Thoracic aortic injury as a complication of spinal surgery: A new case and systematic review (1991-2024).

BACKGROUND

Iatrogenic thoracic aortic injury (TAI) is a rare but well-recognized complication of spine surgery, lacking standardized treatment guidelines due to its rarity and variability of manifestations.

METHODS

We present a new case of TAI successfully managed with endovascular repair and systematically reviewed 52 articles (1991-2024) reporting 64 cases, including demographics, surgical indications, injury patterns, and treatments.

RESULTS

A 53-year-old man with a T7 fracture underwent posterior spinal instrumentation and developed chest pain due to a combination of impingement and screw penetration into the thoracic aorta and was treated with thoracic endovascular aortic repair (TEVAR) and removal of pedicle screws. The review (n = 64; mean age, 50 years; 48% male and 48% female) identified vertebral fractures (42.2%), spinal deformities (31.3%), and posterior approaches (70%) as predominant risk factors. Injuries included thoracic aorta penetration (53%), impingement (21.9%), combined injuries (21.9%), and other rare events (3.2%), with median diagnosis at 31 to 34 months. Treatments comprised TEVAR (51.6%), open repair (31.3%), and conservative management (17.2%). Posterior approaches significantly increased injury risk (P < .001).

CONCLUSIONS

TAI often presents late, requiring surveillance. TEVAR is effective, although open repair remains vital in select cases. This review informs management strategies for this rare complication.