While reading this article :Thoracic pedicle screw placement: Free-hand technique by Yongjung J. Kim, Lawrence G. Lenke regarding Scoliosis and thoraci pedicle screw placement, I came across the two back reference that startled me, an important and interesting reference about how vascular complications can occur by careless pedicle screw placement?..Surgery insight: During surgical performance or surgical procedures and providing patient care, there is nothing like oh you mean that?, well that is very simple or take for granted in a casual way, one must show at most attention and care in every small to big steps, so do the neuromonitoring and anesthesia professionals, you can be of great help to surgeon when you detect changes or unusual activity that can get surgeons attention right away. Ofcourse for surgeons, there is no room for error but absolutely there is no room for Oh I have done 1000s of surgery, pricking a nerve or artery during my pedicle screw insertion is not going to happen, oh well, it did. The following paper describes a case and death of a patient two weeks after the surgery, so be diligent.
Vascular complications22.Heini P, Scholl E, Wyler D, Eggli S. Fatal cardiac tamponade associated with posterior
spinal instrumentation. A case report. Spine 1998;23:2226–30.
Heini et al[22] described a case of fatal cardiac tamponade that14. Suk SI, Kim WJ, Lee SM, Kim JH, Chung ER. Thoracic pedicle screw fixation in
was due to a prick injury of the right coronary artery by a Kirschner
Neurology India | December 2005 | Vol 53 | Issue 4
CMYK517 517 Kim et al: Thoracic pedicle screw placement
wire. The injury was confirmed by autopsy after the patient died
12 days after surgery.
spinal deformities: are they really safe? Spine 2001;26:2049–57.
Suk et al [14] described a case of an overpenetrated screw causing irritation of the thoracic aorta resulting in severe chest pain.25. Minor ME, Morrissey NJ, Peress R, Carroccio A, Ellozy S, Agarwal G, et al.
Endovascular treatment of an iatrogenic thoracic aortic injury after spinal
instrumentation: case report. J Vasc Surg 2004;39:893–6
Recently Minor et al [25] reported endovascular treatment of an iatrogenic aortic injury by misplaced thoracic pedicle screw at T5.I have not yet read all these three papers, I will comment further after I go through them all.