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Vertebral Artery Injury Associated with a Jefferson Fracture

Published online by Cambridge University Press:  18 September 2015

Gregory S. Walsh  and
Michael D. Cusimano
Gregory S. Walsh
Affiliation:
Division of Neurosurgery, St. Michael’s Hospital, University of Toronto, Toronto
Michael D. Cusimano*
Affiliation:
Division of Neurosurgery, St. Michael’s Hospital, University of Toronto, Toronto
*
Division of Neurosurgery, 38 Shuter Street, Toronto, Ontario, Canada M5B 1A6
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Abstract

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Background

The evaluation and treatment of Jefferson fractures, a burst fracture of the ring of CI, has been well documented in the medical literature. Vertebral artery injury associated with a Jefferson fracture is very rare.

Methods

The case study technique was used to summarize the case. Review of the literature was performed to discuss the case. Retrospective chart review of the 174 patients with cervical fractures admitted to St. Michael’s Hospital from 1989–1994 was also performed.

Results

The case of a patient with a Jefferson fracture, with bilateral lateral displacement of the lateral masses causing bilateral vertebral artery occlusions resulting in a lateral medullary and cerebellar infarction is reported. A review of the literature is provided.

Conclusion

A high index of suspicion for this injury is paramount, especially in patients with multiple trauma, where the diagnosis of Jefferson fractures can be delayed.

Résumé

Résumé<span class='italic'><span class='bold'>Introduction</span></span>

L’évaluation et le traitement des fractures de Jefferson, une fracture par éclatement de l’anneau de Cl, sont bien documentés dans la littérature médicale. Il est très rare qu’une lésion de l’artère vertébrale soit associée à une fracture de Jefferson.

<span class='italic'><span class='bold'>Méthodes</span></span>

Nous présentons une étude de cas ainsi qu’une revue de la littérature pour en discuter. Nous avons également révisé les dossiers de 174 patients ayant subi des fractures cervicales qui ont été admis à l’Hôpital St-Michael entre 1989 et 1994.

<span class='italic'><span class='bold'>Résultats</span></span>

Nous rapportons le cas d’un patient avec fracture de Jefferson et déplacement latéral bilatéral des masses latérales causant un infarcissement médullaire et cérébelleux suite à une occlusion bilatérale des artères vertébrales. Nous présentons également une revue de la littérature.

<span class='italic'><span class='bold'>Conclusions</span></span>

Il est très important de considérer cette éventualité, surtout chez les polytraumatisés chez qui le diagnostic de fracture de Jefferson peut être tardif.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 22 , Issue 4 , November 1995 , pp. 308 - 311
Copyright
Copyright © Canadian Neurological Sciences Federation 1995

References

REFERENCES

1. Kesterson, L, Benzel, E, Orrison, W, Coleman, J. Evaluation and treatment of atlas burst fractures (Jefferson fractures). J Neurosurg 1991; 75:213–220.Google Scholar
2. Levine, AM, Edwards, CC. Fractures of the atlas. J Bone Joint Surg[Am] 1991; 73:680–691.Google Scholar
3. Pierce, DS, Barr, JS, Fractures and Dislocations at the Base of the Skull and Upper Cervical Spine. In: Sherk, HH, Dunn, EJ, Eismont, FJ, et al, eds. The Cervical Spine, 2nd Editon. Philadelphia: J.B. Lippincott Co., 1989: 312–324.Google Scholar
4. Siegel, M, Alberts, R. Unusual sign of a Jefferson fracture. Spine 1992; 17:605–606.CrossRefGoogle ScholarPubMed
5. Stephens, RB, Stilwell, DL. Arteries and Veins of the Human Brain. Springfield, Illinois: Charles C. Thomas, 1969; 71–123.Google Scholar
6. Williams, PL, Warwick, R, Dyson, M, Bannister, LH. Gray’s Anatomy, 37th Edition. New York: Churchill Livingstone, 1989; 315–319,750–755.Google Scholar
7. Hanakita, J, Hidenori, M, Nagayasu, S, et al. Angiographic examination and surgical treatment of bow hunter’s stroke. Neurosurgery 1988; 23:228–232.Google Scholar
8. Cornacchia, LG, Abitol, JJ, Heller, J, et al. Blunt injuries to the extracranial cerebral vessels associated with spine fractures. Spine 1991; 16: S506–S510.Google Scholar
9. Deen, HG Jr., McGirr, SJ. Vertebral artery injury associated with cervical spine fracture. Spine 1992; 17: 230–234.CrossRefGoogle ScholarPubMed
10. Lyness, SS, Simeone, FA. Vascular complications of upper cervical spine injuries. Orthop Clin North Am 1978; 9: 1029–1038.Google Scholar
11. Schwarz, N, Buchinger, W, Guadernak, T, et al. Injuries to the cervical spine causing vertebral artery trauma: case reports. J Trauma 1991; 31: 127–133.Google Scholar
12. Parent, AD, Harkey, HL, Touchstone, DA, et al. Lateral cervical spine dislocation and vertebral artery injury. Neurosurgery 1992; 31:501–509.Google Scholar
13. Jabre, A. Subintimal dissection of the vertebral artery in subluxation of the cervical spine. Neurosurgery 1991; 29: 912–915.Google Scholar
14. Lee, C, Woodring, JH, Walsh, JW. Carotid and vertebral artery injury in survivors of atlanto-occipital dislocation: case reports and literature review. J Trauma 1991; 31: 401–407.Google Scholar
15. Woodring, JH, Lee, C, Duncan, V. Transverse process fractures of the cervical vertebrae: are they significant? J Trauma 1993; 34: 797–802.Google Scholar
16. Contostavlos, DM. Massive subarachnoid hemorrhage due to laceration of the vertebral artery associated with fracture of the transverse process of the atlas. J Forensic Sci 1971; 16: 40–56.Google Scholar
17. Raskind, R, North, CM. Vertebral artery injuries following chiropractic cervical spine manipulation – case reports. Angiology 1990; 41:445–452.Google Scholar
18. Lee, C, Woodring, JH. Sagitally oriented fractures of the lateral masses of the cervical vertebrae. J Trauma 1991; 31: 1638–1643.Google Scholar
19. Louw, JA, Mafoyane, NA, Small, B, Neser, CP. Occlusion of the vertebral artery in cervical spine dislocations. J Bone Joint Surg[Br] 1990; 72:679–681.Google Scholar
20. Willis, BK, Greiner, F, Orrison, WW, Benzel, EC. The incidence of vertebral artery injury after midcervical spine fracture of subluxation. Neurosurgery 1994; 34: 435–442.CrossRefGoogle ScholarPubMed
21. Aymard, A, Gobin, YP, Hodes, JE, et al. Endovascular occlusion of vertebral arteries in the treatment of unclippable vertebrobasilar aneurysms. J Neurosurg 1991; 74: 393–398.CrossRefGoogle ScholarPubMed
22. Meier, DE, Brink, BE, Fry, WJ. Vertebral artery trauma: acute recognition and treatment. Arch Surg 1981; 116: 236–239.Google Scholar