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

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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.

Article Information

Current affiliation for Dr. Clarke: Department of Neurologic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota.

Address correspondence to: Jean-Paul Wolinsky, M.D., Department of Neurosurgery, Johns Hopkins School of Medicine, 600 Wolfe Street, Meyer 5-109, Baltimore, Maryland 21231. email: jwolins3@jhmi.edu.

Please include this information when citing this paper: published online August 5, 2011; DOI: 10.3171/2011.7.SPINE10267.

© AANS, except where prohibited by US copyright law.

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Figures

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    Axial (left) and sagittal (right) reconstructed CT images showing a malpositioned right T-6 screw penetrating the aortic lumen.

  • View in gallery

    Left: Intraoperative fluoroscopic image of the positioned stent immediately prior to deposit. To ensure that the screw could be removed, it has been backed out slightly in preparation for delivery. Right: Immediately after stent delivery and replacement of the screw, no contrast extravasation is seen.

  • View in gallery

    Postoperative reconstructed CT scan demonstrating the relationship between the aortic stent and construct. Note that the upper right screw is not attached to the construct.

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