Other

Vertebral Artery Injury in a Patient with Fractured C4 Vertebra

Tihomir Banić orcid.org/0000-0002-1654-5289 ; Department of Spine Surgery, University Hospital for Traumatology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
Morana Banić ; Department of Anesthesiology and Intensive Medicine, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
Ivan Cvjetko ; Department of Vascular Surgery, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
Nenad Somun ; Department of Spine Surgery, University Hospital for Traumatology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
Vide Bilić ; Department of Spine Surgery, University Hospital for Traumatology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
Vinko Vidjak ; Department of Interventional Radiology, Merkur University Hospital, Zagreb, Croatia
Vladimir Pavić ; Department of Spine Surgery, University Hospital for Traumatology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
Ivan Coc ; Department of Spine Surgery, University Hospital for Traumatology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
Tomislav Kokić ; Division of Traumatology and Bone and Joint Surgery, Department of Surgery, Zagreb University Hospital Center, Zagreb, Croatia
Zvonko Kejla ; Department of Spine Surgery, University Hospital for Traumatology, Sestre milosrdnice University Hospital Center, Zagreb, Croatia

Abstract

Vertebral artery injuries due to cervical spine trauma, although rarely described in the literature, are relatively common. While most of them will remain asymptomatic, a small percentage of patients may suffer life threatening complications. We report a case of the right vertebral artery injury in a patient with fracture of C4 vertebra, successfully treated with endovascular approach. A 78-year-old male patient was hospitalized for cervical spine injury caused by falling off the tractor. Radiological assessment revealed fracture of C4 vertebra with proximal two-thirds of C4 body dislocated five millimeters dorsally. Significant swelling of soft prevertebral tissues distally of C2 segment was also present. During emergency surgery using standard anterior approach for cervical spine, excessive bleeding started from the injured right vertebral artery. Bleeding was stopped by tamponade with oxidized regenerated cellulose sheet and C4-C5 anterior fixation; then partial reduction of displacement was done. Fifteen days later, after angiography, endovascular repair of the right vertebral artery was performed using percutaneous stent graft. Follow up computed tomography scan angiography showed valid stent patency without contrast extravasation. In cases of cervical spine trauma, surgeon should always be prepared to manage injury of vertebral artery. Bleeding can primarily be stopped by hemostatic packing, and definitive repair can be successfully achieved by endovascular approach using percutaneous stent graft.

Keywords

Cervical spine; Spinal injuries; Vertebral artery – injury; Vertebral artery – surgery; Fracture fixation; Case reports

Hrčak ID:

133347

URI

https://hrcak.srce.hr/133347

Publication date:

3.11.2014.

Article data in other languages: croatian

Visits: 2.375 *