Lumbar vertebrae erosion due to an aortic aneurysm: multidisciplinary approach to surgical reconstruction (a case study and a non-systematic literature review)

Objective. To present a rare case of lumbar vertebral body erosion caused by an aortic pseudoaneurysm and to conduct a non-systematic literature review to determine diagnostic methods and treatment tactics. Material and Methods. The results of surgical treatment of a patient with contact erosion of the L2 and L3 vertebral bodies caused by a pseudoaneurysm of the abdominal aorta are presented. Surgical treatment was performed in two medical institutions in three stages: 1st – abdominal aortic replacement, 2nd – pedicle screw fixation, and 3rd – resection of the destroyed vertebral bodies with structural supporting fusion using titanium mesh. A search for publications on a combined (vascular and orthopedic) approach to treating such conditions was conducted in eLibrary and PubMed. Results. A favorable clinical and radiological outcome was achieved with a one-year postoperative follow-up period. Current trends in surgical reconstruction for thoracic and lumbar vertebral destruction due to aortic pseudoaneurysm are presented, including a description of the types of destruction, and the kind and stages of interventions. Conclusion. Surgically significant erosions (involving more than 30% of the vertebral body bone mass) caused by an aortic pseudoaneurysm are an extremely rare and require differential diagnosis including mandatory CT, CT angiography, and ultrasound Doppler imaging to distinguish them from tumor and inflammatory vertebral destruction. Staged surgical reconstruction minimizes the risk of complications and is performed in hospitals specializing in cardiovascular and musculoskeletal surgery. This intervention eliminated the risk of aneurysm rupture, alleviated its traumatic effect on the spine, achieved stable fixation, regressed pain, and restored the patient’s functional activity, preventing disability.