J. Poster1, A.M. Jose2, I. Shnaydman2, B. Zangbar2, A. Rafieezadeh2, K. Prabhakaran2, M. Bronstein2, G. Froula2, J. Klein2, J.M. Kirsch2 1Westchester Medical Center, Surgery, Valhalla, NY, USA 2New York Medical College, Surgery, Valhalla, NY, USA
Introduction: Vertebral artery injury (VAI) is high in cervical spine fractures partially because of vertebral artery’s course through C2 transverse foramen. We hypothesized that rates of vertebral artery injury may be lower in isolated dens fractures due to their remote location from the transverse foramen.
Methods: A retrospective analysis of ACS-TQIP (2017-2021) was performed. Patients ≥18 with isolated C2 fractures were dichotomized into isolated dens fractures (IDF) and all other C2 fractures (OthF) and their association with VAI studied. Primary outcome is VAI. Secondary outcomes are cerebrovascular accident (CVA), discharge disposition, and vascular imaging (CTA).
Results:Out of 31,825 patients with isolated C2 fractures, 16,916 (53.2%) were IDF and 14,909 (46.8%) were OthF. Compared to OthF, patients with IDF were female, older (72.15 ± 16.08 vs. 64.87 ± 18.74 years), with the most common mechanism of injury being falls. Overall, 11.9% patients underwent CTA, and 5.7% had VAI. 3.6% IDF sustained VAI and 8.1% of OthF sustained VAI (p < 0.001). Among IDF, VAI was present in 5.7% in <65 and 3.0% in ≥65 (p<0.001). Among OthF, VAI was present in 10.0% in <65 and 6.9% in ≥65 (p<0.001). Of the 1,714 patients with IDF who underwent CTA, 8% had VAI. Of the 2,068 patients with OthF and underwent CTA, 15.2% had VAI. Among OthF, patients with VAI had higher rates of CVA (1.7%) compared to those without VAI (0.2%)(p<0.001). Among IDF, those with VAI had higher rates of CVA (1.2%) compared to those without VAI (0.2%) (p<0.001). Among ≥65 who sustained a fall, VAI was higher among OthF than IDF (2.7% vs. 6.6%, p < 0.001). In geriatric patients with IDF after GLF who had a CTA, 6.5% had a VAI, compared to 14.9% with OthC2F. Keeping OthF as a reference, geriatric fall patients who sustained isolated dens fracture had a lower odds of sustaining VAI (OR: 0.364, p < 0.001). There was no significant difference in the rates of CVA across both groups (p > 0.05).
Conclusion:There was a significantly decreased incidence of VAI in IDF compared to OthC2F. In patients who underwent a CTA, VAI was observed more in OthF than IDF. We observed that VAI rates were higher among OthF than IDF. Geriatric fall patients with isolated dens fracture may not require screening for VAI. However, patients with other C2 fractures should be continued to screen.