Levy Hannah A, Pinter Zachariah W, Hobson Sandra L, Yaszemski Michael J
1Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota; and.
2Department of Orthopedic Surgery, Emory University, Atlanta, Georgia.
J Neurosurg Case Lessons. 2023 Feb 27;5(9). doi: 10.3171/CASE22533.
Iatrogenic aortic injury from pedicle screw malpositioning or anterior prominence in posterior spinal fusion represents a rare but potentially devasting complication. While intraoperative aortic injury is associated with hemodynamic instability, delayed presentations of pedicle screw aortic impingement or violation often present insidiously with pseudoaneurysm or vascular remodeling in clinically asymptomatic patients. Currently, there is a lack of guidance in the field for the recommended surveillance, urgency of operative intervention, and optimal surgical management of delayed pedicle screw aortic injuries.
The following case study discusses the open treatment of delayed thoracic aortic penetration from an excessively long T12 pedicle screw in an asymptomatic adolescent patient with idiopathic scoliosis. The pedicle screw prominence anteriorly was corrected by burring the screw tip until it was flush with the vertebral body. The associated aortic injury was addressed with open vascular repair via primary anastomosis supplemented with a bovine pericardial patch.
Complete aortic wall penetration from an excessively long thoracic pedicle screw with otherwise stable screw positioning may be addressed most effectively with a single anterior surgical approach for open aortic repair and screw tip burring.
在脊柱后路融合术中，椎弓根螺钉位置不当或向前突出导致的医源性主动脉损伤是一种罕见但可能具有毁灭性的并发症。虽然术中主动脉损伤与血流动力学不稳定有关，但椎弓根螺钉对主动脉的压迫或侵犯的延迟表现通常在临床无症状的患者中隐匿出现，表现为假性动脉瘤或血管重塑。目前，在延迟性椎弓根螺钉致主动脉损伤的推荐监测、手术干预的紧迫性以及最佳手术管理方面，该领域缺乏指导。
以下病例研究讨论了一名患有特发性脊柱侧凸的无症状青少年患者，因T12椎弓根螺钉过长导致延迟性胸主动脉穿透的开放治疗。通过打磨螺钉尖端直至其与椎体齐平来纠正椎弓根螺钉向前突出的问题。相关的主动脉损伤通过开放血管修复进行处理，采用一期吻合并辅以牛心包补片。
对于椎弓根螺钉过长导致主动脉壁完全穿透且螺钉位置稳定的情况，采用单一前路手术方法进行开放主动脉修复和螺钉尖端打磨可能是最有效的处理方式。
