Late Diagnosis of Pedicle Screw Malplacement With Perforation of the Thoracic Aorta After Posterior Stabilization in a Patient With Multiple Myeloma

• DOI: 10.1097/brs.0b013e318202e4d1
• Publication Date: 2011-02-23T08:08:49Z
• Authors: Sven K. Tschoeke; Patrick Gahr; Lasse Krug; Antje S. Kasper; Christoph E. Heyde; Wolfgang Ertel
• Keywords: Thoracotomy; Perforation; Thoracic aorta; Thoracic vertebrae

A case report.To demonstrate delayed diagnosis of screw malpositioning with perforation the thoracic aorta after posterior stabilization a Th7-vertebral collapse due to multiple myeloma. Relevant diagnostic and therapeutic strategies are outlined in context rather unfortunate series interventional events.Pedicle instrumentation has become well-established standard surgical treatment various disorders spinal column. Particularly at upper-thoracic level, close anatomic relationship spine places it other major structures high risk. Although iatrogenic vascular injuries rare, few cases have been described.A 64-year-old female patient remarked progressive back pain 2 years uneventful recovery from multilevel by pedicle rod because an osteolytic Th7 vertebra. The subsequent computed tomographic scan demonstrated kyphotic deformity transspinal periaortic malplacement.The revision strategy was interdisciplinary single session two-phase operation. primary phase included left-sided thoracotomy, mobilization aorta, implant removal under monitoring right lateral position. initially planned corporectomy vertebral body replacement cage implantation via anterior approach dismissed critical tissue adhesions Finally, thoracotomy closed, transferred into prone position stabilized reinstrumentation fluoroscopy guidance.Although clinical course malpositioned may stay unremarkable, this illustrates that proven injury is mandatory prevent further damage. appropriate demands exact provident planning using preferably approach.