Malpositioned Pedicle Screw Compressed Thoracic Aorta of a Patient With Adolescent Idiopathic Scoliosis: Case Report and Literature Review

Abstract

Background: Aortic injuries because of pedicle screw placement are quite rare, consequently management strategies to avoid vascular complications are lacking. Intraoperative or postoperative images to reveal the accuracy of screw placement in scoliotic misalignment with freehanded placed pedicle screws is therefore essential. Case Report: A 13-year-old girl with adolescent idiopathic scoliosis (AIS) was presented at the outpatient clinic of the authors department. Operative correction of the scoliotic misalignment including dorsal pedicle screw and rod placement with fusion from T3 to L4 was performed. Computed tomography scan after surgery showed left T9 screw malposition, accompanied by lateral compression of thoracic aorta. No clinical manifestations of aortic stenosis were noted. To avoid severe vascular complications, the thoracic screw was removed with the help of a specialized team of vascular as well as thoracic surgeons through extrapleural thoracotomy. After the removal of the malpositioned screw, the correction maneuvres were applied without the left T9 screw. No posttraumatic aortic aneurysm and other wall injury were identified after the revision surgery. The patient was discharged after 20 days of inpatient stay without the use external immobilization. The girl was in a good clinical condition after the 1-year follow-up visit without vascular or neurological complications. Conclusions: Malpositioned pedicle screws after dorsal correction in patients with adolescent idiopathic scoliosis might be challenging. Aortic injuries because of malpositioned screws are rare; nevertheless, the presence might be a life-threatening condition despite a clinical asymptomatic patient. As a consequence, the authors recommend to perform routine postoperative computed tomography scans combined with angiography in the case of significant lateral screw positioning.