Evaluation of Fractures in the Upper Cervical Vertebrae and Concurrent Blunt Vascular Injuries to the Brain

Objectives:The aim of this study was to explore the relationship between upper cervical spine fracture patterns and associated blunt cerebrovascular injuries (BCVIs), to detail the epidemiology, mechanisms, diagnostic strategies, and management approaches of these conditions, and to highlight the significance of early diagnosis and effective intervention on patient outcomes.Methods: Patients with upper cervical spine fractures and resulting BCVI in two different centers over 10 years were retrospectively evaluated.A detailed manual review was conducted to filter out cases that involved non-acute pathological fractures or those complicated by previous surgeries, narrowing our focus to individuals with acute C1 and/or C2 fractures who underwent critical computed tomography angiography (CTA) within 24 h following their initial diagnosis.Our examination extended to the detection of BCVIs by using the comprehensive capabilities of both CTA and magnetic resonance imaging to uncover the full extent of vascular injuries secondary to spinal trauma.Results: A total of 1,250 patients were identified with acute fractures in the C1 and/or C2 vertebrae.Of these, the distribution between C1 and C2 fractures revealed a higher incidence of C2 fractures, accounting for approximately 70% of the cases.Among the patients with C1 and/or C2 fractures, 150 were diagnosed with BCVIs.The demographic analysis revealed a higher incidence of these injuries in males, comprising 65% of the cases, and predominantly in the age group of 20-40 years.Motor vehicle accidents emerged as the leading cause of both upper cervical spine fractures and associated BCVIs, accounting for 55% of all cases.Among BCVI patients, seven patients had stroke. Conclusion:The results of our investigation provide evidence of the significant risk of BCVIs in patients with upper cervical spine fractures, particularly in a younger, predominantly male demographic involved in high-energy trauma incidents.The findings underscore the importance of a high index of suspicion, timely diagnosis, and appropriate management strategies to improve patient outcomes and reduce the risk of serious complications like stroke.