What is the frequency of aortic dissection (tear in the aorta) caused by trauma to the spine or back?

From the Guidelines

Traumatic aortic dissection following spine or back trauma is rare, occurring in less than 1% of all cases of blunt trauma. Most aortic injuries from trauma result from high-energy impacts like motor vehicle accidents, falls from significant heights, or direct chest trauma rather than isolated back or spine injuries 1. When spine trauma does contribute to aortic dissection, it typically involves severe mechanisms such as hyperflexion-extension injuries or thoracic vertebral fractures that directly impact the adjacent descending thoracic aorta. The anatomical proximity of the thoracic aorta to the spine, particularly at the level of the ligamentum arteriosum, creates a vulnerable point where deceleration forces can cause shearing of the aortic wall.

Some key points to consider in the evaluation of traumatic aortic dissection include:

• The use of imaging studies like CT angiography to evaluate for potential aortic injury, particularly in patients with significant spine trauma in the thoracic region 1
• The importance of prompt recognition and treatment of aortic injuries, as mortality rates can be high if left untreated 1
• The role of pre-existing aortic conditions, such as atherosclerosis or connective tissue disorders, in increasing the risk of dissection even with less severe trauma 1
• The classification of aortic dissection into type A and type B, with type A involving the ascending aorta and/or arch, and type B involving the descending aorta or arch (distal to the L subclavian artery) 1

In terms of diagnosis and management, CT angiography is a highly sensitive and specific imaging modality for detecting traumatic aortic injury, with a negative predictive value approaching 100% 1. Patients with suspected aortic dissection should be evaluated promptly, and those with significant spine trauma in the thoracic region should be considered for imaging studies to rule out aortic injury.

From the Research

Frequency of Aortic Dissection Caused by Trauma to the Spine or Back

• The frequency of aortic dissection caused by trauma to the spine or back is not directly stated in the provided studies, but it can be inferred that trauma is a potential risk factor for aortic dissection 2.
• A study published in 2002 found that remote trauma was noted in two out of 10 patients with abdominal aortic dissection 2.
• However, the majority of the studies focus on the clinical manifestations, risk factors, and diagnosis of aortic dissection, rather than the specific cause of trauma to the spine or back.
• Aortic dissection is a rare but life-threatening condition, and its prompt and proper diagnosis is vital to increase a patient's chance of survival and to prevent grievous complications 3.
• The typical symptoms of acute aortic dissection include severe chest pain, hypotension or syncope, and back pain, which can mimic acute myocardial infarction or pulmonary embolism 3.

Risk Factors for Aortic Dissection

• Advanced age, male gender, long-term history of arterial hypertension, and the presence of aortic aneurysm confer the greatest population attributable risk for aortic dissection 3.
• Patients with genetic connective tissue disorders, such as Marfan, Loeys-Dietz, or Ehlers-Danlos syndrome, and patients with bicuspid aortic valves are at increased risk of aortic dissection at a much younger age 3.
• Hypertension is a common predisposing factor for aortic dissection, and it was present in 29 (58.0%) of 50 patients in one study 4.

Diagnosis of Aortic Dissection

• Imaging provides a robust foundation for diagnosing acute aortic dissection, as well as for monitoring patients at increased risk of aortic disease 3.
• Computed tomography (CT) is the most reliable tool for imaging diagnosis, and it was used to make the correct diagnosis in all cases in one study 4.
• Physicians should always suspect acute aortic dissection in patients with certain clinical conditions, such as difficult-to-control hypertension, giant cell arteritis, bicuspid aortic valve, intracranial aneurysms, simple renal cysts, family history of aortic disease, and Marfan syndrome, especially when a patient presents with ischemic symptoms involving multiple organs without an obvious cause 5.