RT Journal Article
SR Electronic
T1 Neurologically Asymptomatic Lumbar Traumatic Dislocation With Vascular Compression in a Patient With Ankylosing Spondylitis: Case Report
JF International Journal of Spine Surgery
JO Int J Spine Surg
FD International Society for the Advancement of Spine Surgery
SP 7159
DO 10.14444/7159
A1 Mata-Gómez, Jacinto
A1 Gilete-Tejero, Ignacio Javier
A1 Rico-Cotelo, María
A1 Royano-Sánchez, Manuel
A1 Moreno-Flores, Aurora
A1 Ortega-Martínez, Marta
YR 2020
UL https://www.ijssurgery.com/content/early/2020/12/17/7159.abstract
AB Background Ankylosing spondylitis (AS) is associated with high rates of severe thoracolumbar fractures, in many cases with neurological deficits. It is currently a point of debate as to whether the optimal surgical treatment is posterior fixation and fusion or combined approaches. Vascular injuries in this kind of fracture are a challenging issue to solve in the management of these patients.Methods We are reporting the case of a 65-year-old man who presented an L4 traumatic fracture-dislocation. He had a long history of symptomatic AS. No neurological deficits were detected during the initial exploration. During the preoperative work-up, a lumbar spine computed tomography (CT) scan was taken with vascular reconstruction of the abdominal vessels. It confirmed the compression of the abdominal aorta, which had caused more than 90% stenosis. A posterior approach, an open reduction, and fixation with pedicle screws were performed, without hemodynamic or neurological changes. A postoperative angiography demonstrated a complete recovery of the vessel caliber, without contrast leaks.Results After a 2-year follow-up, the patient was pain free and the CT scan revealed bone fusion.Conclusions The vascular structures involved in severe thoracolumbar fractures present a dangerous situation that should be considered in the choice of the surgical approach. The posterior approach alone may be a good option in the absence of vascular damage. However, due to risk of vessel rupture during the fracture reduction, vascular surgeons must take part in the surgery.Level of Evidence 5.Clinical Relevance The article provides help for surgeons who have to treat severe fractures in the context of ankylosing spondylitis