Severe erosion of lumbar vertebral body because of a chronic ruptured abdominal aortic aneurysm

doi:10.1016/j.spinee.2006.12.001

The Spine Journal

Volume 8, Issue 2, March–April 2008, Pages 394-396

https://doi.org/10.1016/j.spinee.2006.12.001 Get rights and content

Abstract

Background context

Erosion of vertebral bodies because of abdominal aortic aneurysm is an extremely rare condition. This vertebral destruction is usually seen after aortic graft surgery; nevertheless, it is not expected in primary aortic aneurysms.

Purpose

The purpose of this article was to present a patient who suffers from back and hip pain because of a chronic ruptured primary aortic aneurysm.

Study design

Case report.

Method

A 51-year-old patient had complaints of back pain. Physical examination revealed a pulsatile mass in the periumblical region. By using conventional radiographies, vertebral erosion was detected at the anterior part of L3–L4–L5 vertebrae. A chronic ruptured thrombosed aortic aneurysm was identified by magnetic resonance imaging.

Results

After resection of the aneurysm, it was possible that the lack of anterior column support could result in future instability. Therefore, an L4–L5 anterior partial corpectomy and reconstruction of the anterior defect with titanium mesh cage with posterior instrumentation and fusion were performed.

Conclusion

It was concluded that back pain caused by chronic aortic aneurysms is a rare condition and may be one of the possible etiologies in differential diagnosis of low back pain and/or sciatica in some patients.

Introduction

Erosion of a lumbar vertebral body because of an abdominal aortic aneurysm is a rare condition. There are a few case reports published on lumbar vertebral destruction caused by an aneurysm after aortic bifurcation graft surgery [1], [2], [3]. Vertebral erosion may be observed secondary to aortic aneurysm that develops because of inflammation, infection [4], [5], and pathologies such as Behçet's disease and syphilitic aortitis. However, it is unexpected in primary aortic aneurysms. The purpose of this study is to report a patient who suffered from back pain because of a chronic ruptured primary aortic aneurysm.

Section snippets

Case report

A male patient, 51 years of age, was referred to cardiovascular surgery clinic with complaints of increasing pain starting in his waist and affecting both legs and hips for a duration of 4 months. The pain was steady in character and increased over time. The rest of his physical examination was normal. Heart rate was 72 beats/min, and his blood pressure was 125/100 mm Hg. Deep palpation of the periumbilical region caused pain, and a pulsatile mass was detected. With deep palpation, the patient

Discussion

Collapse and lytic lesions of the vertebrae are generally associated with fracture, tumor, osteoporosis, spondylodiscitis, or spondylitis. In our case, chronic abdominal aortic aneurysm caused vertebral erosion and may mimic tumor or infection. This is a very rare condition that is detected in patients admitted to the hospital with a complaint of abdominal pain and generally diagnosed coincidentally during radiological examination. There are only a few case reports published on chronic aortic

References (8)

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Vertebral mass resulting from a chronic-contained rupture of an abdominal aortic aneurysm repair graft
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H. Ubukata et al.
Spinal destruction induced by chronic contained rupture of an abdominal aortic aneurysm: report of a case
Surg Today
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Severe erosion of lumbar vertebral body because of abdominal aortic false aneurysm: report of two cases
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A. El Maghraoui et al.
Abdominal aortic aneurysm with lumbar vertebral erosion in Behcet's disease revealed by low back pain: a case report and review of the literature
Rheumatology (Oxford)
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There are more references available in the full text version of this article.

