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

Cultrera, Francesco; Gamberini, Emiliano; Iacono, Gustavo; Turicchia, Giorgio Ubaldo; Agnoletti, Vanni; Tosatto, Luigino

doi:10.1016/j.ijscr.2017.08.015

Cited by 9 publications

(6 citation statements)

References 18 publications

(68 reference statements)

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“…Thoracic spine fractures are common in trauma [1,2]. Blunt aortic injury (BAI) is considered as a rare comorbidity in patients with thoracic spine fractures, only reported as a sporadic case [10][11][12][13][14][15]. The coexistence of traumatic thoracic fractures with BAI were potential catastrophic and BAI is an easily missed diagnosis in this case due to lack of understanding of this combined injury.…”

Section: Discussionmentioning

confidence: 87%

“…While several papers have described the association of spinal fractures with aortic injury, most of them were case reports, autopsy study and literature review case series [10][11][12][13][14][15]. Two retrospective studies reported the correlation between spinal fractures and BAI by first selecting patients with BAI, and then studying these patients for concomitant spine fractures [23,24].…”

Section: Methodsmentioning

confidence: 99%

“…However, this association is poorly studied in the medical literature. Some authors have reported an association between spinal fractures and BAI, but only isolated case reports, autopsy studies, and literature review case series [10][11][12][13][14][15]. No study has attempted to elucidate the risk factors for aortic injury in this patient population.…”

Section: Introductionmentioning

confidence: 99%

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Thoracic Spine Fractures with Blunt Aortic Injury: Incidence, Risk Factors, and Characteristics

Deng

Tang

et al. 2021

JCM

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Background: The coexistence of thoracic fractures and blunt aortic injury (BAI) is potentially catastrophic and easy to be missed in acute trauma settings. Data regarding patients with thoracic fractures complicated with BAI are limited. Methods: The authors conducted a prospective, observational, single-center study including patients with thoracic burst fractures. A multivariate logistic regression model was developed to determine the risk factors of aortic injury. Results: In total, 124 patients with burst fractures of the thoracic spine were included. The incidence of BAI was 11.3% (14/124) in patients with thoracic burst fractures. Among these patients, 11 patients with BAI were missed diagnoses. The main risk factors of BAI were as follows: Injury severity score (OR 1.184; 95% CI, 1.072–1.308; p = 0.001), mechanism of injury, such as crush (OR 10.474; 95% CI, 1.905–57.579; p = 0.007), flail chest (OR = 4.917; 95% CI, 1.122–21.545; p = 0.035), and neurological deficit (OR = 8.299; 95% CI, 0.999–68.933; p = 0.05). Conclusions: BAI (incidence 11.3%) is common in patients with burst fractures of the thoracic spine and is an easily missed diagnosis. We must maintain a high suspicion of injury for BAI when patients with thoracic burst fractures present with these high-risk factors.

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Section: Discussionmentioning

confidence: 87%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Thoracic Spine Fractures with Blunt Aortic Injury: Incidence, Risk Factors, and Characteristics

Deng

Tang

et al. 2021

JCM

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“…Few cases of BTAI with traumatic spinal injuries have been reported in the literature such as that by Fattahi et al [4], who described a hyperextension thoracic spine fracture complicated by paraplegia, aortic dissection, and right hemothorax requiring ICD tube insertion. Cultrera et al [5] described a compression/distraction spinal fracture complicated by aortic encroachment without wall disruption. Bashir et al [6] described an aortic laceration following a T10 vertebral body fracture.…”

Section: Discussionmentioning

confidence: 99%

Aortic Impingement in Displaced Traumatic Spine Fracture with Complete Spinal Cord Transection: A Case Report

et al. 2021

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Aortic impingement associated with traumatic thoracic spinal fractures is a rare and potentially lethal complication that creates management challenges in an already complex clinical problem. Traumatic aortic injury is one of the leading causes of death in blunt trauma. Magerl divided thoracic and lumbar fractures into 3 categories; the primary focus of this report, type C fractures, describes rotational injury and is one of the less common types, especially associated with aortic impingement as such. In this case, a young man was admitted following a near-fatal fall resulting in blunt force trauma to the midthoracic region. Emergency CT revealed a type C complete transection at the level of T11 and a grade I aortic injury. Definitive fixation of the spinal injury was delayed in favor of preventing further vascular injury by prioritizing the securing of hemodynamic stability. In traumatic thoracolumbar injuries, blunt traumatic aortic injury is often managed conservatively. However, blunt thoracic aortic injury is one of the leading causes of death from trauma, and each case requires its own case-by-case multidisciplinary management. In this occasion, management of the vascular insult was paramount to ensuring patient survival and favorable outcome.

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“…The EMBASE, PubMed, and Web of Science databases were searched using the terms "blunt thoracic aortic injury" and "thoracic fracture" to identify reports of blunt thoracic aortic injury as a result of thoracic fracture. The details of the reported identified (2,(4)(5)(6)(7)(8)(9)(10)(11) are shown in Table 1.…”

Section: Introductionmentioning

confidence: 99%

Delayed diagnosis of blunt thoracic aortic injury due to thoracic vertebral fracture: A case report and literature review

Hong²,

Pan³

et al. 2022

Front. Surg.

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Blunt vascular injury of the aorta combined with thoracolumbar fracture is rare. Delayed diagnosis may have a catastrophic outcome. We present a case of blunt thoracic aortic injury combined with a vertebral body fracture at T10 after a fall from height in which the diagnosis was delayed. After consultation with the vascular and spinal surgeons, we performed a thoracic endovascular aortic repair. When the patient’s condition had stabilized, the fractures were reduced using posterior vertebral instrumentation. Prolonged compression of the thoracic aorta resulted in extensive necrosis of muscle tissues in the right lower leg. Fortunately, clinical and radiological examinations performed 7 months and 1 year later did not reveal any further damage. Cases of thoracic vertebral fracture with concomitant blunt thoracic aortic injury reported in the literature are reviewed. Thoracic endovascular aortic repair is a feasible, safe, and effective minimally invasive treatment for aortic injury when combined with thoracic vertebral fracture.

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

Cited by 9 publications

References 18 publications

Thoracic Spine Fractures with Blunt Aortic Injury: Incidence, Risk Factors, and Characteristics

Thoracic Spine Fractures with Blunt Aortic Injury: Incidence, Risk Factors, and Characteristics

Aortic Impingement in Displaced Traumatic Spine Fracture with Complete Spinal Cord Transection: A Case Report

Delayed diagnosis of blunt thoracic aortic injury due to thoracic vertebral fracture: A case report and literature review

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