During L3–5 instrumented spinal surgery for degenerative spondylolisthesis in a 75-year-old woman, the right L-3 pedicle screw was accidentally pushed into the retroperitoneum and then migrated to the inferior vena cava (IVC). The patient was transferred to the surgical intensive care unit, and after careful discussion with cardiology specialists, a minimally invasive endovascular technique was used to remove the migrating pedicle screw within the IVC and thus salvage this critical case.
Pedicle screw instrumentation is an effective procedure, but not risk free. Every detail should be scrutinized during surgery, even instrument construction. A minimally invasive endovascular technique should be considered in this patient population.