[Anesthesia for removal of a screw compressing the aorta after posterior spinal surgery]

Iatrogenic vascular injury in posterior spinal surgery is a rare but potentially serious complication. We describe anesthetic management of a pedicle screw removal after posterior spinal surgery. A 60-year-old man underwent posterior spinal fusion due to ossification of posterior longitudinal ligament, but postoperative computed tomography scans of the chest demonstrated a compression of the posterior wall of the thoracic aorta by the pedicle screw at T10. Therefore, he was scheduled for screw removal. Surgery was performed in the right lateral decubitus position for emergency surgery. An occlusion balloon catheter, percutaneous cardiopulmonary support and a rapid infusion system were prepared in anticipation of massive hemorrhage. The operation was completed successfully without any adverse events. In conclusion, although major vascular injury during posterior spinal fusion is rare, we should be careful of massive hemorrhage.