Delayed aortic injury after thoracic corrective osteotomy: a case report.

Area of Science:

• Spinal Surgery
• Cardiovascular Complications
• Osteoporosis Management

Background:

• Degenerative kyphoscoliosis often requires complex spinal correction surgery, particularly in osteoporotic patients.
• Osteoporosis increases the risk of complications due to bone fragility and altered biomechanics.

Observation:

• A 78-year-old female with osteoporosis underwent corrective osteotomy for degenerative kyphoscoliosis.
• Three weeks postoperatively, the patient experienced cardiopulmonary arrest and expired.
• Autopsy revealed aortic perforation adjacent to a nondisplaced left 9th rib fracture.

Findings:

• Delayed aortic perforation can occur after spinal osteotomy, even without pedicle screw malposition.
• Nondisplaced rib fractures near the aorta pose a significant risk in osteoporotic patients undergoing spinal surgery.
• Positional changes of the aorta and rib fragility contribute to this critical complication.

Implications:

• Spine surgeons must consider the risk of aortic injury in osteoporotic patients, even with seemingly minor rib fractures.
• Careful evaluation of rib integrity around the surgical site is crucial post-vertebral osteotomy.
• This case highlights a novel critical complication requiring heightened awareness in spinal deformity correction.