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

Abstract

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.

Unstable thoracic spine fracture with aortic encroachment: A potentially fatal association and a suggested treatment

“…In such cases direct trauma to the aorta may be the result of the fracture “per se” or it may secondarily complicate surgery for fracture’s reduction [6] , making them a true challenge-to-treat in terms of priority, timing, choice of approach. While several authors describe iatrogenic aortic injuries following spinal surgery [6] , [7] , [8] , [9] , [10] , [12] only a few focus on the management of unstable vertebral column fractures with concomitant or potential aortic lesions [3] , [6] , [13] , [14] , [15] . Although reports are anecdotal one can attempt to get some statements.…”

“…In the setting of severe trauma patients, aortic injuries must therefore be always ruled out with appropriate imaging (CT +/− conventional angiography, MRI) [2] , [5] , [6] , [9] . If actual or potential aortic lesions and unstable spinal fractures coexist, the former takes absolute priority in the treatment schedule and should be addressed “as soon as possible” relatively to patient’s condition [1] , [3] , [7] , [13] , [15] . At this time, a multidisciplinary evaluation involving spine/vascular surgeons, interventional radiologists and ICU specialists becomes mandatory [6] , [7] .…”

Spinal Trauma in Italy: Actuality and Future Perspectives

“…According to the current literature, the incidence of spinal trauma with neurological impairment in Italy is estimated to be between 18 and 20 cases per million [1][2][3]. Usually the most affected patients are young or middle aged, with a male/female ratio of 3,5-4,1 and the trauma is related to road accidents [4][5][6][7][8]. Spine trauma is also related to work accidents: falls from a height in 53% of the cases, road accidents during the drive to and from work in 20% of cases.…”

Blunt multifocal aortic injury with abdominal aortic intimointimal intussusception

“… 1 , 2 Autopsy series demonstrate BAAI in 0.2% of patients dying of blunt trauma. 3 , 4 Approximately 60% of BAAI results from motor vehicle collisions secondary to differential deceleration of fixed and adjacent mobile anatomic components. 4 , 5 , 6 In the thoracic aorta (TA), this commonly occurs at the ligamentum arteriosum between the mobile arch and immobile descending aorta.…”

“… 3 , 4 Approximately 60% of BAAI results from motor vehicle collisions secondary to differential deceleration of fixed and adjacent mobile anatomic components. 4 , 5 , 6 In the thoracic aorta (TA), this commonly occurs at the ligamentum arteriosum between the mobile arch and immobile descending aorta. In the abdominal aorta (AA), injuries ranging from intimal tears to complete transection can arise from forceful aortic compression between mobile abdominal contents and the fixed spinal column.…”