Vertebral Body Erosion in Geriatric Patient : Case Reports and Systematic Review of Literature

Vertebral body erosion has been rarely reported in the literature. We present two geriatric patients with chronic back pain who has vertebral erosion associated with aortic aneurysm, accompanied with literature review.


Introduction
Vertebral body erosion is a rare vertebral pathology and often detected incidentally.Our aim is to present two geriatric patients with chronic back pain who has vertebral erosion associated with aortic aneurysm.

Case History
Case 1: A 71-year-old man with low back pain for more than a year, cortical erosion and vertebral cyst formation of L4 vertebral body were diagnosed on lumbar MRI.There was no compression fracture or bone marrow edema.The fusiform unruptured aneurysmatic dilatation of abdominal aorta was seen adjacent to the vertebral cyst (Figure 1 and Figure 2).The vertebral cyst was thought to be associated with abdominal aortic aneurysm (AAA).The aortic wall defect or paraaortic hematoma was not established.After the diagnosis of AAA associated with vertebral cyst, the patient was referred to cardiovascular surgery.

Case 2:
A 80-year-old man was under follow up assessments due to deteriorated general health status af- aneurysm, we have found that total of 32 cases by since 2000 (Table 1).This corresponds approximately to two cases per year.Among aortic aneurysms causing vertebral erosion, the most commonly defined type is chronic contained ruptured abdominal aortic aneurysm (CCAA), it has irregular posterior aortic wall and chronic stage hematoma with frequently associated with vertebral erosion [1].Vertebral erosion is caused by the mass and pulsation effect of aneurysm and retroperitoneal hematoma can also lead to vertebral erosion [2].Because of high risk of rupture, CCAA necessities surgical intervention.Vertebral erosion associated with aneurysm may cause low back pain.For this reason, there is a risk of misdiagnosis and hazard of delayed diagnosis.In the literature, 16 CCAA [2-17], 7 aortic aneurysms [18][19][20][21] and 1 pseudoaneurysm [19] were defined.Vertebral erosions associated with false aneurysm at prosthetic graft junction in three patients [22,23], and one patient with widespread vertebral lysis with Coxiella burnetti infection related with vascular surgery was also reported in the literature [24].Furthermore, vertebral erosion associated with aortic aneurysms occurred in the course of Behçet's disease were present [25][26][27][28].The most commonly affected vertebra is third lumbar vertebra (L3) and L4, L2, L1 vertebra in descending order.

Conclusion
Vertebral body erosion is a rare pathology in geriatric patient with back pain, associated with aneurysm and infections.

Conflict of Interest
None.

Discussion
Vertebral erosion is generally associated with tumor or infection.Aortic aneurysm also rarely causes vertebral erosion.In the systematic review of Pubmed and Google scholar for vertebral erosion associated with aortic

Table 1:
In the systematic review of Pubmed and Google scholar for vertebral erosion caused by aortic aneurysm .

Figure 2 :
Figure 2: Axial T2W FSE lumbar MRI image: The vertebral cyst (long arrow) is seen adjacent to the aortic aneurysm (arrowhead).

Figure 3 :
Figure 3: A 80-year-old man, operated abdominal aortic aneurysm.Sagittal reformate CT image: Aortic aneurysm with diameter of 85 mm and erosion at the anterior corpus of the adjacent vertebra (L2) is seen (long arrow).

Figure 4 :
Figure 4: Axial CT image shows that chronic contained ruptured aneurysm with bilateral paravertebral hematomas (arrow heads) and also cortical erosion (long arrow) on the contact surface of this vertebras.