Intraoperative pedicle screw migration to the abdominal cavity in a severe osteoporotic spine surgery

Study Design: A case report. Objective: To report a dangerous intraoperative complication of spinal instrumentation surgery. Summary of Background Data: Spinal instrumentation is indispensable for surgical treatment of degenerative spinal disorders. Revision surgeries in cases with severe osteoporosis involve high risks of intraoperative complications. Methods: We present a case of a 79-year-old female who underwent revision surgery for thoracolumbar deformity. She had a medical history of rheumatoid arthritis and severe osteoporosis due to long time steroid medication. In the pedicle screw replacement procedure, the implant fell into the abdominal cavity through the vertebrae, as confirmed by fluoroscopy. Results: An emergent surgical survey with intraoperative computed tomography revealed that the implant was buried in the abdominal wall. General surgeons performed abdominal surgery; ascending colon mesentery and ovarian vein injuries were repaired. The patient recovered without any permanent disorders and was discharged from the hospital on schedule. Conclusions: Although intraoperative pedicle screw drop into the abdominal cavity is rare, this complication could occur in cases with severe osteoporosis and a revision surgery accompanied by screw loosening. Therefore, preoperative detailed radiographic evaluation and meticulous attention during surgery are mandatory for treatment of patients with severe osteoporosis.