The incidence of vertebral artery injury may be as high as 11% after nonpenetrating cervical spinal trauma in patients meeting specific clinical and physical exam criteria. The modified Denver Screening Criteria for BCVI are the most commonly used.19,37 Many patients with VAI have complete spinal cord injuries, fractures through the foramen transversarium, cervical spinal facet dislocation injuries, and/or vertebral subluxation, but many patients with these spinal and spinal cord injuries have normal vertebral arteries when imaged, thus reducing the specificity of these injury patterns with respect to VAI. Many comparative studies in which sensitivity, specificity, and positive and negative predictive value have been, or can be, calculated examined various tests against each other, but not against the gold standard of intravenous catheter angiography, thereby producing Class III medical evidence. However, recent literature providing Class I medical evidence does support CTA as a highly accurate alternative to catheter angiography for screening for VAI in blunt injury trauma patients, with a very high negative predictive value.19,21,24. © 2013 by the Congress of Neurological Surgeons.