Management of major vascular injury during pedicle screw instrumentation of thoracolumbar spine

Clinical Neurology and Neurosurgery
Aleem K MirzaMohamad Bydon

Abstract

Vascular injury is a rare complication of spinal instrumentation. Presentation can vary from immediate hemorrhage to pseudoaneurysm formation. In the literature, surgical approach to repair has varied based on anatomy, acuity of diagnosis, infection, and available technology. In this manuscript, we aim to describe our institutional experience with vascular injuries in thoraco-lumbar spine surgery. We report our institutional experience of three cases of vascular injury secondary to pedicle screw misplacement and their management, as well as a review of the literature. The first case had a history of previous instrumentation and presented with back pain and fever. The patient was taken for instrumentation exploration via a posterior approach. Aortic violation was discovered at T6 intraoperatively during instrumentation removal and the patient underwent emergent endovascular repair. The second case presented with chronic back pain after multiple prior posterior fusions and CT angiogram showing screw perforation on the aorta at T10. The patient underwent elective endovascular repair with synchronous removal of the instrumentation. The third case presented with radicular leg pain 6 months after L4-S1 posterior lumbar interbody fusi...Continue Reading

Citations

Mar 29, 2019·Spine·Amir Abdul-JabbarJens R Chapman
May 20, 2020·JBJS Reviews·Shyam A PatelJeffrey A Rihn
May 16, 2019·European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society·Seung-Woo SuhDong-Gune Chang
Mar 24, 2020·Journal of Surgical Case Reports·Keith GeorgeRon Riesenburger
Mar 13, 2019·SAGE Open Medical Case Reports·Kajetan LatkaDariusz Latka
Aug 20, 2021·European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society·Alice Giotta LuciferoSabino Luzzi

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