Aortic injury in spine surgery……What a spine surgeon needs to know

Alomari, Safwan; Planchard, Ryan; Lo, Sheng Fu L.; Witham, Timothy F.; Bydon, Ali

doi:10.1007/s10143-021-01527-z

Cited by 3 publications

(1 citation statement)

References 78 publications

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“…The delayed vascular sequelae of pedicle screw malpositioning or anterior cortical prominence represent a critical and likely underreported complication of thoracolumbar fusion surgery. 17 This case demonstrates that a long pedicle screw placed without intraoperative aortic injury is capable of eroding through the aortic wall with time. Increased clinical suspicion for pedicle screw aortic injury is warranted in patients undergoing spinal fusion for scoliotic deformity due to spinal aortic tethering, increased aortic mobility, and unpredictable pedicle screw trajectories.…”

Section: Discussionmentioning

confidence: 83%

Delayed open treatment of aortic penetration by a thoracic pedicle screw: illustrative case

Levy

Pinter

Hobson

et al. 2023

Journal of Neurosurgery: Case Lessons

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BACKGROUND Iatrogenic aortic injury from pedicle screw malpositioning or anterior prominence in posterior spinal fusion represents a rare but potentially devasting complication. While intraoperative aortic injury is associated with hemodynamic instability, delayed presentations of pedicle screw aortic impingement or violation often present insidiously with pseudoaneurysm or vascular remodeling in clinically asymptomatic patients. Currently, there is a lack of guidance in the field for the recommended surveillance, urgency of operative intervention, and optimal surgical management of delayed pedicle screw aortic injuries. OBSERVATIONS The following case study discusses the open treatment of delayed thoracic aortic penetration from an excessively long T12 pedicle screw in an asymptomatic adolescent patient with idiopathic scoliosis. The pedicle screw prominence anteriorly was corrected by burring the screw tip until it was flush with the vertebral body. The associated aortic injury was addressed with open vascular repair via primary anastomosis supplemented with a bovine pericardial patch. LESSONS Complete aortic wall penetration from an excessively long thoracic pedicle screw with otherwise stable screw positioning may be addressed most effectively with a single anterior surgical approach for open aortic repair and screw tip burring.

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Section: Discussionmentioning

confidence: 83%

Delayed open treatment of aortic penetration by a thoracic pedicle screw: illustrative case

Levy

Pinter

Hobson

et al. 2023

Journal of Neurosurgery: Case Lessons

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Extracorporeal circulation through peripheral vascular successful rescue Abdominal Aortic Iatrogenic Injury During Total en bloc Spondylectomy for L4 Ewing’s sarcoma: A Case Report

Qiao

Bai

et al. 2023

Preprint

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Introduction: Abdominal aortic iatrogenic injury can result in massive hemorrhage and is a potentially fatal complication of total en-bloc spondylectomy surgery (TES) for primary malignant spinal tumors (PMST). Currently, there is no definite management for this complication. We report a case of a patient with abdominal aorta iatrogenic injury at the intervertebral disc of lumbar 3 (L3) to lumbar 4 (L4) level during TES performed via a posterior approach. Fortunately, our patient had a good outcome with prompt intervention. Patient concerns: A 16-year-old male was admitted to our department with a chief complaint of low lumbar pain, especially pain at night, since the past 6 months. Diagnosis: PMST at L4 (Ewing's sarcoma) with abdominal aorta iatrogenic injury at the L3 − L4 level that occurred during TES that was performed via a posterior approach. Interventions and outcomes: Multi-disciplinary treatment (MDT), including extracorporeal circulation (ECC) through the peripheral vasculature, was immediately performed to allow for the suturing of the abdominal aortic injury. After the abdominal aorta iatrogenic injury repair, the patient’s hemodynamic parameters stabilized. Two weeks later, TES was reattempted and successfully performed for L4 PMST. Conclusion Intraoperative vascular injury during posterior TES is rare; however, it cannot be avoided with surety since the anterior vertebral manipulation during TES is performed blindly. This complication is often lethal and not diagnosed. Consequently, surgeons must have a wide knowledge of the lumbar spine anatomy and its surrounding structures and conduct a detailed preoperative radiological assessment of the tumor and its surrounding structure. Furthermore, the surgeon should be aware of the risk of vascular injury and familiar with its clinical characteristics for prompt and effective diagnosis and intervention once an injury is suspected to avoid serious consequences. For abdominal aortic injury, the immediate establishment of ECC through peripheral vasculature to suture the vascular laceration may be a quick, safe, and effective management.

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Surgical Removal of Anterior Dislocated Cage to Fix Inferior Vena Cava Stenosis

Teshima

Koga

2022

Jpn J Phlebol

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Aortic injury in spine surgery……What a spine surgeon needs to know

Cited by 3 publications

References 78 publications

Delayed open treatment of aortic penetration by a thoracic pedicle screw: illustrative case

Delayed open treatment of aortic penetration by a thoracic pedicle screw: illustrative case

Extracorporeal circulation through peripheral vascular successful rescue Abdominal Aortic Iatrogenic Injury During Total en bloc Spondylectomy for L4 Ewing’s sarcoma: A Case Report

Surgical Removal of Anterior Dislocated Cage to Fix Inferior Vena Cava Stenosis

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