Clinical Impact of Vertebral Artery Injury Detected by Computed Tomography Angiography in Cervical Trauma : A Neurosurgical Perspective

Objectıve: To evaluate the incidence, radiological features, and clinical impact of vertebral artery injury (VAI) detected by computed tomography angiography in patients with cervical trauma, and to assess its association with neurological deficit and mortality. Methods: A retrospective analysis was conducted on 71 cervical trauma patients managed in our neurosurgery clinic between June 2024 to October 2025. After exclusions (age <18 years, malignancy, inadequate imaging, comorbid systemic pathology), 30 patients were included. Demographics, trauma mechanism, computed tomography angiography (CTA) findings, Biffl grading, neurological status and outcomes were compared. Statistical analysis was performed using non-parametric tests with p<0.05 as significance threshold. Results: VAI was detected in 13 patients (43.3%), predominantly Biffl grade 4 (23.3%) and grade 2 (13.3%). Neurological deficit was present in 43.3%, more common in VAI-positive cases, though not statistically significant (p=0.519). Mortality occurred exclusively in the VAI-positive group, demonstrating a significant association (p=0.026). Foramen transversum involvement (p=0.002) and facet joint injury (p=0.038) were significantly associated with vascular injury. No significant correlation was found with age, sex, trauma mechanism or other osseous structures. Conclusıon: The high VAI incidence detected via CTA highlights the importance of early vascular screening in cervical trauma. Biffl grade distribution and significant association with mortality underline the prognostic weight of high-grade lesions. Foramen transversum and facet involvement may serve as predictors of VAI, guiding clinicians on which patients require urgent CTA. Larger prospective studies are warranted. Early CTA screening may improve neurosurgical risk stratification and prevent missed vascular injuries in high-risk cervical trauma patients.