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Upper cervical spine fracture patterns and blunt cerebrovascular injuries

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Abstract

Purpose

To determine patterns of C1 and C2 vertebral fractures that are associated with blunt cerebrovascular injury (BCVI).

Methods

Retrospective chart review of clinical and imaging reports at a level 1 trauma center over 10 consecutive years was conducted in patients with C1 and C2 fractures. Student t-test and chi-squared analyses were used to determine associations between fracture levels and fracture types with the presence of BCVI on CTA and/or MRI or stroke on CT and/or MRI.

Results

Multilevel fractures were associated with higher incidence of BCVI compared to isolated C1 or C2 fractures (p < 0.01), but not with stroke (p = 0.16). There was no difference in incidence of BCVI or stroke between isolated C1 and isolated C2 fractures (p = 0.46, p = 0.25). Involvement of the transverse foramen (TF) alone was not associated with BCVI or stroke (p = 0.10–0.40, p = 0.34–0.43). However, TF fractures that were comminuted or contained fracture fragment(s) were associated with increased BCVI (p < 0.01, p = 0.02), though not with stroke (p = 0.11, p = 0.09). In addition, high-energy mechanism of injury was also associated with BCVI (p < 0.01) and stroke (p < 0.01).

Conclusion

C1 and C2 fractures are associated with BCVI in the presence of high-energy mechanism of injury, concomitant fractures of other cervical vertebral body levels, comminuted TF fractures, or TF fractures with internal fragments. Attention to these fracture parameters is important in evaluating C1 and C2 fractures for BCVI.

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Data Availability

 The data that support the findings of this study are available upon request.

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Funding

The database used for this study was funded by GE Healthcare.

Author information

Authors and Affiliations

  1. Department of Radiology, Brigham & Women’s Hospital, Boston, USA

    Ngoc-Anh Tran

  2. Center for Clinical Data Science, Massachusetts General Hospital & Brigham & Women’s Hospital, Boston, USA

    Jayashri P. Pawar

  3. Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, USA

    Daniel Tobert & Mitchel B. Harris

  4. Trauma Imaging Research and Innovation Center, Brigham & Women’s Hospital, Boston, USA

    Bharti Khurana

Authors
  1. Ngoc-Anh Tran
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  2. Jayashri P. Pawar
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  3. Daniel Tobert
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  4. Mitchel B. Harris
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  5. Bharti Khurana
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Correspondence to Ngoc-Anh Tran.

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Conflict of interest

Dr. Khurana is a research consultant at GE Company, editor at Wolters Kluwer, and author at Cambridge University Press. Dr. Tobert is an editor at Wolters Kluwer.

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A portion of this manuscript was presented at the 2020 RSNA Annual Conference.

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Tran, NA., Pawar, J.P., Tobert, D. et al. Upper cervical spine fracture patterns and blunt cerebrovascular injuries. Emerg Radiol 30, 315–323 (2023). https://doi.org/10.1007/s10140-023-02129-6

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