Traumatic vertebral artery injuries in the geriatric population: a retrospective cohort study

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  • Department of Neurological Surgery, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin
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OBJECTIVE

Traumatic vertebral artery injuries (TVAIs) are a common finding in cervical spine trauma and can predispose patients to posterior circulation infarction. While extensive research has been conducted regarding the management and criteria for imaging in patients with suspected blunt vascular injury, little research has been conducted highlighting these injuries in the geriatric population.

METHODS

The authors performed a retrospective review of all patients evaluated at a level 1 trauma center and found to have TVAIs between January 1, 2010, and January 1, 2018. Biometric, clinical, and imaging data were obtained from a trauma registry database. Patients were divided into 2 groups on the basis of age, a geriatric group (age ≥ 65 years) and an adult group (age 18 to < 65 years). Variables evaluated included type of trauma, mortality, Injury Severity Score (ISS), and ICU length of stay. The Student t-test was used for continuous variables, and Pearson’s chi-square test was used for categorical variables.

RESULTS

Of the 2698 of patients identified with traumatic cervical spine injuries, 103 patients demonstrated evidence of TVAI. Of these patients, 69 were < 65 and 34 were ≥ 65 years old at the time of their trauma. There was no difference in the incidence of TVAIs between the 2 groups. The ICU length of stay (4.71 vs 4.32 days, p > 0.05), hospital length of stay (10.71 vs 10.72 days, p > 0.05), and the ISS (21.50 vs 21.32, p > 0.05) did not differ significantly between the 2 groups. Mortality was significantly higher in the geriatric group, occurring in 9 of 34 patients (26.5%) compared with only 3 of 69 patients (4.4%) in the adult group (p < 0.001). Ground-level falls were the most common inciting event in the geriatric group (44% vs 14.5%, p < 0.001), whereas motor vehicle accidents were the most common etiology in the younger population (72.5% vs 38.2%, p < 0.001). Incidence of ischemic stroke did not vary significantly between the 2 groups (p > 0.05).

CONCLUSIONS

TVAI in the older adult population is associated with a significantly greater risk of mortality than in the younger adult population, despite the 2 groups having similar ISSs. Additionally, low-velocity mechanisms of injury, such as ground-level falls, are a greater risk factor for acquired TVAI in older adults than in younger adults, in whom it is a significantly less common etiology.

ABBREVIATIONS BCVI = blunt cerebrovascular injury; ISS = Injury Severity Score; TVAI = traumatic vertebral artery injury.

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Contributor Notes

Correspondence Paul Page: University of Wisconsin Hospitals and Clinics, Madison, WI. page@neurosurgery.wisc.edu.

INCLUDE WHEN CITING Published online January 17, 2020; DOI: 10.3171/2019.11.SPINE191055.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Beliaev AM, Barber PA, Marshall RJ, Civil I: Denver screening protocol for blunt cerebrovascular injury reduces the use of multi-detector computed tomography angiography. ANZ J Surg 84:429432, 2014

    • Search Google Scholar
    • Export Citation
  • 2

    Berne JD, Norwood SH: Blunt vertebral artery injuries in the era of computed tomographic angiographic screening: incidence and outcomes from 8292 patients. J Trauma 67:13331338, 2009

    • Search Google Scholar
    • Export Citation
  • 3

    Biffl WL, Moore EE, Elliott JP, Ray C, Offner PJ, Franciose RJ, : The devastating potential of blunt vertebral arterial injuries. Ann Surg 231:672681, 2000

    • Search Google Scholar
    • Export Citation
  • 4

    Biffl WL, Moore EE, Offner PJ, Brega KE, Franciose RJ, Burch JM: Blunt carotid arterial injuries: implications of a new grading scale. J Trauma 47:845853, 1999

    • Search Google Scholar
    • Export Citation
  • 5

    Calland JF, Ingraham AM, Martin N, Marshall GT, Schulman CI, Stapleton T, : Evaluation and management of geriatric trauma: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg 73 (5 Suppl 4):S345S350, 2012

    • Search Google Scholar
    • Export Citation
  • 6

    Gioffrè-Florio M, Murabito LM, Visalli C, Pergolizzi FP, Famà F: Trauma in elderly patients: a study of prevalence, comorbidities and gender differences. G Chir 39:3540, 2018

    • Search Google Scholar
    • Export Citation
  • 7

    Gubler KD, Maier RV, Davis R, Koepsell T, Soderberg R, Rivara FP: Trauma recidivism in the elderly. J Trauma 41:952956, 1996

  • 8

    Hasan I, Wapnick S, Tenner MS, Couldwell W: Vertebral artery dissection in children: a comprehensive review. Pediatr Neurosurg 37:168177, 2002

    • Search Google Scholar
    • Export Citation
  • 9

    Miller PR, Fabian TC, Bee TK, Timmons S, Chamsuddin A, Finkle R, : Blunt cerebrovascular injuries: diagnosis and treatment. J Trauma 51:279286, 2001

    • Search Google Scholar
    • Export Citation
  • 10

    Newhall K, Gottlieb DJ, Stone DH, Goodney PP: Trends in the diagnosis and outcomes of traumatic carotid and vertebral artery dissections among Medicare beneficiaries. Ann Vasc Surg 36:145152, 2016

    • Search Google Scholar
    • Export Citation
  • 11

    Scott WW, Sharp S, Figueroa SA, Eastman AL, Hatchette CV, Madden CJ, : Clinical and radiographic outcomes following traumatic Grade 3 and 4 carotid artery injuries: a 10-year retrospective analysis from a Level 1 trauma center. The Parkland Carotid and Vertebral Artery Injury Survey. J Neurosurg 122:610615, 2015

    • Search Google Scholar
    • Export Citation
  • 12

    Scott WW, Sharp S, Figueroa SA, Eastman AL, Hatchette CV, Madden CJ, : Clinical and radiographic outcomes following traumatic Grade 1 and 2 carotid artery injuries: a 10-year retrospective analysis from a Level I trauma center. The Parkland Carotid and Vertebral Artery Injury Survey. J Neurosurg 122:11961201, 2015

    • Search Google Scholar
    • Export Citation
  • 13

    Wang H, Orbach DB: Traumatic dissecting aneurysm at the vertebrobasilar junction in a 3-month-old infant: evaluation and treatment strategies. Case report. J Neurosurg Pediatr 1:415419, 2008

    • Search Google Scholar
    • Export Citation

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