European Spine Journal - 2026-08-08 - Journal Article
Internal jugular vein thrombosis in cervical spine trauma causing pulmonary embolism - a rare case report and review of the literature.
Vanamala SK, Kanna RM, Shetty AP, Rajasekaran S
Topics
Key Takeaway
Post-traumatic IJV thrombosis caused saddle pulmonary embolism on POD2 in a C6-C7 AO type C ASIA grade C patient despite negative lower-limb venous ultrasound, with complete IJV recanalization confirmed at 3 weeks after thrombolysis.
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Summary
This case report describes a 50-year-old male with AO type C C6-C7 fracture-dislocation and ASIA grade C quadriparesis who developed saddle PE on POD2 after combined same-day posterior instrumentation and ACDF. Lower-limb DVT workup was negative; retrospective review of preoperative MRI and neck ultrasound identified absent left IJV flow void indicating occult post-traumatic thrombus as the embolic source. Thrombolysis achieved hemodynamic stabilization, IJV recanalized by 3 weeks, and the patient was independently ambulant at 6 months.
Key Limitation
Single case report makes it impossible to determine true incidence of post-traumatic IJV thrombosis in cervical spine trauma or to establish evidence-based screening or anticoagulation thresholds.
Original Abstract
PURPOSE
To report an extremely rare occurrence of post-traumatic internal jugular vein (IJV) thrombosis leading to pulmonary embolism following cervical spine fracture dislocation.
METHODS
A 50-year-old healthy man with an AO type C C6-C7 fracture-dislocation and ASIA grade C quadriparesis underwent combined same-day posterior decompression-instrumentation and anterior cervical discectomy and fusion.
RESULTS
On post-operative day 2, acute desaturation prompted CT pulmonary angiography, which demonstrated a saddle pulmonary embolism. Lower-limb venous ultrasound was negative for deep vein thrombosis. Pre-operative MRI and neck ultrasonogram revealed absence of left IJV flow indicating a post-traumatic thrombus serving as an occult embolic source. Progressive hemodynamic instability necessitated thrombolysis, prolonged mechanical ventilation, and tracheostomy. Follow-up ultrasonography at three weeks confirmed complete IJV recanalization. At six months, the patient was independently ambulant.
CONCLUSION
Peri-vertebral venous injury may serve as a hidden source of thromboembolism in high-energy cervical spine trauma. Absence of IJV flow void on MRI should prompt focused vascular assessment. Early recognition and decisive multidisciplinary management can be lifesaving.