Pseudo-aneurysm of a lumbar artery after flexion-distraction injury of the thoraco-lumbar spine and surgical realignment: rupture treated by endovascular embolization.
METHODS
A unique case of pseudo-aneurysm of a lumbar artery after injury of the thoracolumbar spine was presented.


OBJECTIVE
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.


BACKGROUND
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.


METHODS
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.


RESULTS
Endovascular embolization achieved resolution of the pseudo-aneurysm, regression of the hematoma and progressive recovery of the patient during a period of 6 months.


CONCLUSIONS
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.
Domenicucci
Maurizio
M
Department of Neurosurgery, La Sapienza Rome University, Rome, Italy. alexramieri@libero.it
Ramieri
Alessandro
A
Lenzi
Jacopo
J
Fontana
Elena
E
Martini
Stefano
S
D000063:Accidents, Traffic; D000328:Adult; D017541:Aneurysm, False / Q000209:etiology / Q000601:surgery / Q000628:therapy; D001158:Arteries / Q000293:injuries; D004621:Embolization, Therapeutic; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy; D006801:Humans; D008159:Lumbar Vertebrae / Q000098:blood supply / Q000293:injuries; D008279:Magnetic Resonance Imaging; D008297:Male; D020127:Recovery of Function; D012421:Rupture; D016103:Spinal Fractures / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion; D013904:Thoracic Vertebrae / Q000098:blood supply / Q000293:injuries; D014057:Tomography, X-Ray Computed