Aortic aneurysm complicated with pyogenic spondylitis following vertebroplasty.
Percutaneous vertebroplasty is a commonly used procedure for the treatment of painful vertebral fractures induced by osteoporosis or metastatic disease. It is generally considered to be safe and effective. However, infectious complications can be serious. We present a patient in whom pyogenic spondylitis developed 3 months after vertebroplasty. During the debridement, profuse bleeding was encountered from injury to the aorta and the patient was managed with primary closure. Two months after the initial surgery, an aortic aneurysm was detected. A wide resection of all infected tissue, including the bony lesion and aortic aneurysm was performed, and the descending thoracic aorta was replaced with a vascular graft. A titanium mesh cage filled with bone graft was employed for anterior reconstruction. Our patient illustrates that a life-threatening aortic aneurysm can indeed occur as an infectious complication of this minimally invasive procedure due to the proximity of the aorta to the thoracolumbar vertebra. The spine surgeon should be aware of the possibility of aortic wall erosion caused by long-standing spondylitis, and be prepared to manage an inadvertent injury to the aorta during surgical debridement.
Kwak
Hyung-Jun
HJ
Department of Neurosurgery, Chonnam National University Hospital, 8 Hak-Dong, Gwangju, 501-757, South Korea.
Lee
Jung-Kil
JK
Kim
Yeon-Seong
YS
Moon
Kyung-Sub
KS
Joo
Sung-Pil
SP
Kim
Jae-Hyoo
JH
Kim
Soo-Han
SH
Chang
Won-Chae
WC
D001014:Aortic Aneurysm / Q000209:etiology*; D050815:Fractures, Compression / Q000601:surgery; D006801:Humans; D016268:Internal Fixators / Q000009:adverse effects*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D013166:Spondylitis / Q000209:etiology*; D013530:Surgical Wound Infection / Q000209:etiology*