Potential large vessel injury during thoracolumbar pedicle screw removal. A case report.

STUDY

DESIGN

A case study of a previously unreported complication of unsuccessful broken pedicle screw removal in the thoracolumbar spine is presented.

OBJECTIVES

To emphasize an increased awareness of the potential for large vessel injury during difficult broken pedicle screw removal in the thoracolumbar spine and to encourage the thorough evaluation of indications for the removal of any broken distal fragment in a vertebral body.

SUMMARY OF BACKGROUND DATA: Reported complications of pedicle screw removal include the inability to remove the distal screw fragment, nerve root injury, and dural sheath violation. Damage to anterior vascular structures, including the vena cava, iliac arterial and venous systems, and aorta, has not yet been reported in association with difficult broken pedicle screw removal.

METHODS

An instrument designed to capture the distal end of a screw fragment through an interference fit resulted in inadvertent screw migration into the retroperitoneal space. Plain roentgenograms and computed tomography were used to document this complication, revealing the close proximity of the screw fragment to the aorta.

RESULTS

Expedient recognition of the anteriorly migrated screw fragment with its subsequent removal resulted in a satisfactory outcome.

CONCLUSION

Great care must be taken during the removal of broken pedicle screws to prevent injury to surrounding structures. Additionally, indications for the removal of distal screw fragments must be carefully established. Instruments designed to capture the end of the distal screw fragment through an interference fit may allow anterior screw migration to occur, particularly in osteoporotic bone.