Traumatic fall injury causing a displaced vertebral body fracture with concomitant abdominal aortic injury

Thoraco-lumbar fractures with blunt traumatic aortic injury in adult patients: correlations and management

PURPOSE

Traumatic thoraco-lumbar spine fracture spine with a concomitant blunt aortic injury is uncommon but potentially a fatal association. Our aim was to clarify: morphology of spinal fractures related to vascular damages and vice versa, diagnostic procedures and decision-making process for the best treatment options for spine and vessels.

METHODS

We enrolled 42 cases culled from the literature and five personal ones, reviewing in detail by AO Spine Classification, Society of Vascular Surgery classification and Abbreviated Injury Scale for neurological evaluation.

RESULTS

Most fractures were at T11-L2 (29 cases; 62%) and type C (17; 70%). 17 (38%) were neurological. Most common vascular damage was the rupture (20; 43%), followed by intimal tear (13; 28%) and pseudoaneurysm (9; 19%). Vascular injury often required open or endovascular repair before spinal fixation. Distraction developed aortic intimal damage until rupture, while flexion-distraction lumbar artery pseudoaneurysm and rotation-torsion full laceration of collateral branches. CT and angio-CT were investigations of choice, followed by angiography. Neurological condition remained unchanged in 28 cases (90%). Overall mortality was 30%, but it was higher in AIS A.

CONCLUSION

Relationship between thoraco-lumbar fracture and vascular lesion is rare, but potentially fatal. Comprehension of spinal biomechanics and vascular damages could be crucial to avoid poor results or decrease mortality. Frequently, traction of the aorta and its vessels is realized by C-dislocated fractures. CT and angio-CT are recommended. Spine stabilization should always follow the vascular repair. Early severe deficits worse the prognosis related to neurological recovery and survival. These slides can be retrieved under Electronic Supplementary Material.

Laceration of abdominal aorta by a fragment of fractured L2 vertebral body after a low-energy injury: a case report and review of literature

STUDY DESIGN

A rare case of direct injury to the wall of abdominal aorta caused by a displaced fracture of the L2 vertebral body resulting from a low-energy injury. Potential injury mechanism and predisposing factors are discussed along with a review of literature pertaining to the subject.

OBJECTIVE

To describe a unique case of direct aortic wall injury caused by a displaced vertebral body fracture.

SUMMARY OF BACKGROUND DATA

The literature on aortic wall injuries after vertebral fractures is reviewed. So far, only the injuries of the thoracic aorta were extensively described. Injuries of the abdominal aorta are much less frequent and usually associated with high-energy trauma. However, coexisting disorders, predisposing the patient to thoracolumbar vertebral body fractures (e.g., osteoporosis, chronic alcoholism) and aortic wall injuries (atherosclerosis) make aforementioned complication possible, despite the low-energy mechanism of injury.

METHODS

A clinical and radiographical interpretation of the reported case is presented.

RESULTS

Laceration of abdominal aorta was caused by a sharp, anteriorly displaced bone fragment of the fractured L2 vertebral body.

CONCLUSION

The reported case adds to the literature on vertebral fractures by describing another mechanism leading to aortic wall disruption. Similar vascular complications may be identified more frequently in the future given the high prevalence of osteoporosis and atherosclerosis in the general population.

Blunt abdominal aortic disruption (BAAD) in shear fracture of the adult thoraco-lumbar spine: case report and literature review

To present a rare case of association of abdominal aorta rupture and flexion-distraction fracture of thoracolumbar spine and to review the literature on this condition. In non-penetrating abdominal traumatic injuries with flexion-distraction fractures of the thoracolumbar spine, rupture of the abdominal aorta is an extremely rare occurrence but its outcome is potentially lethal. This association of skeletal and vascular lesions mainly affects young patients and involves the thoraco-lumbar junction and the portion of the aorta that lies in front of it. The authors analyze the pertinent literature and describe a case, operated in two sittings, of a traumatic lesion of the aorta attributable to a fracture of L1, focusing on mechanism of damage, diagnosis and surgical treatment. At 2-year follow-up examination, there were no neurological deficits. A review of the pertinent literature has shown that mortality can be reduced by a meticulous clinical and radiological work-up for a correct diagnosis followed by surgical repair of any damaged vessels. The possibility of performing a rapid diagnosis by means of total-body CT-scan plus CT-angiography allows repair of vascular damage, stabilization of the patient's hemodynamic conditions and, subsequently, surgical treatment of the vertebral fracture.