A case of cervical spine and cord injury with occlusion and stenosis of vertebral arteries is reported.
A 16-year-old girl was transferred to our hospital because of head and neck injuries sustained in a fall from a motorcycle. She had a vertex skin wound and complained of neck pain. She showed severe quadriparesis with complete flaccid plegia on the right and paresis below the C₅level on the left, hyperesthesia of the upper extremities and left hemihypesthesia below the upper thoracic level. Cervical films showed unilateral interfacetal dislocation and fracture of the C₄ vertebral body. CT scan revealed multiple fractures in the body, transverse process and posterior arch at C₄ and C₅, and clock-wise rotation of C₃. Vertebral angiograms showed complete occlusion of the right vertebral artery at the lower portion of C₄ and lateral displacement and narrowing of the left vertebral artery at the C₄ level. She was operated on four days after the trauma. Initially, posterior reduction of the interfacetal dislocation and wire fusion of C₃, C₄ and C₅ was carried out, and then while still under general anesthesia, an anterior approach was used to aclieve decompres and an iliac bone graft was performed. A halo-vest was attached. Postoperatively, neurological deficits gradually improved, and she was able to walk despite the right hemiparesis one month after surgery. Postoperative angiograms showed improvement in the narrowing of the left vertebral artery and recanalization of the right vertebral artery. Acute cervical spinal trauma may be associated with narrowing or occlusion of the vertebral arteries even if symptoms of vertebro-basilar insufficiency are not apparent. It is important to ascertain the state of the vertebral arteries in order to properly treat severe cervical spinal injuries.