• Tammy R Kopelman, Steven Leeds, Nicole E Berardoni, Patrick J O'Neill, Poya Hedayati, Sydney J Vail, Paola G Pieri, Iman Feiz-Erfan, and Melissa A Singer Pressman.
• Division of Burns, Trauma, and Surgical Critical Care, Maricopa Medical Center, Phoenix, AZ 85008, USA. Tammy_Kopelman@dmgaz.org
• Am. J. Surg. 2011 Dec 1;202(6):684-8; discussion 688-9.

BackgroundIt has been suggested that specific cervical spine fractures (CSfx) (location at upper cervical spine [CS], subluxation, or involvement of the transverse foramen) are predictive of blunt cerebrovascular injury (BCVI). We sought to determine the incidence of BCVI with CSfx in the absence of high-risk injury patterns.MethodsWe performed a retrospective study in patients with CSfx who underwent evaluation for BCVI. The presence of recognized CS risk factors for BCVI and other risk factors (Glasgow coma score ≤ 8, skull-based fracture, complex facial fractures, soft-tissue neck injury) were reviewed. Patients were divided into 2 groups based on the presence/absence of risk factors.ResultsA total of 260 patients had CSfx. When screened for high-risk pattern of injury for BCVI, 168 patients were identified and 13 had a BCVI (8%). The remaining 92 patients had isolated low CSfx (C4-C7) without other risk factors for BCVI. In this group, 2 patients were diagnosed with BCVI (2%). Failure to screen all patients with CSfx would have missed 2 of 15 BCVIs (13%).ConclusionsWe propose that all CS fracture patterns warrant screening for BCVI.Copyright © 2011 Elsevier Inc. All rights reserved.

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