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Occipitocervical dissociation
2%
37/1910
C1 fracture with extension into left transverse foramen with 2mm of displacement
14%
265/1910
Facet subluxation/dislocation
263/1910
Hangman’s fracture
28%
527/1910
Basilar skull fracture
41%
791/1910
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In patients with blunt cervical spine trauma, vertebral artery injury (VAI) is associated with occipitocervical dissociations, basilar skull fractures, facet subluxations/dislocations, and fracture involving the transverse foramen with displacement 1mm or greater. Hangman’s fractures are not associated with VAIs. VAI in patients with cervical spine trauma is a marker of severe injury. Accordingly, VAI are associated with occipitocervical dissociation and basilar skill fractures. As a result of the anatomic location of the vertebral artery, fractures displaced 1mm or greater in the vertebral foramen are also associated with VAIs. VAI can lead to neurological events with devastating sequelae. Risk factors associated with neurologic events related to VAIs include male gender, facet subluxations/dislocations, ankylosing spondylitis (AS), and diffuse idiopathic skeletal hyperostosis (DISH). Lebl et al. reviewed 1204 patients with cervical spine trauma, of which 253 underwent screening for VAI by multidetector computed tomography angiogram. VAI was diagnosed in 17% of the patients. The authors identified high-risk factors for VAI or neurological events secondary to VAI to include: basilar skull fractures, occipitocervical dissociation, fractures in patients with AS/DISH, facet subluxation/dislocations and fracture displacement 1mm or greater into the transverse foramen. Hangman’s fractures (P=0.993) were not associated with VAI. Dreger et al. reviewed 637 patients with cervical spine fractures with 108 undergoing CTA/MRA. Fifteen patients (13.8%) were diagnosed with VAI and 4 underwent treatment. The authors suggest that further research is needed to develop cost-effective evaluations and treatments for VAIs associated with cervical spine fractures. Illustration A is a CT with 3D reconstruction of a traumatic C2 spondylolisthesis (Hangman's fracture). Incorrect Answers: Answers 1,2,3&5: These answers are incorrect, as the above explanation provides evidence that these injuries are in fact associated with VAI.
2.3
(9)
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