Cervical Spinal Cord Injury Complicated by a Giant Vertebral Pseudoaneurysm within a Vertebral Body Fracture: A Case Report.

Most pseudoaneurysms after traumatic vertebral artery injuries are caused by penetrating or blunt injuries without vertebral fractures. Here, we report a cervical spinal cord injury in a patient with a giant vertebral artery pseudoaneurysm within a split cervical vertebral fracture. An 82-year-old man presented with a history of complete paralysis of the left side of his body due to basilar artery occlusion. He fell while riding in a wheelchair and presented with obstructive respiratory failure 2 days before transfer to our hospital. Radiological examination revealed C4-5 split fractures with diffuse idiopathic skeletal hyperostosis and a suspected cervical spinal cord injury. A contrast-enhanced lesion was observed within the fracture cavity of the C5 vertebral body, which was suggestive of a pseudoaneurysm originating from the left vertebral artery. Because of a history of basilar artery occlusion and a right vertebral artery that terminated in the posterior inferior cerebellar artery, we did not perform emergency interventional treatment. After conservative treatment under sedation for 3 days, cerebral angiography revealed the almost complete disappearance of the pseudoaneurysm. The patient was deemed to have undergone fracture reduction, posterior decompression, and fusion (C3-7) without risk of aneurysm rupture. Although his neurological recovery was limited, the pseudoaneurysm disappearance and tendency of the fractured vertebral body to fuse were confirmed. Pseudoaneurysms of the vertebral artery associated with vertebral body fractures are extremely rare. This report suggests that pseudoaneurysms within a split cervical vertebral fracture could spontaneously disappear with conservative treatment, with care to avoid rupture and embolism.