Vertebral body erosion by a chronic contained rupture of thoracoabdominal aortic aneurysm: systematic review and spine surgical recommendations

Background: Vertebral body erosion (VBE) is commonly caused by neoplastic, inflammatory, or infectious diseases: it can be rarely associated with aortic wall disorders, such as chronic contained rupture of aortic aneurysm (CCR-AA). CCR-AA is a rare event comprising <5% of all reported cases. This condition is easily undiagnosed, differential diagnosis may be challenging, and there is no consensus or recommendation that dictates guidance on management of spinal surgical treatment. Methods: We performed a systematic review of the literature of all cases of VBE secondary to CCR-AA to identify clinical, radiologic, and surgical outcome characteristics with the aim of providing a basis for future research studies. Results: The search returned 80 patients. All reported patients had a history of hypertension. In almost all patients, the AA size reported was high (mean diameter, 7.056 cm). The treatment of this condition involves various reported treatment strategies: a totally conservative approach, treatment of the aortic aneurysm through a minimally invasive endovascular procedure, or an open surgery and combined approach. Despite the wide variability in therapeutic strategy, the rate of good outcomes was relatively high at 80%. Conclusions: Back pain and pain along the vertebral column are such frequent symptoms that unusual causes or serious and life-threatening complications may be overlooked. In addition to the common traumatic and degenerative causes of back pain, AA must also be considered. A combined approach between vascular and spine surgery could be achieved without any increased risk.