title: Delayed perforation of the aorta by a thoracic pedicle screw.
abstract: Pedicle screw instrumentation has become increasingly popular during the past 20 years and a vast selection of products is available on the market. With rising implantation rates, reports about specific complications also have increased. The main reason for these complications is the fact that the course of the pedicle and in turn the positioning of the pedicle screw cannot be adequately controlled visually. Based on the anatomy of the surrounding structures, complications caused by malpositioning can be divided into three main groups: mechanical, neurological and vascular. Beyond mechanical limitations of spinal motion, nerve injury can lead to neurological problems while injuries to vascular structures usually cause hemorrhage. These typical problems in general become apparent intraoperatively or in the immediate postoperative course. We report on a rare delayed complication and analyze the factors that led to it. In addition, we outline our treatment strategy. The goal has to be to avoid such problems in the future by using suitable navigational aids.
authors.affiliation: Department of Orthopedics and Orthopedic Surgery, Ludwig-Maximilians-University Munich, Marchioninistrasse 15, 81377, Munich, Germany. bernd.wegener@med.uni-muenchen.de
authors.forename: Bernd
authors.initials: B
authors.lastname: Wegener
authors.forename: Christof
authors.initials: C
authors.lastname: Birkenmaier
authors.forename: Andreas
authors.initials: A
authors.lastname: Fottner
authors.forename: Volkmar
authors.initials: V
authors.lastname: Jansson
authors.forename: Hans Roland
authors.initials: HR
authors.lastname: Dürr
mesh_terms: D015746:Abdominal Pain / Q000473:pathology; D000368:Aged; D001013:Aorta, Thoracic / Q000293:injuries* / Q000473:pathology / Q000601:surgery; D001863:Bone Screws / Q000009:adverse effects*; D002292:Carcinoma, Renal Cell / Q000556:secondary / Q000601:surgery; D018450:Disease Progression; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology; D007796:Laminectomy / Q000009:adverse effects* / Q000295:instrumentation; D008279:Magnetic Resonance Imaging; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000295:instrumentation; D012086:Reoperation; D013125:Spinal Neoplasms / Q000556:secondary / Q000601:surgery; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed