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Malpositioned pedicle screw in spine deformity surgery endangering the aorta: report of two cases, review of literature, and proposed management algorithm.
- Source :
-
Spine deformity [Spine Deform] 2020 Aug; Vol. 8 (4), pp. 809-817. Date of Electronic Publication: 2020 Mar 13. - Publication Year :
- 2020
-
Abstract
- Study Design: Case reports and review of the literature with a proposed management algorithm.<br />Objectives: To report two cases of a potential vascular complication due to an incorrectly placed pedicle screw (PS) during spine deformity surgery. Relevant literature regarding the management of vascular complications is reviewed, and an evidence-based management algorithm is proposed. Aortic lesions represent a rare but potentially life-threatening complications with spine deformity and revision surgery, significantly increasing the risk. A management algorithm for an aortic lesion in the case of a malpositioned PS has not yet been published.<br />Methods: Case 1: An 18-year-old female with proximal thoracic spinal non-instrumented fusion underwent a revision corrective procedure due to a progressive right-sided thoracolumbar compensatory curve. However, postoperative computed tomography (CT) performed to evaluate the position of the PS revealed malposition of the left T9 PS, which was abutting the descending aorta with CT angiography excluding the perforation of the aorta. Case 2: A 17-year-old male was scheduled for correction of Lenke 3-C-N adolescent idiopathic scoliosis. Postoperative routine evaluation with low-dose CT revealed a left T9 PS paravertebral malposition, and subsequent CTA demonstrated that the thread of the PS was in contact with the descending thoracic aorta and an unlikely hemodynamically significant vessel injury.<br />Results: Successful removal of both malpositioned PS was performed. In the first case, a cardiovascular surgeon attended the operation if an urgent thoracotomy was needed, and in the second case, additional video-assisted thoracoscopic control of the aorta was performed during PS removal.<br />Conclusions: Preoperative imaging in spinal surgery is essential to avoid major vascular and other complications when placing PS, especially in thoracic deformities. When a potential major vessel complication emerges, an interdisciplinary approach and an appropriate management algorithm are mandatory to make the best clinical decisions.<br />Level of Evidence: 4.
- Subjects :
- Adolescent
Algorithms
Child
Device Removal methods
Female
Follow-Up Studies
Humans
Lumbar Vertebrae diagnostic imaging
Male
Postoperative Complications etiology
Reoperation
Scoliosis congenital
Scoliosis diagnostic imaging
Spinal Fusion methods
Surgery, Computer-Assisted
Thoracic Vertebrae diagnostic imaging
Tomography, X-Ray Computed
Treatment Outcome
Lumbar Vertebrae surgery
Pedicle Screws adverse effects
Postoperative Complications surgery
Scoliosis surgery
Spinal Fusion adverse effects
Spinal Fusion instrumentation
Thoracic Vertebrae surgery
Subjects
Details
- Language :
- English
- ISSN :
- 2212-1358
- Volume :
- 8
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Spine deformity
- Publication Type :
- Academic Journal
- Accession number :
- 32170660
- Full Text :
- https://doi.org/10.1007/s43390-020-00094-5