Vertebral artery dissection during traumatic injury of the cervical spine, two case reports.

Introduction: If severe cervical spinal cord injury or severe cervical vertebral fracture, subluxation or luxation is confirmed, 20-40% have vertebral artery dissection or occlusion. These can be asymptomatic, but can cause ad- ditional neurological damage in addition to cervical my- elon and cervical nerve root symptoms.

Aims: Vertebral artery dissection can be caused by direct injuries, stab wounds or gunshot wounds. Indirect vertebral artery dissection can occur at the same time as subluxation, luxation, or complex fractures of the cervical vertebra. CTA is the examination procedure of choice. In many cases, DSA examination and, if necessary, neuroin- terventional treatment must precede open neurosurgery. Methods: Our first patient, a 52-year-old male patient, drifted off the highway at high speed as the driver of a car.Complete luxation of a C.VI vertebra caused uni- lateral vertebral artery 2-segment dissection-occlusion. Before cervical spine surgery, a 12 kg pull was applied under a DSA image intensifier, as a result of which the arch of the cervical spine and the luxated C.VI. his ver- tebra returned to its original position before the luxation. Before surgery, the dissected vertebral artery was closed during endovascular intervention. In the second case, our 67-year-old male patient was stabbed in the neck with a long screwdriver from behind by his own son after a fight at home. CT examination shows the tip of the screwdriver in between the vertebrae C.IV-V. passing through the left vertebral canal. The patient had no neurological symp- toms. In both of our cases, parent vessel occlusion was performed at the level of the vertebral artery injury before the neurosurgical operation.

Result: After occlusion of the vertebral artery, neuro- surgery procedures could be performed safely in both pa- tients. We did not detect any bleeding from the vertebral artery in any of his operations.

Conclusion: If the dissection of the vertebral artery does not cause neurological loss and is not complete, then the occlusion must