Delayed presentation of infected common iliac artery pseudoaneurysm caused by malpositioned pedicle screw after minimally invasive scoliosis surgery
To report delayed onset common iliac artery perforation and infected pseudoaneurysm caused by malpositioned pedicle screw after minimally invasive scoliosis surgery (MISS).
A 21-year-old female was referred to our hospital with a 1-week history of abrupt right-sided low back pain, lower abdominal pain, and fever with a history of MISS using cannulated pedicle screws 18 months earlier. Paravertebral arterial erosion with pseudoaneurysm and retroperitoneal and paraspinal abscess were suspected.
We performed resection of the pseudoaneurysm, vascular repair of right common iliac artery by angioplasty with a bovine patch and removal of implant. At 6 months after the last surgery, she had no limitations or problems in her daily activities with no recurrence of low back pain, abdominal pain, or fever as well as without loss of deformity.
Our case showed that misplaced pedicle screws can cause potentially fatal complications, such as infected pseudoaneurysm, even in the late postoperative period.
KeywordsAbscess Common iliac artery Fistula Pseudoaneurysm Malpositioned cannulated pedicle screw Minimally invasive scoliosis surgery
Compliance with ethical standards
Conflict of interest
None of the authors has any potential conflict of interest.
- 1.Kim YJ, Lenke LG, Kim J, Bridwell KH, Cho SK, Cheh G, Sides B (2006) Comparative analysis of pedicle screw versus hybrid instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 31(3):291–298. https://doi.org/10.1097/01.brs.0000197865.20803.d4 CrossRefGoogle Scholar
- 6.Bingol H, Cingoz F, Yilmaz AT, Yasar M, Tatar H (2004) Vascular complications related to lumbar disc surgery. J Neurosurg 100(3 Suppl Spine):249–253Google Scholar
- 9.Mirza AK, Alvi MA, Naylor RM, Kerezoudis P, Krauss WE, Clarke MJ, Shepherd DL, Nassr A, DeMartino RR, Bydon M (2017) Management of major vascular injury during pedicle screw instrumentation of thoracolumbar spine. Clin Neurol Neurosurg 163:53–59. https://doi.org/10.1016/j.clineuro.2017.10.011 CrossRefGoogle Scholar
- 12.Gelalis ID, Paschos NK, Pakos EE, Politis AN, Arnaoutoglou CM, Karageorgos AC, Ploumis A, Xenakis TA (2012) Accuracy of pedicle screw placement: a systematic review of prospective in vivo studies comparing free hand, fluoroscopy guidance and navigation techniques. Eur Spine J 21(2):247–255. https://doi.org/10.1007/s00586-011-2011-3 CrossRefGoogle Scholar
- 14.Qiu XS, Jiang H, Qian BP, Wang WJ, Zhu F, Zhu ZZ, Qiu Y (2014) Influence of prone positioning on potential risk of aorta injury from pedicle screw misplacement in adolescent idiopathic scoliosis patients. J Spinal Disord Tech 27(5):E162–E167. https://doi.org/10.1097/bsd.0000000000000075 CrossRefGoogle Scholar
- 15.Sarwahi V, Suggs W, Wollowick AL, Kulkarni PM, Lo Y, Amaral TD, Thornhill B (2014) Pedicle screws adjacent to the great vessels or viscera: a study of 2132 pedicle screws in pediatric spine deformity. J Spinal Disord Tech 27(2):64–69. https://doi.org/10.1097/BSD.0b013e31825bfecd CrossRefGoogle Scholar
- 16.Kopp R, Beisse R, Weidenhagen R, Piltz S, Hauck S, Becker CR, Pieske O, Buhren V, Jauch KW, Lauterjung L (2007) Strategies for prevention and operative treatment of aortic lesions related to spinal interventions. Spine (Phila Pa 1976) 32(25):E753–E760. https://doi.org/10.1097/brs.0b013e31815b657c CrossRefGoogle Scholar
- 19.Sokolic J, Sosa T, Ugljen R, Biocina B, Simunic S, Slobodnjak Z (1991) Extrinsic erosion of the descending aorta by a vertebral fixator. Tex Heart Inst J 18(2):136–139Google Scholar
- 20.Parker SL, Amin AG, Santiago-Dieppa D, Liauw JA, Bydon A, Sciubba DM, Wolinsky JP, Gokaslan ZL, Witham TF (2014) Incidence and clinical significance of vascular encroachment resulting from freehand placement of pedicle screws in the thoracic and lumbar spine: analysis of 6816 consecutive screws. Spine (Phila Pa 1976) 39(8):683–687. https://doi.org/10.1097/brs.0000000000000221 CrossRefGoogle Scholar
- 21.Than KD, Mummaneni PV, Bridges KJ, Tran S, Park P, Chou D, La Marca F, Uribe JS, Vogel TD, Nunley PD, Eastlack RK, Anand N, Okonkwo DO, Kanter AS, Mundis GM Jr (2017) Complication rates associated with open versus percutaneous pedicle screw instrumentation among patients undergoing minimally invasive interbody fusion for adult spinal deformity. Neurosurg Focus 43(6):E7. https://doi.org/10.3171/2017.8.focus17479 CrossRefGoogle Scholar
- 23.Sarwahi V, Horn JJ, Kulkarni PM, Wollowick AL, Lo Y, Gambassi M, Amaral TD (2016) minimally invasive surgery in patients with adolescent idiopathic scoliosis: is it better than the standard approach? A 2-year follow-up study. Clin Spine Surg 29(8):331–340. https://doi.org/10.1097/bsd.0000000000000106 CrossRefGoogle Scholar
- 24.Qiao J, Zhu F, Xu L, Zhu Z, Qian B, Liu Z, Qiu Y (2012) Comparison of the aorta impingement risks between thoracolumbar/lumbar curves with different convexities in adolescent idiopathic scoliosis: a computed tomography study. Eur Spine J 21(10):2043–2049. https://doi.org/10.1007/s00586-012-2315-y CrossRefGoogle Scholar