Blunt abdominal aortic disruption (BAAD) in shear fracture of the adult thoraco-lumbar spine: case report and literature review

Abstract

To present a rare case of association of abdominal aorta rupture and flexion-distraction fracture of thoracolumbar spine and to review the literature on this condition. In non-penetrating abdominal traumatic injuries with flexion-distraction fractures of the thoracolumbar spine, rupture of the abdominal aorta is an extremely rare occurrence but its outcome is potentially lethal. This association of skeletal and vascular lesions mainly affects young patients and involves the thoraco-lumbar junction and the portion of the aorta that lies in front of it. The authors analyze the pertinent literature and describe a case, operated in two sittings, of a traumatic lesion of the aorta attributable to a fracture of L1, focusing on mechanism of damage, diagnosis and surgical treatment. At 2-year follow-up examination, there were no neurological deficits. A review of the pertinent literature has shown that mortality can be reduced by a meticulous clinical and radiological work-up for a correct diagnosis followed by surgical repair of any damaged vessels. The possibility of performing a rapid diagnosis by means of total-body CT-scan plus CT-angiography allows repair of vascular damage, stabilization of the patient's hemodynamic conditions and, subsequently, surgical treatment of the vertebral fracture.

Fig. 1

a CT-scans of the skull: frontal skull fracture with rupture of the sinus, pneumocephalus and contusion of the right frontal parenchyma. b Total-body spiral CT-scan and 3-D reconstruction: fracture-dislocation of L1, classified as Magerl type C. c and d Total-body spiral CT-scan and CT-angiography with 3-D reconstruction: dilatation of the posterior wall of the aorta at the level of the injured vertebral body and dissection of the renal artery

Fig. 2

a Postoperative CT-scans of the skull: complete reconstruction of the frontal sinus. b Postoperative sagittal CT-scan of thoraco-lumbar spine: surgical stabilization of the L1 vertebral fracture using pedicular screws at L2 level, laminar hooks at T10–T11 level, longitudinal rods and postero-lateral arthrodesis

Fig. 3

X-rays control performed at 2-year follow-up