Work

Vertebral artery injury in patients presenting to the emergency department with cervical spine fractures: national trends, predictors, and cerebrovascular outcomes

Year: 2026

Type: article

Abstract: Background: Vertebral artery injury (VAI) is an uncommon but serious sequela of cervical spine trauma, with a varying reported incidence. Prior studies have been limited by small sample size and inconsistent follow-up. This study identified predictors of VAI in emergency department (ED) patients with cervical fractures and evaluated the association with ninety-day stroke. Methods: Adult patients presenting to the ED with acute cervical fractures were identified in the 2010-2022 PearlDiver Mariner M170 database, excluding those with less than ninety days of follow-up. Demographic, clinical and nonclinical characteristics were compared between patients with and without VAI diagnosed on the same day of presentation. Multivariable regression analysis identified independent predictors of VAI. Additionally, multivariate regression assessed VAI association with ninety-day stroke, adjusting for age, sex, and Elixhauser Comorbidity Index (ECI). Results: Among 153,948 patients with cervical fractures, VAI was noted in 777 (0.50%), increasing from 0.33% in 2010 to 0.76% in 2022 (p < .001). Independent predictors, in decreasing OR, included upper cervical fracture (OR 1.93), high-energy trauma (OR 1.88), ECI (relative to 0: 1-2, OR 1.77; 3-4, OR 1.38), insurance (relative to Medicare: commercial, OR 1.50; Medicaid, OR 1.51), male sex (OR 1.28), and younger age (per decade decrease, OR 1.01) (p < .05 each). VAI was independently associated with stroke (OR 3.62, p < .001). Conclusions: VAI detection increased over the study period, and several clinical and nonclinical factors independently predicted VAI. VAI conferred over 3-fold higher odds of ninety-day stroke. Early recognition of high-risk patients may guide strategies to reduce cerebrovascular complications.

Source: North American Spine Society Journal (NASSJ)

DOI: 10.1016/j.xnsj.2026.100950