# Paraplegia After Seat Belt Abdominal Aorta Occlusion Associated With L4 Chance Fracture

## TL;DR

A car accident caused a rare injury where a seat belt led to a blocked abdominal aorta and a spinal fracture, resulting in paraplegia.

## Contribution

This case highlights a rare association between abdominal aortic occlusion and L4 Chance fracture following blunt trauma.

## Key findings

- Blunt trauma from a seat belt caused aortic occlusion and L4 Chance fracture.
- Aortic atherosclerosis may have contributed to the occlusion above the fracture.
- Delayed treatment of aortic injury can lead to paraplegia and limb ischemia.

## Abstract

Blunt traumatic injury to the chest or abdomen can produce injury to the aorta, which can compromise perfusion to the lower spinal cord. This report presents the case of a seat belt-restrained driver who sustained blunt abdominal trauma and progressive paraplegia. The trauma produced an acute occlusion of the abdominal aorta associated with an L4 Chance fracture and multiple bowel injuries. The Chance fracture occurred two levels below the aortic occlusion. The significant aortic atherosclerosis changes in this patient could have triggered the complete occlusion two levels above the fracture. An aortic injury associated with a vertebral fracture represents a severe and potentially lethal condition. Lower limb ischemia in the setting of a blunt abdominal injury could lead to a high diagnostic suspicion of abdominal aortic injury. Treatment of the vascular injury should be performed without delay to prevent or reduce permanent neurological deficits and ischemic injuries.