Thoraco-lumbar fractures with blunt traumatic aortic damage in grownup sufferers: correlations and administration.
Eur Backbone J. 2018 Apr 16;:
Authors: Santoro G, Ramieri A, Chiarella V, Vigliotta M, Domenicucci M
PURPOSE: Traumatic thoraco-lumbar backbone fracture backbone with a concomitant blunt aortic damage is rare however doubtlessly a deadly affiliation. Our purpose was to make clear: morphology of spinal fractures associated to vascular damages and vice versa, diagnostic procedures and decision-making course of for the very best therapy choices for backbone and vessels.
METHODS: We enrolled 42 instances culled from the literature and 5 private ones, reviewing intimately by AO Backbone Classification, Society of Vascular Surgical procedure classification and Abbreviated Harm Scale for neurological analysis.
RESULTS: Most fractures had been at T11-L2 (29 instances; 62%) and kind C (17; 70%). 17 (38%) had been neurological. Most typical vascular harm was the rupture (20; 43%), adopted by intimal tear (13; 28%) and pseudoaneurysm (9; 19%). Vascular damage typically required open or endovascular restore earlier than spinal fixation. Distraction developed aortic intimal harm till rupture, whereas flexion-distraction lumbar artery pseudoaneurysm and rotation-torsion full laceration of collateral branches. CT and angio-CT had been investigations of alternative, adopted by angiography. Neurological situation remained unchanged in 28 instances (90%). Total mortality was 30%, nevertheless it was larger in AIS A.
CONCLUSION: Relationship between thoraco-lumbar fracture and vascular lesion is uncommon, however doubtlessly deadly. Comprehension of spinal biomechanics and vascular damages might be essential to keep away from poor outcomes or lower mortality. Steadily, traction of the aorta and its vessels is realized by C-dislocated fractures. CT and angio-CT are really useful. Backbone stabilization ought to at all times comply with the vascular restore. Early extreme deficits worse the prognosis associated to neurological restoration and survival. These slides may be retrieved underneath Digital Supplementary Materials.
PMID: 29663146 [PubMed – as supplied by publisher]