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

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 re...

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Detalles Bibliográficos
Autores principales: Cultrera, Francesco, Gamberini, Emiliano, Iacono, Gustavo, Turicchia, Giorgio Ubaldo, Agnoletti, Vanni, Tosatto, Luigino
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573841/
https://www.ncbi.nlm.nih.gov/pubmed/28846951
http://dx.doi.org/10.1016/j.ijscr.2017.08.015
Descripción
Sumario: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.