title: Cerebral infarction due to an embolism after cervical pedicle screw fixation.
abstract: METHODS
  Case report and clinical discussion.
  
  
  OBJECTIVE
  We report a rare case of delayed onset of cerebral infarction caused by an embolism after cervical pedicle screw (CPS) fixation.
  
  
  BACKGROUND
  CPS has a risk of vertebral artery (VA) injury. CPSs sometimes breach the transverse foramen without rupture of the VA. Most breaches are not considered harmful.
  
  
  METHODS
  We present a case in a 71-year-old man who underwent an operation for CPS fixation and laminoplasty for cervical spondylomyelopathy. He presented symptoms of hemiparesis 3 days after the operation. The left C4 pedicle screw was proven to breach the transverse foramen. An angiogram showed a thrombus cranial to the screw.
  
  
  RESULTS
  The patient underwent anticoagulation therapy without removal of screw. After 2 weeks, the thrombus had disappeared. Subsequently, the pedicle screws were removed. At final follow-up, the patient complained of a grade 4/5 hemiparesis, facial nerve palsy, and hearing loss in his left ear.
  
  
  CONCLUSIONS
  To our knowledge, this is the first case report of delayed onset of cerebral infarction caused by an embolism after CPS fixation. When a CPS perforates the transverse foramen, even if no apparent VA injury occurs during the operation, the surgeon must take care not to risk cerebral infarction because of an embolism.
authors.affiliation: Department of Orthopedic Surgery, Kurashiki Central Hospital, Okayama, Japan. eo10957@kchnet.or.jp
authors.forename: Eijiro
authors.initials: E
authors.lastname: Onishi
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Sekimoto
authors.forename: Ryu
authors.initials: R
authors.lastname: Fukumitsu
authors.forename: Sen
authors.initials: S
authors.lastname: Yamagata
authors.forename: Mutsumi
authors.initials: M
authors.lastname: Matsushita
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001863:Bone Screws / Q000009:adverse effects*; D002533:Cerebral Angiography; D002544:Cerebral Infarction / Q000188:drug therapy / Q000209:etiology*; D002574:Cervical Vertebrae / Q000601:surgery; D004617:Embolism / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D007796:Laminectomy / Q000009:adverse effects*; D008297:Male; D055009:Spondylosis / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants