Elective thoracotomy for pedicle screw removal to prevent severe aortic bleeding

Area of Science:

• Spinal Surgery
• Vascular Surgery
• Radiology

Background:

• A 33-year-old female sustained severe spinal trauma, necessitating posterior thoracic spinal instrumentation.
• Post-operative complications involving spinal implants are a significant concern in orthopedic and neurosurgical procedures.

Observation:

• Thirteen months post-instrumentation, a pedicle screw was suspected to be impinging on the aorta.
• Computed tomography angiography confirmed the suspected aortic contact, necessitating surgical intervention.

Findings:

• The case highlights a rare but serious complication of spinal instrumentation: aortic penetration by a pedicle screw.
• Surgical planning involved direct aortic exposure for potential immediate repair during implant removal.

Implications:

• This case underscores the importance of vigilant post-operative monitoring for spinal instrumentation complications.
• There is a clear need for comparative studies evaluating the efficacy and safety of different techniques for removing aortic-penetrating pedicle screws.