Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Neurological Surgery, Johns Hopkins Hospital, 600 North Wolfe Street, Meyer 5-109, Baltimore, MD, 21287, USA.
Neurosurg Rev. 2021 Dec;44(6):3189-3196. doi: 10.1007/s10143-021-01527-z. Epub 2021 Apr 14.
Aortic injury is a rare, yet underreported and underestimated complication of spine surgery. Anatomical relation between the aorta and the spine changes under physiological (positional) as well as pathological (deformity) conditions, which puts the aorta at risk of injury during spine surgery. Clinical presentation of aortic injury ranges from asymptomatic perforation of the aorta to acute fatal bleeding. Although several diagnostic methods have been reported, CT-angiography remains an important diagnostic study. Several advancements in the open and the endovascular surgical management have been reported to be successfully used in the management of aortic injury following spine surgery. Management approach of malpositioned screws abutting the aorta is still controversial. Anatomical knowledge and understanding of the previously reported mechanisms of aortic injury are important to be integrated in the preoperative planning process. If the complication occurs, time-to- recognition and to-appropriate-management are important factors for predicting mortality. If unrecognized and untreated in the acutely injured patients, mortality can approach 100%.
主动脉损伤是脊柱手术罕见但报道较少且被低估的并发症。主动脉与脊柱的解剖关系在生理（体位）和病理（畸形）条件下发生变化，这使得主动脉在脊柱手术过程中容易受伤。主动脉损伤的临床表现从无症状的主动脉穿孔到急性致命性出血不等。尽管已经报道了几种诊断方法，但 CT 血管造影仍然是一种重要的诊断研究。已经报道了几种开放和血管内手术管理方面的进展，这些进展已成功用于脊柱手术后主动脉损伤的管理。对于毗邻主动脉的错位螺钉的处理方法仍存在争议。了解主动脉损伤的解剖知识和先前报道的机制对于整合到术前规划过程中很重要。如果发生并发症，及时识别和适当处理是预测死亡率的重要因素。如果在急性损伤的患者中未被识别和未得到治疗，死亡率可接近 100%。
