Tactics for the treatment of potential and true thoracic aorta injuries by pedicle screws in the absence of acute bleeding: analysis of a small clinical series and literature data

Abstract

Objective. To analyse the results of treatment of patients in whom, after fixation of the thoracic spine, contact of screws with the aorta with its wall injury was revealed. Material and Methods. Three own observations and literature data were analysed. Results. Three patients with potential (1 case) and true (2 cases) injury to the thoracic aorta by a transpedicular screw underwent simultaneous surgical intervention including thoracic endovascular aortic repair (TEVAR) followed by remounting (2 cases) or removal of the transpedicular fixation system. An analysis of publications on this topic is presented. Conclusion. Intramural hematoma caused by screw malposition is an indication for aortic repair due to the risk of its dissection or rupture. It is advisable to give preference to endovascular methods of treating vascular injuries under conditions of local anesthesia as the first stage, and then to perform the revision of transpedicular fixation system under anesthesia.

Keywords

• vascular complications
• aortic injury
• screw malposition
• transpedicular fixation
• tevar
• vertebral fracture