Published online Apr 16, 2014. doi: 10.12998/wjcc.v2.i4.100
Revised: January 27, 2014
Accepted: February 16, 2014
Published online: April 16, 2014
Processing time: 163 Days and 13.6 Hours
We present a case of a 33-year-old female who sustained multiple injuries of her spine, including spinous process fractures of C5 to C7 and a lamina fracture of C6 and C7. Her thoracic spine showed transverse process fractures of T4 to T10, a compression fracture and lamina fracture of T3, spinous process and transverse process fractures of T4 and T5, a rotation injury of T6, as well as a compression fracture of L1. Thirteen months after posterior thoracic spinal instrumentation, a pedicle screw was suspected to be in contact with the aorta, which was proved by computed tomography angiograms. Consequently, implant removal was planned with direct exposure of the aorta in order to allow for immediate repair if needed. So far, studies that compare different techniques to remove pedicle screws that are suspected to penetrate the aorta are missing. However, different techniques have been described in case reports, mainly minimally invasive endovascular techniques vs open techniques such as thoracotomy.
Core tip: Large vessel damage is described during spinal surgery and can lead to perforation of the aorta by misplaced pedicle screws. However, misplaced pedicle screws are often seen within postoperative computed tomography scans, only resulting in elective pedicle screw removal/exchange. Different techniques are available. We describe the use of a thoracotomy to prevent lethal hemorrhage. The importance of preoperative planning is highlighted, including pondering the advantages and disadvantages.