Cerebral infarction due to an embolism after cervical pedicle screw fixation.

STUDY

DESIGN

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.

SUMMARY OF BACKGROUND DATA: 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.

CONCLUSION

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.