LAUSR

This study is nationwide retrospective multicenter study to investigate the incidence and characteristics of blunt cerebrovascular injury (BCVI) in elderly Japanese patients with cervical spine fractures (C-SF) and cervical spinal cord injury (C-SCI). The study enrolled 1512 patients (average age: 75.8 ± 6.9 years; 1007 males, 505 females) from 33 nationwide institutions. Fifty-three patients were diagnosed as having BCVI by angiography. We assessed neurological evaluation, comorbidities and classification of C-SF/dislocation in the elderly patients with/without BCVI and collected 6-month follow-up data on treatment, complications and patient outcome. We also statistically analyzed the relative risk (RR) and relationship between BCVI and other factors. Significant differences were identified between BCVI (+) (n=53) and (-) (n=1459) patients with American Spinal Injury Association Impairment Scale (ASIA) A, C, D, cervical fracture, C3-7 injury level, cervical dislocation, spinal surgery for cervical fracture/dislocation, transverse spinal cord lesion and/or head injury. Fifty-three (3.5%) elderly patients had C-SF and/or C-SCI complicated by BCVI including 28 (53%) cases of vertebral artery (VA) occlusion, 7 (13%) of VA dissection, 4 (8%) of VA rupture, 7 (13%) of vasoconstriction and 7 (13%) unknown. Sixteen cases were treated by interventional radiology. Rates of mortality and brain infarction from BCVI were 0.13% and 0.40%, respectively. RR of BCVI was significantly higher in the elderly cervical injury patients with head injury, severe neurological deficit, ASIA A (RR: 4.33), cervical fracture at the C3-7 level (RR: 7.39) and cervical dislocation at the C1-6 level (RR: 3.06-7.18). In conclusion, Fifty-three (3.5%) elderly patients were complicated with BCVI. BCVI more frequently complicated head injury, severe neurological deficit (ASIA A SCI and transverse spinal cord lesions), cervical fracture and cervical dislocation in these patients. Six patients (11%) suffered brain infarction, and two patients died from BCVI.