Vol.:(0123456789) 1 3 European Spine Journal https://doi.org/10.1007/s00586-018-5601-5 ORIGINAL ARTICLE Thoraco‑lumbar fractures with blunt traumatic aortic injury in adult patients: correlations and management Giorgio Santoro 1  · Alessandro Ramieri 2,3  · Vito Chiarella 1  · Massimo Vigliotta 1  · Maurizio Domenicucci 1 Received: 28 February 2018 / Accepted: 9 April 2018 © Springer-Verlag GmbH Germany, part of Springer Nature 2018 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, diag- nostic procedures and decision-making process for the best treatment options for spine and vessels. Methods We enrolled 42 cases culled from the literature and fve personal ones, reviewing in detail by AO Spine Classifca- tion, Society of Vascular Surgery classifcation 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 fxation. Distraction developed aortic intimal damage until rupture, while fexion–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 defcits worse the prognosis related to neurological recovery and survival. Graphical abstract These slides can be retrieved under Electronic Supplementary Material. Key points 1. Blunt trauma 2. Thoraco-lumbar facture 3. Aortic injury Take Home Messages 1. Traumac thoraco-lumbar spine fracture spine with a concomitant blunt aorc injury is uncommon but potenally a fatal associaon. 2. C-fracture in flexion-distracon, with dislocaon and/or rotaon, affecng vicms of traffic accidents or high-energy traumazed paents, may be related to abdominal aorta injury or laceraon of its collateral branches due to their common damaging biomechanics. 3. Early and postoperave mortality is high, as greater as more severe is the inial neurological status. However, prompt recognion, classificaon and treatment of the vertebro-vascular damage can likely reduce this fatal event. Keywords Blunt trauma · Thoraco-lumbar fracture · Aortic injury · Vascular surgery · Spine stabilization Introduction Blunt vascular injuries of the aorta and/or its collateral branches (blunt traumatic aortic injury or BTAI) associated with thoraco-lumbar spine fractures are rare [1, 2]. Their occurrence may be asymptomatic or very serious and deadly, with mortality rate of 85–90% during vascular full laceration Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00586-018-5601-5) contains supplementary material, which is available to authorized users. * Alessandro Ramieri alexramieri@libero.it Extended author information available on the last page of the article