Pesce A, Armocida D, Petrella G, Guerrini F, Pompucci A. Vertebral body erosion by a chronic contained rupture of thoraco-abdominal aortic aneurysm: systematic review and spine surgical recommendations.
World Neurosurg 2021;
158:e75-e86. [PMID:
34737100 DOI:
10.1016/j.wneu.2021.10.116]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND
Vertebral body erosion (VBE) is commonly caused by neoplastic, inflammatory or infectious diseases: it can be rarely associated with aortic wall disorders, such as contained rupture of aortic aneurysm (CCR-AA). CCR-AA is a rare event consisting of less than 5% of all reported cases. This condition is easily undiagnosed, differential diagnosis may be challenging, and there is no consensus or recommendation that dictates guidance on management of spinal surgical treatment.
MATERIAL AND METHODS
We performed a systematic review of literature of all cases of VBE secondary to CCR-AA to identify clinical, radiological, and surgical outcome characteristics with the aim of providing a basis for future research studies.
RESULTS
The search returned a total of 80 patients. All reported cases have a history of hypertension. In almost all cases the AA size reported was very high (mean diameter of 7.056 cm). The treatment of this condition involves various reported treatment strategies: a totally conservative approach, treatment of the aortic aneurysm through a minimally invasive endovascular procedure, or through open surgery and combined approach. Despite the wide variability in therapeutic strategy, the rate of good outcomes was 80%, relatively high.
CONCLUSIONS
''Back pain'' and pain along the vertebral column are such frequent complaints that unusual etiologies or serious and life threatening complications may be overlooked. In addition to the common traumatic and degenerative causes of back pain, AA must also be considered. A combined approach between vascular and spine surgery could be achieved without any increased risk.
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