Upper abdominal aortic injury during spinal surgery

Smythe, W. Roy; Carpenter, Jeffrey P.

doi:10.1016/s0741-5214(97)70310-0

Cited by 34 publications

(15 citation statements)

References 10 publications

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“…Intraoperative vascular injuries are most commonly documented in association with lumbar discectomy procedures; 1,5,6,8,22,25 however, aortic injuries from pedicle screw placement have been reported. 27 In these cases, the return of pulsatile, bright red blood from the cannulated pedicle and associated hypotension should trigger immediate intervention. In some cases, hemorrhages may not be detected intraoperatively because the injury site is sealed by instrumentation.…”

Section: Discussionmentioning

confidence: 99%

“…13,20,22 Spinal instrumentation has been associated with major vascular complications resulting in both early intraoperative and late secondary vascular injuries. 10,11,16,20,27,29,31 Secondary injuries may occur due to direct penetration of the implant or by chronic erosion due to the arterial wall pulsating against the instrumentation, and have been seen up to 7 years after instrumentation placement. 14 Thus, if instrumentation is abutting or penetrating a major vascular structure, consideration of implant removal and potential vascular repair must occur, even in asymptomatic patients in whom this is discovered on routine follow-up.…”

mentioning

confidence: 99%

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

Clarke

Guzzo

Wolinsky

et al. 2011

SPI

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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.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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

Clarke

Guzzo

Wolinsky

et al. 2011

SPI

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“…If such a delayed aortic injury is suspected, a CT scan with intravenous contrast or aortographic scan is recommended. 21 Another case of severe intrathoracic screwrelated complication has been described, but in the treatment of a vertebral fracture 18 : a fatal cardiac tamponade occurred (caused by a prick injury of the right coronary artery) due to a Kirschner wire during thoracic instru- mentation for a T11 burst fracture. Pleural effusion with fever occurred in one patient in our series: a left T5 screw was lateral and inside the thoracic cavity ( Figure 2).…”

Section: Discussionmentioning

confidence: 99%

Complications of Thoracic Pedicle Screws in Scoliosis Treatment

Silvestre

Parisini

Lolli

et al. 2007

Spine

232

171

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“…In the series of severe scoliosis treated with thoracic pedicle screws [14,27], as also in our series, no complications caused by intra-thoracic screws have been reported. However, when screws are in proximity of the thoracic aorta's wall (less than 5 mm) there is the risk of a subsequent vascular lesion, and a CT scan with intravenous contrast or an aortograph is recommended before the removal of the screw [47].…”

Section: Discussionmentioning

confidence: 99%

Posterior fusion only for thoracic adolescent idiopathic scoliosis of more than 80°: pedicle screws versus hybrid instrumentation

et al. 2008

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The treatment of thoracic adolescent idiopathic scoliosis (AIS) of more than 80°traditionally consisted of a combined procedure, an anterior release performed through an open thoracotomy followed by a posterior fusion. Recently, some studies have reassessed the role of posterior fusion only as treatment for severe thoracic AIS; the correction rate of the thoracic curves was comparable to most series of combined anterior and posterior surgery, with shorter surgery time and without the negative effect on pulmonary function of anterior transthoracic exposure. Compared with other studies published so far on the use of posterior fusion alone for severe thoracic AIS, the present study examines a larger group of patients (52 cases) reviewed at a longer follow-up (average 6.7 years, range 4.5-8.5 years). The aim of the study was to evaluate the clinical and radiographic outcome of surgical treatment for severe thoracic ([80°) AIS treated with posterior spinal fusion alone, and compare comprehensively the results of posterior fusion with a hybrid construct (proximal hooks and distal pedicle screws) versus a pedicle screw instrumentation. All patients (n = 52) with main thoracic AIS curves greater than 80°(Lenke type 1, 2, 3, and 4), surgically treated between 1996 and 2000 at one institution, by posterior spinal fusion either with hybrid instrumentation (PSF-H group; n = 27 patients), or with pedicle screw-only construct (PSF-S group; n = 25 patients) were reviewed. There were no differences between the two groups in terms of age, Risser's sign, Cobb preoperative main thoracic (MT) curve magnitude (PSF-H: 92°vs. PSF-S: 88°), or flexibility on bending films (PSF-H: 27% vs. PSF-S: 25%). Statistical analysis was performed using the t test (paired and unpaired), Wilcoxon test for nonparametric paired analysis, and the Mann-Whitney test for non-parametric unpaired analysis. At the last follow-up, the PSF-S group, when compared to the PSF-H group had a final MT correction rate of 52.4 versus 44.52% (P = 0.001), with a loss of -1.9°versus -11.3°( P = 0.0005), a TL/L correction of 50 versus 43% (ns), a greater correction of the lowest instrumented vertebra translation (-1.00 vs. -0.54 cm; P = 0.04), and tilt (-19°vs. -10°; P = 0.005) on the coronal plane. There were no statistically significant differences in sagittal and global coronal alignment between the two groups (C7-S1 offset: PSF-H = 0.5 cm vs. PSF-S = 0 cm). In the hybrid series (27 patients) surgery-related complications necessitated three revision surgeries, whereas in the screw group (25 patients) one revision surgery was performed. No neurological complications or deep wound infection occurred in this series. In conclusion, posterior spinal fusion for severe thoracic AIS with pedicle screws only, when compared to hybrid construct, allowed a greater coronal correction of both main thoracic and secondary lumbar curves, less loss of the postoperative correction achieved, and fewer revision surgeries. Posterior-only fusion with pedicle screws enabled a good and...

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Upper abdominal aortic injury during spinal surgery

Cited by 34 publications

References 10 publications

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

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

Complications of Thoracic Pedicle Screws in Scoliosis Treatment

Posterior fusion only for thoracic adolescent idiopathic scoliosis of more than 80°: pedicle screws versus hybrid instrumentation

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