European Spine Journal

, Volume 20, Issue 12, pp 2202–2209 | Cite as

Vertebral artery injuries following cervical spine trauma: a prospective observational study

  • Christian-Andreas Mueller
  • Inga Peters
  • Martin Podlogar
  • Attila Kovacs
  • Horst Urbach
  • Karl Schaller
  • Johannes Schramm
  • Thomas Kral
Original Article



The purpose of this study was to report on the incidence, diagnosis and clinical manifestation of VAI following cervical spine injuries observed in a prospective observational study with a standardized clinical and radiographical protocol.


During a 16-year period, 69 (mean age: 43 ± 20.7 years; 25 female, 44 male) of 599 patients had cervical spine injury suspicious for VAI due to facet luxation and/or fractures extending into the transverse foramen. Diagnosis and management of these patients followed a previously published protocol (Kral in Zentralbl Neurochir 63:153–158, 2002). Digital subtraction angiography (DSA) was performed in all 69 patients. Injury grading of VAI was done according to Biffl et al. (Ann Surg 231:672–681, 2000). All patients with VAI were treated with anticoagulation (heparin followed by ASS) for 6 months.


In cases suspicious for VAI, the incidence of VAI detected by DSA was 27.5% (n = 19 of 69 patients). VAI Grade I occurred in 15.8%, Grade II in 26.3%, Grade IV in 52.6% and Grade V in 5.2%. Of 19 patients, 4 (21%) had clinical signs of vertebrobasilar ischemia. Two patients died in hospital after 4 and 21 days respectively. Of 69 patients, 33 (47.8%) with suspected VAI had unstable spine injuries and were treated surgically.


In patients with cervical spine fractures or dislocations crossing the course of the vertebral artery, VAI are relatively frequent and may be associated with significant morbidity and mortality. VAI were identified by DSA in 27.5%. Despite anticoagulation therapy, 5.8% became clinically symptomatic and 2.9% died due to cerebrovascular ischemia.


Vertebral artery injury Arteriography Cervical spine trauma CT-angiography MR-angiography 


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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Christian-Andreas Mueller
    • 1
    • 2
  • Inga Peters
    • 1
  • Martin Podlogar
    • 1
  • Attila Kovacs
    • 3
  • Horst Urbach
    • 3
  • Karl Schaller
    • 1
    • 4
  • Johannes Schramm
    • 1
  • Thomas Kral
    • 1
    • 5
  1. 1.Department of NeurosurgeryRheinische Friedrich-Wilhelms Universität BonnBonnGermany
  2. 2.Department of NeurosurgeryUniversity Hospital of the Aachen University (RWTH)AachenGermany
  3. 3.Department of Radiology and NeuroradiologyRheinische Friedrich-Wilhelms Universität BonnBonnGermany
  4. 4.Department of Neurosurgery, Faculty of Medicine, Geneva University Medical CenterUniversity of GenevaGenevaSwitzerland
  5. 5.Department of NeurosurgeryGemeinschaftskrankenhausHerdecke, RuhrGermany

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