Aortic Injury by Thoracic Pedicle Screw. When Is Aortic Repair Required? Literature Review and Three New Cases
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Date
2019
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Abstract
Purpose: Aortic injury by pedicle screw is rare but can cause serious complications. It has not been clearly determined when aortic repair is necessary in cases of screw impingement without perforation of the aortic wall. In this article, we review the treatment and clinical course of pedicle screw aortic impingement and attempt to clarify this issue. Methods: Cases of aortic injury during thoracic screw procedures were found using a MEDLINE search and analyzed together with 3 new cases that we present. Results: Nineteen cases collected from the literature and 3 new cases were included in the study. In 7 of the cases, aortic impingement by the pedicle screw was detected during postoperative follow-up (day 1) radiologic examinations. In the other cases, time to presentation of aortic impingement ranged between 2 weeks and 60 months after fixation. The main indications for thoracic spinal fixation were post-traumatic vertebral fracture and kyphoscoliosis/scoliosis. Repair of the aortic damage ranged from primary repair to stent and tube graft placement by the thoracic endovascular aortic repair method. Conclusions: In cases in which the screw impinges less than 5 mm into the aortic wall, hardware revision without aortic repair may be sufficient if recognized early and there are no sign of aortic leakage in vascular imaging. However, cases with more than 5 mm of screw impingement should undergo aortic repair first, even in the absence of aortic leakage, following by screw revision. © 2019
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Aorta , Aortography , Blood Vessel Prosthesis , Computed Tomography Angiography , Endovascular Procedures , Female , Humans , Iatrogenic Disease , Lumbar Vertebrae , Male , Middle Aged , Pedicle Screws , Reoperation , Spinal Fractures , Stents , Thoracic Vertebrae , Vascular Grafting , Vascular System Injuries , vancomycin , adult , American Spinal Injury Association impairment scale , aortic disease , aortic hemorrhage , aortic impingement , aortic reconstruction , aortic trauma , aortography , backache , bleeding , case report , chill , clinical article , computer assisted tomography , emergency surgery , emergency ward , endovascular aneurysm repair , female , fever , fluoroscopy , follow up , fracture fixation , general anesthesia , hematothorax , hospital admission , hospital discharge , human , kyphoscoliosis , low back pain , lumbar spine , lumbosacral spine , male , Medline , middle aged , nuclear magnetic resonance imaging , outpatient department , paraspinal muscle , physiotherapy , prone position , rehabilitation center , reoperation , Review , scoliosis , second lumbar vertebra , sedimentation rate , skin incision , spine fracture , spine injury , thoracic spine , thorax pain , thorax radiography , treatment duration , treatment indication , vertebra body , adverse device effect , aorta , blood vessel graft , blood vessel injury , blood vessel prosthesis , computed tomographic angiography , endovascular surgery , iatrogenic disease , injury , lumbar vertebra , pedicle screw , spine fracture , stent , thoracic vertebra