Walk like an Egyptian
=====================

* Gajen Sunthar Kanaganayagam
* Thomas Ember
* Rachel E Bell
* Peter R Taylor

Vertebral stabilisation is common following trauma, tumour or infective processes. Here we show images of vertebral erosion due to a thoracoabdominal aortic aneurysm (TAAA).

A 67-year-old Egyptian man presented with a 2-year history of back pain, worse over the past 3 months, and found that standing or walking exacerbated the pain and caused a dull ache in both legs. On examination he had a large expansile mass in the abdomen but no positive neurological findings. A CT scan showed a 9.9×9.8 cm Crawford type III TAAA (see fig 1A,B) with vertebral erosion at T12 and L1. He went on to have an open repair of his TAAA and was readmitted 6 weeks later for posterior instrumentation from T9 to T11 and L2 to L3. Postoperative images can be seen in fig 2.

![Figure 1](http://casereports.bmj.com/https://casereports.bmj.com/content/casereports/2009/bcr.10.2008.1051/F1.medium.gif)

[Figure 1](http://casereports.bmj.com/content/2009/bcr.10.2008.1051/F1)

Figure 1 
CT scan with contrast showing thoracoabdominal aortic aneurysm and vertebral erosion. Transverse plane through L1 (A) and sagittal planes (B).

![Figure 2](http://casereports.bmj.com/https://casereports.bmj.com/content/casereports/2009/bcr.10.2008.1051/F2.medium.gif)

[Figure 2](http://casereports.bmj.com/content/2009/bcr.10.2008.1051/F2)

Figure 2 
Postoperative pictures. There are bilateral transpedicular screws through T9–T11 and L2–L3 with interconnecting spinal rods. There is anterior scalloping of the T12, L1 and L2 vertebral bodies. Vertebral alignment is maintained. There is also evidence of mild degenerative disease with mild loss of disc height at L5/S1.

Vertebral erosion secondary to an aortic aneurysm is well known.1,2 However, the majority of cases of vertebral erosion are associated with mycotic aneurysms and subsequent vertebral osteomyelitis. This patient required open surgery, however some patients can be treated successfully with endoluminal stent grafts.3 In this patient the long history of back pain suggests that continued expansion of the aneurysm was the cause for the erosion of the vertebrae. No organism was grown from the aneurysm thrombus sent for microbiology.

## Footnotes

*   **Competing interests:** none.

*   **Patient consent:** Patient/guardian consent was obtained for publication.

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