Aseptic lysis L2–L3 as complication of abdominal aortic aneurysm repair
© The Author(s) 2014
Received: 28 July 2013
Accepted: 23 June 2014
Published: 15 July 2014
Osteolytic vertebral erosion is usually related to tumours, spondylitis or spondylodiscitis. Few reports in the literature describe lytic lesions of anterior lumbar vertebral bodies resulting from abdominal aortic aneurysm or false aneurysm. We report a case of abdominal aortic false aneurysm that caused lytic lesions of the second and third vertebral bodies in an 80-year-old man who underwent endovascular aneurysm repair. Fluoroscopy guided biopsy excluded infection or tumour. We performed a posterior spinal fusion and decompression because of bone loss of the second and third lumbar vertebral bodies and central stenosis. Postoperatively the patient showed satisfactory relief in low-back and thigh pain but, unfortunately, he died 1 month after surgery because of respiratory complications. This case suggests that when a lytic lesion of a lumbar vertebral body is discovered in a patient who has undergone endovascular aneurysm repair, an abdominal aortic false aneurysm may be the cause of the vertebral erosion even in cases without infective pathogenesis.
KeywordsContained aneurysm rupture Vertebral erosion False aneurysm Endovascular repair
Osteolytic vertebral erosion is usually related to tumour, spondylitis or spondylodiscitis. Vertebral erosion determined by an abdominal aortic aneurysm is rare but already described [1–5]. Very few cases of vertebral lesion caused by false aneurysm secondary to prosthetic stent have been reported [5–9], and this is the first case of vertebral erosion due to a false aneurysm in a patient who underwent endovascular aneurysm surgery in absence of disco-vertebral infection.
Osteolytic vertebral erosion is usually caused by neoplasms, spondylitis or spondylodiscitis. Some reports in the literature report that an abdominal aortic aneurysm can cause erosion of the lumbar vertebral body, due to a progressive aneurysmatic sac expansion [1–5]. Few authors [6, 7] have reported lumbar vertebral erosion resulting from abdominal aortic contained rupture aneurysm in patients surgically treated for an abdominal aortic aneurysm by a conventional open surgical repair. Other authors have reported vertebral lesions resulting from endovascular abdominal aneurysm repair complicated by an infection [8, 9]. To the best of our knowledge, this is the first report of a case in which an endovascular aneurysm repair (EVAR) for an abdominal aortic aneurysm was complicated by an abdominal aortic false aneurysm which caused severe erosion of two lumbar vertebral bodies and disc through an inflammatory mechanism, without signs of infective pathogenesis. It is possible to assume that, despite the endovascular procedure, the pseudo-aneurysmatic sac can cause an inflammatory stimulus that is erosive for the adjacent vertebrae and discs. Pre-existing osteopenia, frequently observed in old patients, can contribute to the development of the vertebral erosion.
If the patient is in good general condition, an anterior approach with the removal of the prosthesis  and L2–L3 decompression and fusion should be considered.
We assume that when a lytic lesion of a lumbar vertebral body or disc is discovered in a patient treated for an abdominal aortic aneurysm by endovascular repair, an abdominal aortic false aneurysm can be the cause of the vertebral or disc erosion even in cases without infective complication.
Conflict of interest
The authors declare that they have no conflict of interest.
The patient provided his consent to the publication of this case report.
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