Intravascular ultrasound to aid in the diagnosis and revision of an intra-aortic pedicle screw: illustrative case

Landon D. Ehlers, Patrick J. Opperman, Jack E. Mordeson, Jonathan R. Thompson, Daniel L. Surdell

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND Pedicle screw impingement on vessel walls has the potential for complications due to pulsatile effects and wall erosion. Artifacts from spinal instrumentation create difficulty in accurately evaluating this interface. The authors present the first case of intravascular ultrasound (IVUS) used to characterize a pedicle screw breach into the aortic lumen. OBSERVATIONS A 21-year-old female with surgically corrected scoliosis underwent computed tomography angiography (CTA) 3 years postoperatively, which revealed a pedicle screw within the thoracic aorta lumen. Metal artifact distorted the CTA images, which prompted the decision to use intraoperative IVUS. The IVUS confirmed the noninvasive imaging findings and guided final decisions regarding aortic endograft size and location during spine hardware revision. LESSONS For asymptomatic patients presenting with pedicle screws malpositioned in or near the aorta, treatment decisions revolve around the extent of vessel wall penetration. Intraluminal depth can be obscured by artifact on computed tomography or magnetic resonance imaging or inadequately evaluated by a transesophageal echocardiogram. In our intraoperative experience, IVUS confirmed the depth of vessel lumen violation by a single pedicle screw and no wall penetration by two additional screws of concern. This was useful in deciding on thoracic endovascular aortic repair graft size and landing zone and facilitated safe spinal instrumentation removal and revision.

Original languageEnglish (US)
Article numberCASE23272
JournalJournal of Neurosurgery: Case Lessons
Volume6
Issue number7
DOIs
StatePublished - Aug 2023

Keywords

  • aorta
  • case report
  • intravascular ultrasound
  • pedicle screw
  • revision

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

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