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Delayed aortic injury after thoracic corrective osteotomy: a case report

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Abstract

Purpose

To present a case of delayed aortic perforation due to a nondisplaced fracture of the 9th rib after vertebral osteotomy for degenerative kyphoscoliosis in patients with osteoporosis.

Methods

A 78-year-old female patient with osteoporosis had undergone T9-iliac correction surgery for degenerative kyphoscoliosis. After 2 years, the patient underwent T10 pedicle subtraction osteotomy for a T10 vertebral fracture and progression of kyphosis. Postoperatively, the patient had been doing well for 3 weeks; however, just before the day of discharge, she died following a cardiopulmonary arrest. An autopsy was performed with the consent of her family.

Results

Autopsy revealed a large amount of blood and a clot in the left thoracic cavity. Aortic perforation was found just in front of a nondisplaced fracture of the left 9th rib.

Conclusion

This report describes a new critical complication after spinal correction surgery. Even without pedicle screw malposition, aortic injuries can happen to patients with osteoporosis after corrective osteotomy for degenerative kyphoscoliosis due to positional change of aorta and fragility of the ribs. The spine surgeon should be aware of this type of complication, and rib fractures around the aorta after vertebral osteotomy should not be neglected even when there is no displacement.

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References

  1. Sevuk U, Mesut A, Kiraz I, Kose K, Ayaz F, Erkul A (2016) Delayed presentation of aortic injury by a thoracic pedicle screw. J Card Surg 31:220–230

    Article  Google Scholar 

  2. Kitamura R, Colon M, Dave J (2012) Delayed presentation of aortic laceration from seventh rib fracture: an uncommon complication. J Thorac Cardiovasc Surg 144:e121-123

    Article  Google Scholar 

  3. Bruno VD, Batchelor TJ (2009) Late aortic injury: a rare complication of posterior rib fracture. Ann Thorac Surg 87:301–303

    Article  Google Scholar 

  4. Iyoda A, Satoh N, Yamakawa H, Fujino M, Hiroshima K, Fujisawa T (2003) Rupture of the descending thoracic aorta caused by blunt chest trauma: report of a case. Surg Today 33:755–757

    Article  Google Scholar 

  5. Sata S, Yoshida J, Nishida T, Ueno Y (2007) Sharp rib fragment threatening to lacerate the aorta in a patient with flail chest. Gen Thorac Cardiovasc Surg 55:252–254

    Article  Google Scholar 

  6. Barrett-Connor E, Nielson CM, Orwoll E, Bauer DC, Cauley JA (2010) Epidemiology of rib fractures in older men: osteoporotic fractures in men (MrOS) prospective cohort study. BMJ 340:c1069

    Article  Google Scholar 

  7. Moore KL (1985) The thoracic aorta. In: Moore KL (ed) Clinically oriented anatomy, 2nd edn. Williams & Wilkins, Baltimore, pp 132–133

    Google Scholar 

  8. Sevastik B, Xiong B, Hedlund R, Sevastik J (1996) The position of the aorta in relation to the vertebra in patients with idiopathic thoracic scoliosis. Surg Radiol Anat 18:51–56

    Article  CAS  Google Scholar 

  9. Sucato DJ, Duchene C (2003) The position of the aorta relative to the spine: a comparison of patients with and without idiopathic scoliosis. J Bone Joint Surg Am 85:1461–1469

    Article  Google Scholar 

  10. Maruyama T, Takeshita K, Nakamura K, Kitagawa T (2004) Spatial relations between the vertebral body and the thoracic aorta in adolescent idiopathic scoliosis. Spine 29:2067–2069

    Article  Google Scholar 

  11. Smith JS, Sansur CA, Donaldson WF III, Perra JH, Mudiyam R, Choma TJ, Zeller RD, Knapp DR Jr, Noordeen HH, Berven SH, Goytan MJ (2011) Short-term morbidity and mortality associated with correction of thoracolumbar fixed sagittal plane deformity: a report from the scoliosis research society morbidity and mortality committee. Spine 36:958–964

    Article  Google Scholar 

  12. Zanirato A, Damilano M, Formica M, Piazzolla A, Lovi A, Villafañe JH, Berjano P (2018) Complications in adult spine deformity surgery: a systematic review of the recent literature with reporting of aggregated incidences. Eur Spine J 27:2272–2284

    Article  Google Scholar 

  13. Brenner M, Teeter W, Hadud M, Hoehn M, O’Connor J, Stein D, Scalea T (2017) Long-term outcomes of thoracic endovascular repair: a single institution’s 11-year experience. J Trauma Acute Care Surg 82:687–693

    Article  Google Scholar 

  14. Azizzadeh A, Ray HM, Dubose JJ, Charlton-Ouw KM, Miller CC, Coogan SM, Safi HJ, Estrera AL (2014) Outcomes of endovascular repair for patients with blunt traumatic aortic injury. J Trauma Acute Care Surg 76:510–516

    Article  Google Scholar 

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Funding

No financial support was received for this work.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi Abeno-Ku, Osaka, 545-8585, Japan

    Sho Masuda, Akinobu Suzuki, Shinji Takahashi, Koji Tamai & Hiroaki Nakamura

Authors
  1. Sho Masuda
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  2. Akinobu Suzuki
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  3. Shinji Takahashi
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  4. Koji Tamai
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  5. Hiroaki Nakamura
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Contributions

All authors contributed to the treatment of this patient. Data collection was performed by Sho Masuda and Akinobu Suzuki. The first draft of the manuscript was written by Sho Masuda. Akinobu Suzuki revised previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Akinobu Suzuki.

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All authors declare that there is no conflict of interest for this work.

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Consent from the patient’s family was obtained for the publication of this case report.

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Masuda, S., Suzuki, A., Takahashi, S. et al. Delayed aortic injury after thoracic corrective osteotomy: a case report. Eur Spine J 31, 3703–3707 (2022). https://doi.org/10.1007/s00586-021-07014-9

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  • DOI: https://doi.org/10.1007/s00586-021-07014-9

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