Unstable thoracic spine fracture with aortic encroachment: A potentially fatal association and a suggested treatment

Highlights • The association of unstable spinal fractures and pending aortic injuries is a therapeutic dilemma. • Inappropriate treatment can lead to catastrophic consequences. • A multidisciplinary, case-by-case evaluation is mandatory. • Vascular lesions must be treated first. • We suggest “best but safest” procedure sequence: endovascular aortic repair and then posterior spinal cord reconstruction.
Background The coexistence of an unstable spinal fracture with a pending aortic lesion is potentially catastrophic and a therapeutic challenge as to timing of treatment, assigning priorities and selecting the best approach. Case report A 41 year-old healthy male victim of bike accident. Imaging revealed a fracture of 6th and 7th thoracic vertebrae with a bone fragment in close proximity to the descending thoracic aorta. After consultation with spine/vascular surgeons and interventional radiologists it was decided to secure the potential aortic injury with an endovascular stent-graft followed by posterior vertebral instrumentation for fracture’s reduction. Discussion/conclusion A multi-specialists teamwork approach is mandatory. Vascular lesion is priority, followed by vertebral surgery. As to the treatment options, we suggest a “best but still safest” philosophy: endovascular repair and posterior spinal instrumentation should be considered first in the acute stage.