertebral artery injury had fracture to foramen transversarium. There was a statistical association between patients with and without vertebral artery injuries in reference to associated foramentransversarium fractures. 9 of 11 patients with vertebral artery injury had cervical dislocation, and 23 of the 50 patients with no vertebral artery injury had cervical dislocation. There was a statistical association bet...
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