Endovascular treatment of thoracic aorta injury after spinal column surgery

Abstract

A 61-year-old woman with a history of left dorso-lumbar scoliosis and severe dorso-lumbar kyphosis underwent surgical treatment of a spinal deformity. Surgery was conducted on the patient by performing a dorso-lumbar spinal arthrodesis (T6-L5) by means of the insertion of two longitudinal rods and a number of pedicle-expander screws at different vertebral levels. Following the orthopedic surgery, the patient presented paraparesis of the lower limbs and anemia that required transfusion. In the immediate postoperative period, a noncontrast-enhanced computed tomography (CT) scan was obtained to assess the medullary canal. A deviation of the left screw placed at T6 was detected; this screw projected outward from the vertebral cortex, protruding into the descending thoracic aorta. A contrast-enhanced CT scan showed that the screw had been malpositioned, and the image was highly suggestive of a perforation of the aortic wall, despite a lack of evidence of a peri-aortic hematoma, extravasation of contrast medium, or pleural effusion. The patient remained hemodynamically stable, and the decision was to perform an endovascular repair electively within 24 hours.