Case ReportUnstable thoracic spine fracture with aortic encroachment: A potentially fatal association and a suggested treatment

•The association of unstable spinal fractures and pending aortic injuries is a therapeutic dilemma.•Inappropriate treatment can lead to catastrophic consequences.•A multidisciplinary, case-by-case evaluation is mandatory.•Vascular lesions must be treated first.•We suggest “best but safest” procedure sequence: endovascular aortic repair and then posterior spinal cord reconstruction.

BackgroundThe coexistence of an unstable spinal fracture with a pending aortic lesion is potentially catastrophic and a therapeutic challenge as to timing of treatment, assigning priorities and selecting the best approach.Case reportA 41 year-old healthy male victim of bike accident. Imaging revealed a fracture of 6th and 7th thoracic vertebrae with a bone fragment in close proximity to the descending thoracic aorta. After consultation with spine/vascular surgeons and interventional radiologists it was decided to secure the potential aortic injury with an endovascular stent-graft followed by posterior vertebral instrumentation for fracture's reduction.Discussion/conclusionA multi-specialists teamwork approach is mandatory. Vascular lesion is priority, followed by vertebral surgery. As to the treatment options, we suggest a “best but still safest” philosophy: endovascular repair and posterior spinal instrumentation should be considered first in the acute stage.