PT  - JOURNAL ARTICLE
AU  - Mata-Gómez, Jacinto
AU  - Gilete-Tejero, Ignacio Javier
AU  - Rico-Cotelo, María
AU  - Royano-Sánchez, Manuel
AU  - Moreno-Flores, Aurora
AU  - Ortega-Martínez, Marta
TI  - Neurologically Asymptomatic Lumbar Traumatic Dislocation With Vascular Compression in a Patient With Ankylosing Spondylitis: Case Report
AID  - 10.14444/7159
DP  - 2021 Feb 01
TA  - International Journal of Spine Surgery
PG  - S16--S20
VI  - 14
IP  - s4
4099  - https://www.ijssurgery.com/content/14/s4/S16.short
4100  - https://www.ijssurgery.com/content/14/s4/S16.full
SO  - Int J Spine Surg2021 Feb 01; 14
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