Pseudo-Aneurysm of a Lumbar Artery After Flexion-Distraction Injury of the Thoraco-Lumbar Spine and Surgical Realignment

• DOI: 10.1097/brs.0b013e3181624b93
• Publication Date: 2009-03-05T12:57:10Z
• Authors: Maurizio Domenicucci; Alessandro Ramieri; Jacopo Lenzi; Elena Fontana; Stefano Martini
• Keywords: Adult; Male; Rupture; Lumbar Vertebrae; Accidents, Traffic; Hemorrhage; Arteries; Recovery of Function; Embolization, Therapeutic; Magnetic Resonance Imaging; Thoracic Vertebrae; 3. Good health; 03 medical and health sciences; Spinal Fusion; 0302 clinical medicine; Aneurysm; Embolization; Lumbar Vertebrae; Spinal Fractures; Humans; Spinal Fractures; Tomography, X-Ray Computed; Aneurysm, False

A unique case of pseudo-aneurysm of a lumbar artery after injury of the thoracolumbar spine was presented.To describe the exceptional occurrence of pseudo-aneurysm of a lumbar artery after flexion-distraction fracture of thoracolumbar junction and to discuss the mechanism of formation and the therapeutic solution.Injury of a lumbar artery represents a potential cause of massive, life-threatening, retroperitoneal bleeding. It may be associated with lesions of the abdomen, lower limbs, pelvic bones, and spinal column. Fracture of a transverse process may be responsible for direct laceration of a lumbar artery, but formation of a pseudo-aneurysm is an uncommon event. The diagnosis is difficult and often delayed. The treatment of choice is endovascular embolization.In a patient who had a posttraumatic severe thoracolumbar vertebral dislocation with complete spinal cord lesion after road accident, we performed surgical reduction and stabilization via posterior approach. After 7 days, he developed a progressive anemia due to retroperitoneal hemorrhage and formation of a pseudo-aneurysm of the lumbar artery at L1 level.Endovascular embolization achieved resolution of the pseudo-aneurysm, regression of the hematoma and progressive recovery of the patient during a period of 6 months.Pseudo-aneurysm of a lumbar artery has never previously been described in association with flexion-distraction type vertebral fracture, in which the spinal column is subjected to greater, shear-type, forces. Stretching of the arterial wall due to the traumatic dislocation of the spine and subsequent surgical realignment may be considered as the mechanism of formation and rupture of the pseudo-aneurysm. Dangerous bleeding in the retroperitoneal space and in the operative field can be effectively managed by endovascular intervention.