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Blunt traumatic vertebral artery injury: a clinical review

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Abstract

Blunt traumatic vertebral injury (TVAI) is frequently associated with head and neck injury and is being detected with increasing frequency due to improved imaging of the trauma patient. In a few cases, it can lead to potentially fatal posterior circulation ischaemia There is debate in the literature regarding whether TVAI should be actively screened for and, if so, how. Management of TVAI may be conservative, medical (antiplatelet agents or anticoagulation), endovascular or open surgery. We review the literature concerning the mechanisms and presentation of TVAI following blunt injury and the current screening recommendations. Management strategies proposed are based on the radiological grade and clinical severity of TVAI, where high-grade symptomatic injuries and high-grade injuries in patients where anticoagulation is contraindicated are treated endovascularly and asymptomatic or low-grade injuries are managed with anticoagulation where it is not contraindicated. Follow-up is via CT angiography to assess for resolution of the injury.

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Authors and Affiliations

  1. Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK

    R. M. deSouza, M. J. Crocker & N. Haliasos

  2. Department of Neuroradiology, University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK

    A. Rennie

  3. Department of Neurosurgery, University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK

    A. Saxena

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  1. R. M. deSouza
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  3. N. Haliasos
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Correspondence to R. M. deSouza.

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deSouza, R.M., Crocker, M.J., Haliasos, N. et al. Blunt traumatic vertebral artery injury: a clinical review. Eur Spine J 20, 1405–1416 (2011). https://doi.org/10.1007/s00586-011-1862-y

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