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European Spine Journal

, Volume 27, Supplement 2, pp 248–257 | Cite as

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

  • Giorgio Santoro
  • Alessandro Ramieri
  • Vito Chiarella
  • Massimo Vigliotta
  • Maurizio Domenicucci
Original Article

Abstract

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.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

Keywords

Blunt trauma Thoraco-lumbar fracture Aortic injury Vascular surgery Spine stabilization 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

586_2018_5601_MOESM1_ESM.pptx (1.1 mb)
Supplementary material 1 (PPTX 1082 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Giorgio Santoro
    • 1
  • Alessandro Ramieri
    • 2
    • 3
  • Vito Chiarella
    • 1
  • Massimo Vigliotta
    • 1
  • Maurizio Domenicucci
    • 1
  1. 1.Neurosurgery, Department of Neurology and Psychiatry“Sapienza” UniversityRomeItaly
  2. 2.Don Gnocchi FoundationMilanItaly
  3. 3.Don Gnocchi Foundation, ONLUSRomeItaly

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