Go Seimei, Mochizuki Shingo, Yamada Kazunori, Takahashi Shinya
Akane-Foundation Tsuchiya General Hospital, Department of Cardiovascular Surgery, Japan.
Hiroshima University, Department of Cardiovascular Surgery, Japan.
Trauma Case Rep. 2021 Feb 9;32:100401. doi: 10.1016/j.tcr.2021.100401. eCollection 2021 Apr.
Vascular injury caused by spinal screw displacement is a rare complication of spinal fusion surgery. Here, we report a case with no perforation of the aortic wall, which we treated by means of simultaneous thoracic endovascular aorta repair (TEVAR) and screw removal. An 82-year-old female underwent corrective spinal fixation. Postoperatively, a screw became displaced from the vertebrae and contacted the outer membrane of the descending aorta. To prevent rupture of the aorta, we performed stent graft placement from the right common femoral aorta. We left a flexion-resistant catheter in the left arm and moved the patient into an abdominal position with the left arm extended upward to enable immediate insertion of a guidewire and occlusion balloon if necessary. Then we removed the displaced screw with a drill. This safe and effective method can prevent possible aortic injuries secondary to displaced spinal screws. The key to our method is the simultaneous performance of TEVAR and screw removal, made possible through patient repositioning.
脊柱螺钉移位导致的血管损伤是脊柱融合手术中一种罕见的并发症。在此，我们报告一例主动脉壁未穿孔的病例，我们通过同期胸段血管腔内主动脉修复术（TEVAR）和取出螺钉进行治疗。一名82岁女性接受了脊柱矫正固定术。术后，一枚螺钉从椎体移位并接触到降主动脉外膜。为防止主动脉破裂，我们从右股总动脉进行了支架植入。我们在左臂留置了一根抗屈曲导管，并将患者转为腹部卧位，左臂向上伸展，以便在必要时能立即插入导丝和封堵球囊。然后我们用钻头取出移位的螺钉。这种安全有效的方法可预防脊柱螺钉移位继发的可能的主动脉损伤。我们方法的关键是通过患者重新定位实现TEVAR和取出螺钉的同期进行。
