SPINE Volume 43, Number 5, p E320 2018 Wolters Kluwer Health, Inc. All rights reserved. LETTER At last, concurrent BCI was identified as a risk factor for Letter to Indications for CT Angiography of the VAI in the study. However, in our opinion, it is unpractical Vertebral Arteries After Trauma to consider it as an indication for CTA of vertebral arteries after trauma. Because diagnosis of BCI is also largely e read with great interest the article by Drain depended on CTA. Thus, setting it as an indication for et al. The authors conducted their study to CTA of vertebral arteries is not helpful to decrease risks W identify factors that predict vertebral artery that include radiation exposure and nephrotoxicity. injury (VAI) after trauma. Finally, they concluded that Qiunan Lyu, MD female sex, lower Glasgow Coma Scale, cervical spine Huiliang Yang, MD fracture, and concurrent blunt carotid injury (BCI) were Chunguang Zhou, PhD risk factors for VAI. The clinical importance of the article Limin Liu, PhD was undisputed. However, we have some concerns about Yueming Song, PhD this study. Department of Orthopedics Surgery First, it has been reported that computed tomography West China Hospital, Sichuan University angiography (CTA) can increase detection of blunt vertebral 2–4 Sichuan, China artery injury in patients with blunt trauma. However, firstname.lastname@example.org screening with CTA or magnetic resonance angiography for blunt cerebrovascular injury (BCVI) was only performed in References 144 (7.77%) patients in the study. And all of the nine VAI 1. Drain JP, Weinberg DS, Ramey JS, et al. Indications for CT- were diagnosed in the screening group, and no VAI was angiography of the vertebral arteries after trauma. Spine (Phila diagnosed in the nonscreening group. It was probable that Pa 1976) 2017; [Epub ahead of print]. 2. Miller PR, Fabian TC, Croce MA, et al. Prospective screening for some BCVI were neglected in the 1710 (92.23%) patients blunt cerebrovascular injuries: analysis of diagnostic modalities and who did not receive screening. It would be better if the outcomes. Ann Surg 2002;236:386–93; discussion 393–5. authors introduce the indications for CTA that they applied 3. Payabvash S, McKinney AM, McKinney ZJ, et al. Screening and in the article, because proper indications can decrease the detection of blunt vertebral artery injury in patients with upper cervical fractures: the role of cervical CT and CT angiography. Eur J missed diagnosis rate of BCVI. Radiol 2014;83:571–7. Second, in the study, the records of patients who did not 4. Biffl WL, Moore EE, Elliott JP, et al. The devastating potential of undergo screening were followed for 2 years to ensure that blunt vertebral arterial injuries. Ann Surg 2000;231:672–81. 5. Scott WW, Sharp S, Figueroa SA, et al. Clinical and radiological occult VAI was not missed. However, many previous studies outcomes following traumatic grade 1 and 2 vertebral artery inju- have founded that some VAI without treatment can resolve ries: a 10-year retrospective analysis from a level 1 trauma center. 5–9 5 at follow-ups. Scott et al found that 97% patients with J Neurosurg 2014;121:450–6. VAI who did not receive treatment had stable, improved, or 6. Cothren CC, Biffl WL, Moore EE, et al. Treatment for blunt cerebrovascular injuries: equivalence of anticoagulation and anti- resolved injuries on final imaging. In the study of Desouza platelet agents. Arch Surg 2009;144:685–90. et al, 85.7% VAI that were not treated with any medical or 7. Stein DM, Boswell S, Sliker CW, et al. Blunt cerebrovascular procedural therapy demonstrated improvement, and 14.3% injuries: does treatment always matter? J Trauma 2009;66:132– was stable. Therefore, if occult VAI improve or resolve at 43; discussion 143–4. 8. Desouza RM, Crocker MJ, Haliasos N, et al. Blunt traumatic follow-ups, diagnosis of VAI will not be made based on the vertebral artery injury: a clinical review. Eur Spine J 2011;20: records of the patients. Thus, some asymptomatic VAI were 1405–16. probably neglected in the patients who did not receive 9. Lee YJ, Ahn JY, Han IB, et al. Therapeutic endovascular treatments angiography in the study. for traumatic vertebral artery injuries. J Trauma 2007;62:886–91. The manuscript submitted does not contain information about medical device(s)/drug(s). No funds were received in support of this work. No relevant financial activities outside the submitted work. DOI: 10.1097/BRS.0000000000002530 E320 www.spinejournal.com March 2018 Copyright © 2018 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
Spine – Wolters Kluwer Health
Published: Mar 1, 2018
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