Tactics for the treatment of potential and true thoracic aorta injuries by pedicle screws in the absence of acute bleeding: analysis of a small clinical series and literature data
https://doi.org/10.14531/ss2022.4.46-51
Abstract
Objective. To analyse the results of treatment of patients in whom, after fixation of the thoracic spine, contact of screws with the aorta with its wall injury was revealed.
Material and Methods. Three own observations and literature data were analysed.
Results. Three patients with potential (1 case) and true (2 cases) injury to the thoracic aorta by a transpedicular screw underwent simultaneous surgical intervention including thoracic endovascular aortic repair (TEVAR) followed by remounting (2 cases) or removal of the transpedicular fixation system. An analysis of publications on this topic is presented.
Conclusion. Intramural hematoma caused by screw malposition is an indication for aortic repair due to the risk of its dissection or rupture.
It is advisable to give preference to endovascular methods of treating vascular injuries under conditions of local anesthesia as the first stage, and then to perform the revision of transpedicular fixation system under anesthesia.
About the Authors
A. G. Aganesov
Petrovsky National Research Centre of Surgery
2 Abrikosovskiy pereulok, Moscow, 119991, Russia
Russian Federation
Russian Federation
DMSc, Chief of Spine Surgery Department
M. M. Aleksanyan
Petrovsky National Research Centre of Surgery
2 Abrikosovskiy pereulok, Moscow, 119991, Russia
Russian Federation
Russian Federation
MD, PhD, Senior researcher of Spine Surgery Department
S. A. Abugov
Petrovsky National Research Centre of Surgery
2 Abrikosovskiy pereulok, Moscow, 119991, Russia
Russian Federation
Russian Federation
DMSc, Chief of X-Ray Surgical (X-ray Endovascular) Methods of Diagnosis and Treatment
G. V. Mardanyan
Petrovsky National Research Centre of Surgery
2 Abrikosovskiy pereulok, Moscow, 119991, Russia
Russian Federation
Russian Federation
MD, PhD, Senior researcher of X-Ray Surgical (X-ray Endovascular) Methods of Diagnosis and Treatment
References
1. Mackiewicz-Milewska M, Lach S, Mackiewicz-Nartowicz H. [Thoracic aorta aneurysm as a complication after transpedicular stabilization of the thoracic vertebral column - a case study]. Ann Readapt Med Phys. 2008;51:46–49. French. DOI: 10.1016/j.annrmp.2007.09.006.
2. Takeshita K, Maruyama T, Sugita S, Oshima Y, Morii J, Chikuda H, Ono T, Nakamura K. Is a right pedicle screw always away from the aorta in scoliosis? Spine. 2011;36:1519–1524. DOI: 10.1097/BRS.0b013e31820f8e6b.
3. Губин А.В., Рябых С.О., Бурцев А.В. Ретроспективный анализ мальпозиции винтов после инструментальной коррекции деформаций грудного и поясничного отделов позвоночника // Хирургия позвоночника. 2015. Т. 12, № 1. С. 8–13. DOI: 10.14531/ss2015.1.8-13. [Gubin AV, Ryabykh SO, Burtsev AV. Retrospective analysis of screw malposition following instrumented correction of thoracic and lumbar spine deformities. Hir. Pozvonoc. 205;12(1):8–13].
4. Kayaci S, Cakir T, Dolgun M, Cakir E, Bozok S, Temiz C, Caglar YS. Aortic injury by thoracic pedicle screw. When is aortic repair required? Literature review and three new cases. World Neurosurg. 2019;128:216–224. DOI: 10.1016/j.wneu.2019.04.173.
5. Valic M, Zizek D, Span M, Mihalic R, Mohar J. Malpositioned pedicle screw in spine deformity surgery endangering the aorta: report of two cases, review of literature, and proposed management algorithm. Spine Deform. 2020;8:809–817. DOI: 10.1007/s43390-020-00094-5.
6. Inamasu J, Guiot BH. Vascular injury and complication in neurosurgical spine surgery. Acta Neurochir (Wien). 2006;148:375–386. DOI: 10.1007/s00701-005-0669-1.
7. Takeshita K, Maruyama T, Ono T, Ogihara S, Chikuda H, Shoda N, Nakao Y, Matsudaira K, Seichi A, Nakamura K. New parameters to represent the position of the aorta relative to the spine for pedicle screw placement. Eur. Spine J. 2010;19:815–820. DOI: 10.1007/s00586-010-1298-9.
8. Blocher M, Mayer M, Resch H, Ortmaier R. Leriche-like syndrome as a delayed complication following posterior instrumentation of a traumatic L1 fracture: A case report and literature review. Spine. 2015;40:E1195–E1197. DOI: 10.1097/BRS.0000000000001057. 9. Rabellino M, Garcia-Monaco R, Cesareo V, Rostagno R, Sola C. Endovascular treatment of iatrogenic aortic injury after spinal surgery. Minim Invasive Ther Allied Technol. 2013;22:56–60. DOI: 10.3109/13645706.2012.692332.