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A rare case of a previously treated thoraco-abdominal aortic aneurysm eroding into the thoracic spine is described. Initially, several follow-up CT angiography scans showed an increasing aneurysm sack, but no endoleak could be depicted. Then, a new rapidly developing erosion into the thoracic spine was noted. MRI imaging excluded any other underlying infectious or malignant process. Additional contrast-enhanced ultrasound excluded an endoleak. A 3D-printed model of the aneurysm and spine and cinematic renderings were created to improve visualization. She underwent relining of the thoracic stent graft. Follow-up imaging showed a stable aneurysm size and no progression of the vertebral erosions.
Vertebral Body Erosion by a Chronic Contained Rupture of Thoracoabdominal Aortic Aneurysm: Systematic Review and Spine Surgical Recommendations
2022, World Neurosurgery
Citation Excerpt :
The erosion is most often located in the anterior region of the vertebral body and does not generally exceed 50% of the vertebral body; however, an erosion involving >2 vertebral bodies is common and can result in a vertebral instability. Furthermore, AA may cause pain according to the degree of destruction or neurologic deficit caused by the pressure on neural elements.3 The main signs that confirm the diagnosis are spinal pain and neurologic deficits (claudicatio, paraparesis, or paraplegia).4
Vertebral body erosion (VBE) is commonly caused by neoplastic, inflammatory, or infectious diseases: it can be rarely associated with aortic wall disorders, such as chronic contained rupture of aortic aneurysm (CCR-AA). CCR-AA is a rare event comprising <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.
We performed a systematic review of the literature of all cases of VBE secondary to CCR-AA to identify clinical, radiologic, and surgical outcome characteristics with the aim of providing a basis for future research studies.
The search returned 80 patients. All reported patients had a history of hypertension. In almost all patients, the AA size reported was high (mean diameter, 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 an open surgery and combined approach. Despite the wide variability in therapeutic strategy, the rate of good outcomes was relatively high at 80%.
Back pain and pain along the vertebral column are such frequent symptoms that unusual causes 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.
Low back pain and abdominal aortic aneurysm: Red flags
2022, Rehabilitacion
Aproximadamente el 70% de los adultos experimentarán dolor lumbar en algún momento de su vida. En la mayoría de los casos no se puede identificar una causa, tratándose de algias inespecíficas. Las guías clínicas sobre el manejo del dolor lumbar indican sospechar la presencia de procesos graves mediante las denominadas banderas rojas (red flags). El aneurisma de aorta abdominal en el 91% de los casos se acompaña de dolor lumbar, de allí su importancia de incluirlo como diagnóstico diferencial. Exponemos el caso de un varón de 75 años con dolor lumbar, sin mejoría con tratamiento conservador, derivado a consulta de rehabilitación 3 meses después del inicio de los síntomas, y ante signos de alarma se solicitan estudios de imagen que evidencian aneurisma de aorta abdominal y masa renal derecha. Debemos tener presente las banderas rojas en pacientes con lumbalgia y así evitar desenlaces que pueden poner en riesgo su vida.
Approximately 70% of adults will experience low back pain at some point in their life. Most of the cases cannot be identified a cause, being nonspecific pains. The clinical guidelines on the management of low back pain indicate suspecting the presence of serious processes by means of the so-called red flags. Abdominal aortic aneurysm in 91% of cases is accompanied by low back pain, hence its importance of including it as a differential diagnosis. We present the case of a 75-year-old man with low back pain, without improvement with conservative treatment, referred to a rehabilitation consultation 3 months after the onset of symptoms, and in the event of warning signs, imaging studies are requested that show abdominal aortic aneurysm and mass right kidney. We must bear in mind the red flags in patients with low back pain, and thus avoid outcomes that can put their lives at risk.
Delayed Traumatic Aortic Pseudoaneurysm Formation Causing Vertebral Body Erosion and Back Pain: Case Report and Literature Review
2018, World Neurosurgery
Citation Excerpt :
Typically, back pain is due to local neurovascular compression by the pseudoaneurysm; however, there are case reports noting VB erosion in patients with eventually diagnosed abdominal aortic pseudoaneurysm presenting with back pain.6,20-24 All but 1 of those reports of VB erosion were secondary to graft operations, with Aydogan et al.25 reporting erosion primarily due to the formed aneurysm. It is still unclear at this point why this patient presented in such a delayed fashion after his injury.
Aortic pseudoaneurysms are a rare cause of chronic back pain, usually resulting from compression of the adjacent neurovasculature. It is uncommon for patients with pseudoaneurysms of the abdominal aorta to present in a delayed fashion after initial traumatic injury.
We describe an unusual case of delayed pseudoaneurysm formation with subsequent erosion into the adjacent L1 vertebral body. This pseudoaneurysm was secondary to a gunshot wound with retained ballistic fragment that had occurred 27 years previously. Herein, we discuss the patient's presenting symptoms, imaging, and overall treatment. In this particular case, we used a combined surgical and endovascular (hybrid) approach after the patient experienced recurrent low back pain, weeks after a primary endovascular treatment was performed. We additionally review the current literature on the management of aortic pseudoaneurysms causing vertebral body erosion and back pain.
In our patient, a combined surgical and endovascular (hybrid) approach led to the complete resolution of his back pain symptoms and to complete exclusion of the pseudoaneurysm on follow-up imaging. Endovascular management of aortic pseudoaneurysms may be a reasonable alternative to open surgery in high-risk patients; however, this approach may result in a higher recurrence of pseudoaneurysm and initial presenting symptoms. Further investigation is needed to elucidate the efficacy of endovascular treatment of these lesions.
Abdominal aortic rupture and spondylodiscitis: Emergent Evar and staged spinal fixation
2014, Annals of Vascular Surgery
Concomitant aortic aneurismal pathology and vertebral erosion are seldom reported in literature. The differential diagnosis between a primary vertebral disease affecting the aortic wall and a primary aortic pathology causing a vertebral disruption is quite difficult. We report on a patient presenting with increasing lumbar pain and neurologic lower limbs deficit due to a vertebral erosion accompanied by aortic rupture treated by emergent endovascular aortic repair procedure and then staged vertebral fixation. Microbiological tests on intraoperative periaortic fluid collection samples showed no clear sign of infection and clinical conditions progressively improved. At 12-month follow-up, the patient is in good clinical condition, with a small residual walking impairment and no clinical, laboratory, or imaging sign of aortic endograft infection.
Chronic back pain as the first symptom in the rupture of an abdominal aortic aneurism: Presentation of 2 cases
2010, Reumatologia Clinica

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Case ReportSevere erosion of lumbar vertebral body because of a chronic ruptured abdominal aortic aneurysm

Abstract

Background context

Purpose

Study design

Method

Results

Conclusion

Introduction

Section snippets

Case report

Discussion

Vertebral mass resulting from a chronic-contained rupture of an abdominal aortic aneurysm repair graft

AJNR Am J Neuroradiol

Spinal destruction induced by chronic contained rupture of an abdominal aortic aneurysm: report of a case

Surg Today

Severe erosion of lumbar vertebral body because of abdominal aortic false aneurysm: report of two cases

Spine

Abdominal aortic aneurysm with lumbar vertebral erosion in Behcet's disease revealed by low back pain: a case report and review of the literature

Rheumatology (Oxford)

Case Report
Severe erosion of lumbar vertebral body because of a chronic ruptured abdominal aortic aneurysm