Paraparesis due to pressure erosion of the thoracic spine by an aortic aneurysm: remission of symptoms following resection of the aneurysm and vertebral reconstruction

Summary

Background. There are only a few descriptions in the literature of thoraco-abdominal aortic aneurysms responsible for erosion of the vertebral column and compression of the spinal cord. This case is therefore presented to provide an opportunity to discuss the pathomechanic aspects and to demonstrate the feasibility of total surgical repair by an interdisciplinary approach.

Methods. A thoraco-abdominal aortic aneurysm caused extensive erosion of vertebral bodies T5–8, leading to invasion of the spinal canal and compression of the cord. The clinical signs were paraparesis and chronic thoracolumbar pain. In a combined operation the aneurysm was replaced by a Dacron prosthesis. Corpectomy of T5–8 was carried out and a titanium mesh cage filled with autogenous bone tissue was inserted. The vertebral column was stabilized using dorsal and lateral instrumentation.

Findings. Clinical and imaging follow-up after three years showed remission of the patient’s severe paraparesis and chronic pain and long-term technical success of the vertebral and aortic reconstruction.

Interpretation. Complete thoraco-abdominal aortic replacement and spinal column repair can be successfully accomplished with good clinical and neurological long-term results.