Acute aortic dissection or ruptured aortic aneurysm associated with back pain and paraplegia

Acute aortic dissection and a ruptured aortic aneurysm are both catastrophic events that usually present suddenly. Although these conditions are relatively uncommon compared to other diseases treated by the orthopedists as a primary practitioner, they are of primary importance. The purpose of this study was to investigate the key points that differentiate these conditions from spinal disease. A review of 50 patients with aortic dissection (n=40) or a ruptured aortic aneurysm (n=10) was performed to determine the manifestations (eg, back pain and paraplegia). We also evaluated the predisposing factor and blood pressure on admission and reviewed clinical imaging (radiographs, computed tomography [CT]) retrospectively. Sudden severe isolated back pain was observed in 18 (45.0%) of 40 patients, and 31 (77.5%) of 40 patients had at least some back pain in aortic dissection, while 1 patient had sudden paraplegia with a ruptured aortic aneurysm. Hypertension was the most predisposing factor and was present in 29 (58.0%) of 50 patients. On admission, hypertension was present in 26 (56.5%) of 46 patients, and hypotension was present in 14 (30.4%) of 46 patients. In all cases, the correct diagnosis was made based on CT. For a patient with an abrupt onset of severe back pain, acute aortic dissection and a ruptured aortic aneurysm should be considered in the differential diagnosis from spinal disease. The most reliable tool for imaging diagnosis was CT.