Combined endovascular and neurosurgical approach to the removal of an intraaortic pedicle screw

Abstract

Iatrogenic aortic injuries are a potentially devastating complication of spine surgery. In instrumented cases, injuries may occur in the perioperative period due to iatrogenic vessel injury, or they may occur years later as prominent implants erode or penetrate major vessels. The authors present a case of a 71-year-old man in whom a thoracic pedicle screw was found perforating the thoracic aorta during routine follow-up 6 months after surgery. Due to the risk of future complications, the screw was removed while simultaneously delivering an endovascular aortic stent to gain vascular control. Surgical considerations and potential technical limitations are discussed.

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

“…Though it has been suggested that the pedicle screw may be a nidus for thrombus formation and subsequent embolism, this has never been reported in the literature. 13 In other cases, as in our case, there is a gradual shifting of the pedicle screw toward a vessel, and penetration happens and worsens over time. 12 In most of these cases, the misaligned screw is discovered incidentally.…”

“…The most common presenting symptom is atypical back pain, though most patients are asymptomatic. Though it has been suggested that the pedicle screw may be a nidus for thrombus formation and subsequent embolism, this has never been reported in the literature …”

Delayed Presentation of Aortic Injury by a Thoracic Pedicle Screw

“…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.…”

Current concepts and controversies on adolescent idiopathic scoliosis: Part II

“…A medial breach, reported from 1.7-14%, may lead to dural leaks and/or neurological injury, especially when this occurs at the levels of the spinal cord (1.2-3%) 20214344. A lateral or anterior vertebral penetration may result in acute or delayed perforation of the aorta, inferior vena cava, iliac vessels, lumbar arteries, esophagus, lungs, ureter, and bowels 35454647484950515253. The risk of visceral and neural injury is highest from T4 to T7 because the pedicle channels are narrowest across these levels.…”