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Deng H, Tang TX, Tang LS, Chen D, Luo JL, Dong LM, Gao SH, Tang ZH. Thoracic Spine Fractures with Blunt Aortic Injury: Incidence, Risk Factors, and Characteristics. J Clin Med 2021; 10:jcm10225220. [PMID: 34830504 PMCID: PMC8623488 DOI: 10.3390/jcm10225220] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/04/2021] [Accepted: 11/06/2021] [Indexed: 12/03/2022] Open
Abstract
Background: The coexistence of thoracic fractures and blunt aortic injury (BAI) is potentially catastrophic and easy to be missed in acute trauma settings. Data regarding patients with thoracic fractures complicated with BAI are limited. Methods: The authors conducted a prospective, observational, single-center study including patients with thoracic burst fractures. A multivariate logistic regression model was developed to determine the risk factors of aortic injury. Results: In total, 124 patients with burst fractures of the thoracic spine were included. The incidence of BAI was 11.3% (14/124) in patients with thoracic burst fractures. Among these patients, 11 patients with BAI were missed diagnoses. The main risk factors of BAI were as follows: Injury severity score (OR 1.184; 95% CI, 1.072–1.308; p = 0.001), mechanism of injury, such as crush (OR 10.474; 95% CI, 1.905–57.579; p = 0.007), flail chest (OR = 4.917; 95% CI, 1.122–21.545; p = 0.035), and neurological deficit (OR = 8.299; 95% CI, 0.999–68.933; p = 0.05). Conclusions: BAI (incidence 11.3%) is common in patients with burst fractures of the thoracic spine and is an easily missed diagnosis. We must maintain a high suspicion of injury for BAI when patients with thoracic burst fractures present with these high-risk factors.
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Affiliation(s)
- Hai Deng
- Division of Trauma & Surgical Critical Care, Department of Trauma Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (H.D.); (L.-S.T.); (D.C.); (J.-L.L.); (L.-M.D.)
| | - Ting-Xuan Tang
- Class 1901, School of Medicine, Wuhan University of Science and Technology, Wuhan 430065, China;
| | - Liang-Sheng Tang
- Division of Trauma & Surgical Critical Care, Department of Trauma Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (H.D.); (L.-S.T.); (D.C.); (J.-L.L.); (L.-M.D.)
| | - Deng Chen
- Division of Trauma & Surgical Critical Care, Department of Trauma Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (H.D.); (L.-S.T.); (D.C.); (J.-L.L.); (L.-M.D.)
| | - Jia-Liu Luo
- Division of Trauma & Surgical Critical Care, Department of Trauma Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (H.D.); (L.-S.T.); (D.C.); (J.-L.L.); (L.-M.D.)
| | - Li-Ming Dong
- Division of Trauma & Surgical Critical Care, Department of Trauma Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (H.D.); (L.-S.T.); (D.C.); (J.-L.L.); (L.-M.D.)
| | - Si-Hai Gao
- Department of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
- Correspondence: (S.-H.G.); (Z.-H.T.); Tel.: +86-27-83665306 (Z.-H.T.)
| | - Zhao-Hui Tang
- Division of Trauma & Surgical Critical Care, Department of Trauma Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (H.D.); (L.-S.T.); (D.C.); (J.-L.L.); (L.-M.D.)
- Correspondence: (S.-H.G.); (Z.-H.T.); Tel.: +86-27-83665306 (Z.-H.T.)
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Santoro G, Ramieri A, Chiarella V, Vigliotta M, Domenicucci M. Thoraco-lumbar fractures with blunt traumatic aortic injury in adult patients: correlations and management. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:248-257. [PMID: 29663146 DOI: 10.1007/s00586-018-5601-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 04/09/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE Traumatic thoraco-lumbar spine fracture spine with a concomitant blunt aortic injury is uncommon but potentially a fatal association. Our aim was to clarify: morphology of spinal fractures related to vascular damages and vice versa, diagnostic procedures and decision-making process for the best treatment options for spine and vessels. METHODS We enrolled 42 cases culled from the literature and five personal ones, reviewing in detail by AO Spine Classification, Society of Vascular Surgery classification and Abbreviated Injury Scale for neurological evaluation. RESULTS Most fractures were at T11-L2 (29 cases; 62%) and type C (17; 70%). 17 (38%) were neurological. Most common vascular damage was the rupture (20; 43%), followed by intimal tear (13; 28%) and pseudoaneurysm (9; 19%). Vascular injury often required open or endovascular repair before spinal fixation. Distraction developed aortic intimal damage until rupture, while flexion-distraction lumbar artery pseudoaneurysm and rotation-torsion full laceration of collateral branches. CT and angio-CT were investigations of choice, followed by angiography. Neurological condition remained unchanged in 28 cases (90%). Overall mortality was 30%, but it was higher in AIS A. CONCLUSION Relationship between thoraco-lumbar fracture and vascular lesion is rare, but potentially fatal. Comprehension of spinal biomechanics and vascular damages could be crucial to avoid poor results or decrease mortality. Frequently, traction of the aorta and its vessels is realized by C-dislocated fractures. CT and angio-CT are recommended. Spine stabilization should always follow the vascular repair. Early severe deficits worse the prognosis related to neurological recovery and survival. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Giorgio Santoro
- Neurosurgery, Department of Neurology and Psychiatry, "Sapienza" University, Rome, Italy
| | - Alessandro Ramieri
- Don Gnocchi Foundation, Milan, Italy.
- Don Gnocchi Foundation, ONLUS, Via M. Caviglia, 30, Rome, Italy.
| | - Vito Chiarella
- Neurosurgery, Department of Neurology and Psychiatry, "Sapienza" University, Rome, Italy
| | - Massimo Vigliotta
- Neurosurgery, Department of Neurology and Psychiatry, "Sapienza" University, Rome, Italy
| | - Maurizio Domenicucci
- Neurosurgery, Department of Neurology and Psychiatry, "Sapienza" University, Rome, Italy
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