Esophageal Injury From Thoracic Pedicle Screw Placement in a Polytrauma Patient

O’Brien, Joseph R.; Krushinski, Erik M.; Zarro, Christopher; Sciadini, Marcus F.; Gelb, Daniel E.; Ludwig, Steven C.

doi:10.1097/00005131-200607000-00012

Cited by 28 publications

(33 citation statements)

References 22 publications

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“…36,[39][40][41][42][43][44][45][46] Despite none of the perforations caused screw-related complications in this study, there were a grade 2 medial perforation which may result in neurologic complications and a grade 2 as well as a grade 3 ( Figure 3) anterior perforation which may risk injury to mediastinal visceral structures. O'Brien et al 47 had reported a case of oesophageal injury after instrumentation of the T3 vertebrae due to backward pressure from the endotracheal tube and trachea that pushed the oesophagus unto the tip of the anterior perforated screws. Belmont et al 39 had reported a higher incidence of anterior perforation from T1 to T4 vertebra compared to T5 to T12 with open pedicle screw placement.…”

Section: Discussionmentioning

confidence: 99%

The use of fluoroscopic guided percutaneous pedicle screws in the upper thoracic spine (T1–T6): Is it safe?

Kwan

Chiu

Chan

et al. 2017

J Orthop Surg (Hong Kong)

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Purpose: This study analysed the accuracy and safety of the fluoroscopic guided percutaneous screws in the upper thoracic vertebrae (T1-T6). Methods: Computed tomography scans from 74 patients were retrospectively evaluated between January 2008 and December 2012. Pedicle perforations were classified by two types of grading systems. For medial, lateral, superior and inferior perforations: grade 0 -no violation; grade 1 -<2 mm; grade 2 -2-4 mm and grade 3 ->4 mm. For anterior perforations: grade 0 -no violation; grade 1 -<4 mm; grade 2 -4-6 mm and grade 3 ->6 mm.Results: There were 35 (47.3%) male and 39 (52.7%) female patients with a total 260 thoracic pedicle screws (T1-T6) analysed. There were 32 screw perforations which account to a perforation rate of 12.3% (11.2% grade 1, 0.7% grade 2 and 0.4% grade 3). None led to pedicle screw-related complications. The perforation rate was highest at T1 (33.3%, all grade 1 perforations), followed by T6 (14.5%) and T4 (14.0%). Conclusion: Fluoroscopic guided percutaneous pedicle screws of the upper thoracic spine (T1-T6) are technically more demanding and carry potential risks of serious complications. Extra precautions need to be taken when fluoroscopic guided percutaneous pedicle screws are placed at T1 and T2 levels, due to high medial pedicular angulation and obstruction of lateral fluoroscopic images by the shoulder girdle and at T4-T6 levels, due to smaller pedicular width.

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Section: Discussionmentioning

confidence: 99%

The use of fluoroscopic guided percutaneous pedicle screws in the upper thoracic spine (T1–T6): Is it safe?

Kwan

Chiu

Chan

et al. 2017

J Orthop Surg (Hong Kong)

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“…15 -20 However, the esophagus also seems at risk of injury with anterior penetrated pedicle screw in the PT region. O'Brien et al 11 reported a case of esophageal injury secondary to anterior vertebral body perforation by TPS at T3 level. In our clinical practice, we also found that anterior wall penetration of the vertebral body poses high risk of injury to the esophagus in the PT curve.…”

Section: Discussionmentioning

confidence: 99%

“…O'Brien et al 11 reported a case of anterior cortical perforation by a pedicle screw at the T3 level causing esophageal injury. In our clinical practice, we also noticed that the esophagus is at a high risk of injury in cases of anterior cortical penetration in the PT region of AIS patients ( Figure 1 ).…”

mentioning

confidence: 99%

Different Proximal Thoracic Curve Patterns Have Different Relative Positions of Esophagus to Spine in Adolescent Idiopathic Scoliosis

Jiang

Mao²,

Zhao³

et al. 2012

Spine

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“…47 Although minor misplacement poses little risk of injury, a displacement greater than 4 mm is associated with a high risk of injury to vital structures depending on the instrumented level. 45 Nerve Root or Spinal Cord Injury. The overall incidence of nerve root or spinal cord injury is rare, ranging between 0.6% and 11%.…”

Section: Management Of Screw-related Complicationsmentioning

confidence: 99%

“…A too long pedicle screw in thoracic region may potentially injure the esopha- gus, the pleura, and the lung. O'Brien et al 45 reported a case of esophagus impingement from pedicle screws at T-3. Esophagoscopy showed a discrete area of attenuation of the mucosa but no perforation.…”

Section: Management Of Screw-related Complicationsmentioning

confidence: 99%

Clinically relevant complications related to pedicle screw placement in thoracolumbar surgery and their management: a literature review of 35,630 pedicle screws

Gautschi

Schatlo²,

Schaller³

et al. 2011

FOC

212

149

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Object The technique of pedicle screw insertion is a mainstay of spinal instrumentation. Some of its potential complications are clinically relevant and may require reoperation or further postoperative care. Methods A literature search was performed using MEDLINE (between 1999 and June 2011) for studies on pedicle screw placement in thoracolumbar surgery. The authors included randomized controlled trials, case-control studies, and case series (≥ 20 patients) from the English-, German-, and French-language literature. The authors assessed study type, the number of patients, the anatomical area, the number of pedicle screws, duration of follow-up, type of pedicle screw placement, incidence of complications, and type of complication. The management of specific complications is discussed. Results Thirty-nine articles with 46 patient groups were reviewed with a total of 35,630 pedicle screws. One study was a randomized controlled trial, 8 were case-control studies, and the remaining articles were case series. Dural lesions and irritation of nerve roots were reported in a mean of 0.18% and 0.19% per pedicle screws, respectively. Thirty-two patients in 10 studies (of 5654 patients from all 39 studies) required further revision surgeries for misplaced pedicle screws causing neurological problems. None of the analyzed studies reported vascular complications, and only 2 studies reported visceral complications of clinical significance. Conclusions Pedicle screw placement in the thoracolumbar region is a safe procedure with an overall high accuracy and a very low rate of clinically relevant complications.

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Esophageal Injury From Thoracic Pedicle Screw Placement in a Polytrauma Patient

Cited by 28 publications

References 22 publications

The use of fluoroscopic guided percutaneous pedicle screws in the upper thoracic spine (T1–T6): Is it safe?

The use of fluoroscopic guided percutaneous pedicle screws in the upper thoracic spine (T1–T6): Is it safe?

Different Proximal Thoracic Curve Patterns Have Different Relative Positions of Esophagus to Spine in Adolescent Idiopathic Scoliosis

Clinically relevant complications related to pedicle screw placement in thoracolumbar surgery and their management: a literature review of 35,630 pedicle screws

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