Aortic Dissection Associated with Penetration of a Spinal Pedicle Screw: A Case Report and Review of the Literature

Abstract

A 30-year-old male underwent a corrective posterior instrumented spinal fusion for scoliosis. Six years later, he was found to have an aortic dissection after aortic penetration of a spinal pedicle screw. We review the literature, including diagnostic modalities, and treatment decision-making for this unusual complication.

Right mainstem bronchoplasty 18 years following thoracic spinal implant surgery

“…The most commonly affected is the right bronchus followed by the left bronchus in 30–40% and the trachea in 5–10% of cases. In our case the presence of the foreign body in the right main stem bronchus depended on location of the spinal implant and its contact with the right main bronchus[ [2] , [3] , [4] , [5] , [6] ]. When a foreign body is aspirated into the airway and remains for more than 30 days, airway remodeling, thickening of the bronchial wall, cartilage damage and fibrosis occurs.…”

Delayed Presentation of Aortic Injury by a Thoracic Pedicle Screw

“…In several cases, repair was performed with the use of cardiopulmonary bypass for distal aortic perfusion and protection of visceral organs during aortic cross-clamping. 43,47,48 Removal of the pedicle screw and cessation of the bleeding with direct pressure was also reported similar to the process of removing an angiogram sheath from the femoral artery. 46 Endovascular stent grafting is increasingly used to treat post-traumatic pseudoaneurysms and also other aortic pathologies with results comparable with open repair.…”

“…The incidence of late presentation is much lower. So far, 38 cases of delayed (≥30 days) presentation of aortic injury by pedicle screws have been reported in the English literature . Table summarizes the presentations and clinical characteristics of these patients.…”

“…Aortic injury can be repaired by primary closure, patch angioplasty, graft interposition with open thoracotomy, or an endovascular approach depending on the experience of the surgical team and the existing facility repair options, location and extent of the defect. In several cases, repair was performed with the use of cardiopulmonary bypass for distal aortic perfusion and protection of visceral organs during aortic cross‐clamping . Removal of the pedicle screw and cessation of the bleeding with direct pressure was also reported similar to the process of removing an angiogram sheath from the femoral artery…”

Unusual Management of Thoracic Aortic Injury After Spinal Instrumentation: Just Glue It!

“…hardware is removed and replaced [4,5]. For asymptomatic patients, a multidisciplinary approach with revision of spinal fixation and aorta repair has been reported, as has primary repair of the vascular injury [1].…”