Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 May;14(4):1356-1368.
doi: 10.1177/21925682231209631. Epub 2023 Nov 4.

A Systematic Review and Meta-Analysis of Vertebral Artery Injury After Cervical Spine Trauma

Kartik Goyal  1   2 , Jesvin T Sunny  1   3 , Conor S Gillespie  1   4 , Martin Wilby  1 , Simon R Clark  1 , Radek Kaiser  5 , Michael G Fehlings  6 , Nisaharan Srikandarajah  1   7
Affiliations
Review

A Systematic Review and Meta-Analysis of Vertebral Artery Injury After Cervical Spine Trauma

Kartik Goyal et al. Global Spine J. 2024 May.

Abstract

Study design: Systematic Review and Meta-Analysis.

Objective: Identify the incidence, mechanism of injury, investigations, management, and outcomes of Vertebral Artery Injury (VAI) after cervical spine trauma.

Methods: A systematic review and meta-analysis were conducted in accordance with the PRISMA guidelines (PROSPERO-ID CRD42021295265). Three databases were searched (PubMed, SCOPUS, Google Scholar, CINAHL PLUS). Incidence of VAI, investigations to diagnose (Computed Tomography Angiography, Digital Subtraction Angiography, Magnetic Resonance Angiography), stroke incidence, and management paradigms (conservative, antiplatelets, anticoagulants, surgical, endovascular treatment) were delineated. Incidence was calculated using pooled proportions random effects meta-analysis.

Results: A total of 44 studies were included (1777 patients). 20-studies (n = 503) included data on trauma type; 75.5% (n = 380) suffered blunt trauma and 24.5% (n = 123) penetrating. The overall incidence of VAI was .95% (95% CI 0.65-1.29). From the 16 studies which reported data on outcomes, 8.87% (95% CI 5.34- 12.99) of patients with VAI had a posterior stroke. Of the 33 studies with investigation data, 91.7% (2929/3629) underwent diagnostic CTA; 7.5% (242/3629) underwent MRA and 3.0% (98/3629) underwent DSA. Management data from 20 papers (n = 475) showed 17.9% (n = 85) undergoing conservative therapy, anticoagulation in 14.1% (n = 67), antiplatelets in 16.4% (n = 78), combined therapy in 25.5% (n = 121) and the rest (n = 124) managed using surgical and endovascular treatments.

Conclusion: VAI in cervical spine trauma has an approximate posterior circulation stroke risk of 9%. Optimal management paradigms for the prevention and management of VAI are yet to be standardized and require further research.

Keywords: cervical spine; neck injuries; neck trauma; spinal injuries; vertebral artery injury.

PubMed Disclaimer

Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
PRISMA Flow diagram, of study selection for inclusion in this review and meta-analysis.
Figure 2.
Figure 2.
Forest plot of cumulative incidence of Vertebral Artery Injury.
Figure 3.
Figure 3.
Forest plot of cumulative incidence of stroke after Vertebral Artery Injury.
See this image and copyright information in PMC

References

    1. Desouza RM, Crocker MJ, Haliasos N, Rennie A, Saxena A. Blunt traumatic vertebral artery injury: A clinical review. European Spine Journal. 2011;20(9):1405-1416. doi:10.1007/s00586-011-1862-y - DOI - PMC - PubMed
    1. Sharma P, Hegde R, Kulkarni A, et al. Traumatic vertebral artery injury: A review of the screening criteria, imaging spectrum, mimics, and pitfalls. Polish Journal of Radiology. 2019;84:307-318. doi:10.5114/pjr.2019.88023 - DOI - PMC - PubMed
    1. Temperley HC, McDonnell JM, O’Sullivan NJ, et al. The Incidence, Characteristics and Outcomes of Vertebral Artery Injury Associated with Cervical Spine Trauma: A Systematic Review. Global Spine Journal. 2023;13(4):1134-1152. doi:10.1177/21925682221137823 - DOI - PMC - PubMed
    1. Mueller CA, Peters I, Podlogar M, et al. Vertebral artery injuries following cervical spine trauma: A prospective observational study. European Spine Journal. 2011;20(12):2202-2209. doi:10.1007/s00586-011-1887-2 - DOI - PMC - PubMed
    1. Simon LV, Nassar A k, Mohseni M. Vertebral Artery Injury. 2022. https://www.ncbi.nlm.nih.gov/books/NBK470363/#article-31118.s11 - PubMed

LinkOut - more resources