9. Гринь А.А., Коваленко Р.А., Коновалов Н.А., Ефимов Д.В., Антонов А.В., Годков И.М. Повреждения структур забрюшинного пространства и органов брюшной полости при операциях на поясничном отделе позвоночника // Нейрохирургия. 2018. Т. 20. № 2. С. 35–42. [Grin' AA, Kovalenko RA, Konovalov NA, Efimov DV, Antonov AV, Godkov IM. Damage to vessels and retroperitoneal organs during lumbar spine surgery through the posterior approach. Russian journal of neurosurgery, 2018;20(2):35–42]. DOI: 10.17650/1683-3295-2018-20-2-35-42.
10. Sandhu HK, Charlton-Ouw KM, Azizzadeh A, Estrera AL, Safi HJ. Spinal screw penetration of the aorta. J Vasc Surg. 2013;57:1668–1670. DOI: 10.1016/j.jvs.2012.10.087.
11. Kakkos SK, Shepard AD. Delayed presentation of aortic injury by pedicle screws: report of two cases and review of the literature. J Vasc Surg. 2008;47:1074–1082. DOI: 10.1016/j.jvs.2007.11.005.
12. Аганесов А.Г., Алексанян М.М., Марданян Г.В., Новикова А.А. Интрамуральная гематома аорты после транспедикулярной фиксации грудного отдела // Хирургия. Журнал им. Н.И. Пирогова. 2020. № 2. С. 84–88. [Aganesov AG, Alexanyan MM, Mardanyan GV, Novikova AA. Aortic intramural hematoma after transpedicular thoracic spine fusion. Pirogov Russian Journal of Surgery. 2020;(2):84–88]. DOI: 10.17116/hirurgia202002184.
13. Коваленко Р.А., Пташников Д.А., Черебилло В.Ю., Кашин В.А. Сравнительный анализ результатов имплантации транспедикулярных винтов в грудном отделе позвоночника с иcпользованием индивидуальных навигационных матриц и методики free hand // Травматология и ортопедия. 2020. Т. 26. № 3. С. 49–60. [Kovalenko RA, Ptashnikov DA, Cherebillo VYu, Kashin VA. Comparison of the accuracy and safety of pedicle screws placement in thoracic spine between 3D printed navigation templates and free hand technique. Traumatology and Orthopedics of Russia. 2020;26(3):49–60]. DOI: 10.21823/2311-2905-2020-26-3-49-60.
14. Абугов С.А., Поляков Р.С., Карамян Д.А., Пурецкий М.В., Марданян Г.В., Чарчян Э.Р. Современное состояние проблемы эндоваскулярного лечения при расслоении аорты B-типа // Эндоваскулярная хирургия. 2021. Т. 8, № 2. С. 121–134. [Abugov SA, Polyakov RS, Karamyan DA, Puretskiy MV, Mardanyan GV, Charchyan ER. Modern condition of the problem of endovascular treatment in type B aortic dissection. Russian Journal of Endovascular surgery. 2021;8(2):121–134]. DOI: 10.24183/2409-4080-2021-8-2-121-134.
15. Claiborne P, Mallios A, Taubman K, Blebea John. Endovascular repair of thoracic aortic injury after spinal instrumentation. J Vasc Surg Cases. 2015;1:264–267. DOI: 10.1016/j.jvsc.2015.09.001.
16. Tong X, Gu P, Yu D, Guo F, Lin X. An endovascular treatment of a thoracic aortic injury caused by a misplaced pedicle screw: Case report and review of the literature. J Formos Med Assoc. 2015;114:464–468. DOI: 10.1016/j.jfma.2013.09.014.
17. Pesenti S, Bartoli MA, Blondel B, Peltier E, Adetchessi T, Fuentes S. Endovascular aortic injury repair after thoracic pedicle screw placement. Orthop Traumatol Surg Res. 2014;100:569–573. DOI: 10.1016/j.otsr.2014.03.020.
18. Potter MQ, Lawrence BD, Kinikini DV, Brodke DS. Periaortic pedicle screw removal with endovascular control of the aorta and intraoperative aortography: a case report and review of the literature. Evid Based Spine Care J. 2013;4:149–153. DOI: 10.1055/s-0033-1357358.
19. Wegener B, Birkenmaier C, Fottner A, Jansson V, Durr HR. Delayed perforation of the aorta by a thoracic pedicle screw. Eu. Spine J. 2008;17(Suppl 2):351–354. DOI:10.1007/s00586-008-0715-9.
Review
For citations:
Aganesov A.G., Aleksanyan M.M., Abugov S.A., Mardanyan G.V. Tactics for the treatment of potential and true thoracic aorta injuries by pedicle screws in the absence of acute bleeding: analysis of a small clinical series and literature data. Russian Journal of Spine Surgery (Khirurgiya Pozvonochnika). 2022;19(4):46-51. https://doi.org/10.14531/ss2022.4.46-51
Email this article 