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

Abstract

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.

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

“…The incidence of aortic injury in patients with lumbar burst fracture is 11.3%, and the probability of a missed diagnosis in these patients is reportedly as high as 78% ( 17 ). CTA has been considered the gold standard for evaluation of patients suspected to have aortic injury ( 18 ) and allows adequate investigation of the extent of vascular injury ( 11 ). In our case, the attending clinician at the referring hospital could not detect the damage to the aorta on CT, leading to delayed diagnosis and treatment.…”

“…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.…”