Hybrid TEVAR and REBOA procedures prior to fracture reduction and fixation in a displaced C-type thoracic spine fracture with bony contact to the aorta - A case report.

Introduction and importance: Spinal injuries, particularly C-type fractures, are common in polytrauma patients. Surgical priorities are strongly influenced by the severity of concomitant injuries and cardiopulmonary stability. Sagitally displaced C-type fractures are associated with risks such as increased blood loss from damaged vessels and the potential for aortic rupture. Case presentation: This report describes a successful case of a 50-year-old male with a severe Th9 translational C-type spinal injury sustained in a motor vehicle accident. The patient presented with bilateral leg paresis and was hemodynamically stable. CT revealed direct contact to the aorta. A combined surgical strategy was used, including TEVAR for aortic protection and REBOA for hemorrhage control via the popliteal artery before surgical realignment and stabilization of the spine. Discussion: This case demonstrates a novel and safe approach combining TEVAR and REBOA to manage high-risk thoracic C-type spine fractures with direct aortic contact. This allows surgical teams to achieve spinal realignment while minimizing the risk of catastrophic aortic injury. The utilization of popliteal artery access facilitates concurrent vascular and spinal intervention in the prone position. Conclusions: Hybrid REBOA and TEVAR offers a safe strategy for managing severely displaced thoracic spinal C-type injuries if the aorta is injured or is at significant risk of secondary rupture i.e. during the repositioning maneuver. Utilizing the popliteal artery for vascular access allows for simultaneous spinal and minimally invasive vascular surgery. Level of evidence: Level V - Single case report.