Malpositioned pedicle screw in spine deformity surgery endangering the aorta: report of two cases, review of literature, and proposed management algorithm

Valič, Matej; Žižek, David; Špan, Matjaž; Mihalič, René; Mohar, Janez

doi:10.1007/s43390-020-00094-5

Cited by 9 publications

(5 citation statements)

References 51 publications

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“…[9] In a recent report on two cases, successful removal of malpositioned pedicle screws was performed in two patients with aortic lesions without using vascular grafts. [10] In the presented case, we operated on the patient in the lateral decubitus position instead of the prone position. Therefore, we considered it appropriate to use a laminar hook instead of using revision screws after removal of the lateralized screws.…”

Section: Discussionmentioning

confidence: 99%

Unexpected localization of a thoracic pedicle screw nearby the aorta after scoliosis surgery

Başak

Ege

Yıldırım

et al. 2022

Jt Dis Relat Surg Case Rep

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Section: Discussionmentioning

confidence: 99%

Unexpected localization of a thoracic pedicle screw nearby the aorta after scoliosis surgery

Başak

Ege

Yıldırım

et al. 2022

Jt Dis Relat Surg Case Rep

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“…2 ). Although the vascular complication is rare, the consequence may be quite devastating [ 13 – 16 ].…”

Section: Discussionmentioning

confidence: 99%

Different angular kyphosis locations have different relative positions of aorta to spine in patients with Pott’s deformity

Liao

Gao

et al. 2022

BMC Musculoskelet Disord

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Background The position of the aorta relative to the spine in kyphosis secondary to Pott's deformity is little understood. The purpose of this study was to investigate the anatomic relationship between the aorta and the spine in patients with Pott’s deformity and to compare it with the normal people. Methods Seventy-six patients with Pott’s deformity (Group TB) and seventy-two age- and sex-matched patients with a normal spine (group NC) were enrolled in this study. The relative position of aorta to the spine was evaluated from T4 to L4 on the computed tomographic angiography scans for controls and at the apex level for TB patient, and was classified into 4 kinds of degrees. Results The left pedicle-aorta angle in group TB was significantly larger than that in group NC at the T6-L3 levels. Group TB exhibited significantly smaller left pedicle-aorta distance, pedicular line-aorta distance and vertebra/rib-aorta distance than those in group NC at the T5-T10 levels, but bigger at the L1-3 levels. Patients with grade 3 and 4 aorta had more segments involved compared with those with grade 1 aorta. Patients with grade 2, 3, and 4 aorta showed larger kyphotic angles than those with grade 1. Conclusions Patients whose morbid segments involved only thoracic vertebrae presented with an “Ω” shaped aorta in sagittal plane, and 4 different kinds of degrees of aorta relative to the vertebra/rib in axial plane. Patients whose morbid segments covered lumbar vertebrae presented with an “M” shaped aorta in sagittal plane, and the aorta shifted further from apex vertebra but was located in close proximity to the vertebral body at levels above and below the osteotomy levels in axial plane.

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“…Although injuries of the aorta in spine surgery are rare, they may be life-threatening. 14 CT scan of 20 cases of anterior internal fixation found that 15% of the vertebral screws were less than 2 mm from the aorta. All screws were followed up for 4.1 years without any clinical symptoms.…”

Section: Discussionmentioning

confidence: 99%

Revision Surgery After Spinal Fusion in Adolescent Idiopathic Scoliosis

Dong

Wang

Tang

et al. 2022

Global Spine Journal

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Study design Retrospective Aanalysis of a Large Cohort of Cases. Objectives To explore the rate and cause of revision surgery after spinal fusion in adolescent idiopathic scoliosis(AIS). Methods The patients diagnosed with AIS who underwent spinal fusion surgery in a single center from 2002 to 2018 were retrospectively analyzed. All the patients were followed up at least 2 years. The causes of revision surgery were analyzed and the incidence of revision surgery was counted. Results A total of 1816 AIS patients were included in the study. After an average of 8.5 years (range 3-18 years) follow-up, a total of 51 patients underwent 54 revision operations. The overall revision rate is 2.8%. The revision rate of combined approach (anterior and posterior) and anterior approach was 6.6% (8/122), and the revision rate of posterior approach was 2.5% (43/1694). The most common causes of revision were malposition of implants/implants failure (37%), followed by poor wound healing/ infection (23%). Spinal decompensation, adding on and proximal junctional kyphosis (PJK) accounted for 20%. The compensatory curve continued to worsen after selective fusion accounted for 14% and finally the discomfort with the implants accounted for 6%. Conclusions The overall revision rate of spinal fusion for AIS is 2.8%. The implants and incision problems were the most common causes of revision surgeries.

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Malpositioned pedicle screw in spine deformity surgery endangering the aorta: report of two cases, review of literature, and proposed management algorithm

Cited by 9 publications

References 51 publications

Unexpected localization of a thoracic pedicle screw nearby the aorta after scoliosis surgery

Unexpected localization of a thoracic pedicle screw nearby the aorta after scoliosis surgery

Different angular kyphosis locations have different relative positions of aorta to spine in patients with Pott’s deformity

Revision Surgery After Spinal Fusion in Adolescent Idiopathic Scoliosis

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