Shoji Hirokazu, Sawakami Kimihiko, Tanaka Yuki, Ishikawa Seiichi, Segawa Hiroyuki, Wakabayashi Takashi
Departments of1Orthopedic Surgery and.
2Cardiovascular Surgery, Niigata City General Hospital, Niigata City, Japan.
J Neurosurg Case Lessons. 2022 Aug 1;4(5). doi: 10.3171/CASE2281.
This study aimed to report an aortic pseudoaneurysm, a rare but lethal complication, after a spinal fracture in ankylosing spine.
An 83-year-old obese woman presented with dementia and was nonambulatory after a fall. She was transported to the hospital, and imaging showed a hyperextension-type L1 fracture with diffuse idiopathic skeletal hyperostosis (DISH). After posterior fusion surgery using percutaneous pedicle screws, screw loosening was detected 10 days postoperatively. Fracture dislocation was reduced by changing to transdiscal screws and rodding while in the lateral position. However, the anterior opening persisted. Enhanced computed tomography performed at 6 weeks postoperatively showed a large aortic pseudoaneurysm extending into the vertebral fracture site without screw loosening. Neither endovascular aortic repair nor open surgery was applicable. The patient was transferred to a sanatorium and died of pneumonia 5 months postoperatively without aortic aneurysm rupture.
An aortic pseudoaneurysm can occur in hyperextension-type spinal fractures in DISH, even after fusion surgery, when the edge of the fracture is in contact with the aortic wall. The anterior opening dislocation should be reduced as much as possible.
本研究旨在报告强直性脊柱炎脊柱骨折后发生的一种罕见但致命的并发症——主动脉假性动脉瘤。
一名83岁肥胖女性，因跌倒后出现痴呆且无法行走。她被送往医院，影像学检查显示L1椎体有过伸型骨折并伴有弥漫性特发性骨肥厚（DISH）。在使用经皮椎弓根螺钉进行后路融合手术后，术后10天检测到螺钉松动。通过改为经椎间盘螺钉并在侧卧位时进行棒状固定来复位骨折脱位。然而，前方开口仍然存在。术后6周进行的增强计算机断层扫描显示一个大的主动脉假性动脉瘤延伸至椎体骨折部位，且无螺钉松动。血管腔内主动脉修复术和开放手术均不适用。患者被转至疗养院，术后5个月死于肺炎，主动脉瘤未破裂。
即使在融合手术后，当骨折边缘与主动脉壁接触时，DISH的过伸型脊柱骨折也可能发生主动脉假性动脉瘤。应尽可能减少前方开口脱位。
