Avtor/Urednik		Valič, Matej; Žižek, David; Špan, Matjaž; Mihalič, Rene; Mohar, Janez
Naslov		Malpositioned pedicle screw in spine deformity surgery endangering the aorta
Tip		članek
Vol. in št.		Letnik 8, št. 4
Leto izdaje		2020
Obseg		str. 809-817
ISSN		2212-1358
Jezik		eng
Abstrakt		Study design Case reports and review of the literature with a proposed management algorithm. Objectives To report two cases of a potential vascular complication due to an incorrectly placed pedicle screw (PS) during spine deformity surgery. Relevant literature regarding the management of vascular complications is reviewed, and an evidence-based management algorithm is proposed. Summary of background data Aortic lesions represent a rare but potentially life-threatening complications with spine deformity and revision surgery, signifcantly increasing the risk. A management algorithm for an aortic lesion in the case of a malpositioned PS has not yet been published. Methods Case 1: An 18-year-old female with proximal thoracic spinal non-instrumented fusion underwent a revision corrective procedure due to a progressive right-sided thoracolumbar compensatory curve. However, postoperative computed tomography (CT) performed to evaluate the position of the PS revealed malposition of the left T9 PS, which was abutting the descending aorta with CT angiography excluding the perforation of the aorta. Case 2: A 17-year-old male was scheduled for correction of Lenke 3-C-N adolescent idiopathic scoliosis. Postoperative routine evaluation with low-dose CT revealed a left T9 PS paravertebral malposition, and subsequent CTA demonstrated that the thread of the PS was in contact with the descending thoracic aorta and an unlikely hemodynamically signifcant vessel injury. Results Successful removal of both malpositioned PS was performed. In the frst case, a cardiovascular surgeon attended the operation if an urgent thoracotomy was needed, and in the second case, additional video-assisted thoracoscopic control of the aorta was performed during PS removal. Conclusions Preoperative imaging in spinal surgery is essential to avoid major vascular and other complications when placing PS, especially in thoracic deformities. When a potential major vessel complication emerges, an interdisciplinary approach and an appropriate management algorithm are mandatory to make the best clinical decisions.
Proste vsebinske oznake		iatrogenic aortic injury malpositioned implants pedicle screw instrumentation revision spine surgery scoliosis iatrogena poškodba aorte malpozicija vsadka revizijska operacija skolioze revision spine surgery scoliosis