title: Fatal cardiac tamponade associated with posterior spinal instrumentation. A case report.
abstract: METHODS
  Case report of a fatal complication of pedicle screw instrumentation and review of the literature.
  
  
  OBJECTIVE
  To describe the clinical and postmortem findings in a 35-year-old man who sustained a T11 burst fracture that was managed by transpedicular posterior instrumentation and who died 12 days after surgery of cardiac tamponade caused by a prick injury of the right coronary artery.
  
  
  BACKGROUND
  Posterior pedicle screw instrumentation is considered a safe and effective method for stabilizing a spinal motion segment. Nevertheless, there are several rare but significant complications that may occur. This is the first report of a heart tamponade after transpedicular screw insertion.
  
  
  METHODS
  A 35-year-old man was treated for a T11 burst fracture with posterior transpedicular stabilization. The surgery was uncomplicated.
  
  
  RESULTS
  Twelve days after the intervention, the patient died of cardiogenic shock. Postmortem examination showed a heart tamponade of 350 mL blood originating in a prick injury of the right coronary artery. Histologic findings showed evidence that the injury was caused during surgery by a Kirschner wire.
  
  
  CONCLUSIONS
  There are numerous possible intraoperative complications in posterior pedicle screw fixation, such as nerve root and spinal cord injuries. This case of a fatal heart tamponade after transpedicular screw insertion is rare. It shows that the surgeon must be aware of potential risks associated with such a procedure and have a comprehensive three-dimensional understanding of the anatomic structures involved.
authors.affiliation: Department of Orthopedic Surgery, University of Berne, Inselspital, Switzerland.
authors.forename: P
authors.initials: P
authors.lastname: Heini
authors.forename: E
authors.initials: E
authors.lastname: Schöll
authors.forename: D
authors.initials: D
authors.lastname: Wyler
authors.forename: S
authors.initials: S
authors.lastname: Eggli
mesh_terms: D000328:Adult; D001863:Bone Screws / Q000009:adverse effects*; D002305:Cardiac Tamponade / Q000209:etiology*; D017809:Fatal Outcome; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000209:etiology; D016103:Spinal Fractures / Q000601:surgery; D013123:Spinal Fusion / Q000009:adverse effects* / Q000295:instrumentation*