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Published on: November 8, 2024
Cerebral infarction due to an embolism after cervical pedicle screw fixation
Eijiro Onishi1, Yoshihiro Sekimoto, Ryu Fukumitsu
1Department of Orthopedic Surgery, Kurashiki Central Hospital, Okayama, Japan. eo10957@kchnet.or.jp
Study Design:
Case report and clinical discussion.
Objective:
We report a rare case of delayed onset of cerebral infarction caused by an embolism after cervical pedicle screw (CPS) fixation.
Summary Of Background Data:
CPS has a risk of vertebral artery (VA) injury. CPSs sometimes breach the transverse foramen without rupture of the VA. Most breaches are not considered harmful.
Methods:
We present a case in a 71-year-old man who underwent an operation for CPS fixation and laminoplasty for cervical spondylomyelopathy. He presented symptoms of hemiparesis 3 days after the operation. The left C4 pedicle screw was proven to breach the transverse foramen. An angiogram showed a thrombus cranial to the screw.
Results:
The patient underwent anticoagulation therapy without removal of screw. After 2 weeks, the thrombus had disappeared. Subsequently, the pedicle screws were removed. At final follow-up, the patient complained of a grade 4/5 hemiparesis, facial nerve palsy, and hearing loss in his left ear.
Conclusion:
To our knowledge, this is the first case report of delayed onset of cerebral infarction caused by an embolism after CPS fixation. When a CPS perforates the transverse foramen, even if no apparent VA injury occurs during the operation, the surgeon must take care not to risk cerebral infarction because of an embolism.
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