The Experts below are selected from a list of 18 Experts worldwide ranked by ideXlab platform
Alexander D. Shepard - One of the best experts on this subject based on the ideXlab platform.
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Delayed presentation of aortic injury by pedicle screws: Report of two cases and review of the literature
Journal of vascular surgery, 2008Co-Authors: Stavros K. Kakkos, Alexander D. ShepardAbstract:Objectives Perforation of the Aorta by pedicle screws is a rare but serious complication of spine fixation surgery. This article reviews the clinical presentation and management of this complication. Methods Presented are two cases of thoracic Aorta Perforation by a pedicle screw and a review of the appropriate literature performed using a MEDLINE search. Results Literature review identified eight additional patients. In most cases, aortic Perforation was recognized and managed within 18 months of the spine surgery. Clinical presentation included acute bleeding, necessitating urgent exploration in two patients, and pseudoaneurysm formation in five cases, two of which were infected. Depending on the extent of aortic damage and the presence or absence of infection, management ranged from endovascular grafting, to screw burring with closure of the Perforation site, to aortic reconstruction with a tube graft and complete orthopedic hardware removal. Outcome was favorable in all patients who were operated on. Conclusions The small number of reported cases indicates either the rarity of this complication or unawareness of its existence. The true incidence of this complication is probably under-reported. Orthopedic and vascular surgeons should be aware of this potentially fatal problem. Prevention remains the best treatment. Once encountered, a variety of techniques are available to manage this complication with reasonable outcome.
Stavros K. Kakkos - One of the best experts on this subject based on the ideXlab platform.
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Delayed presentation of aortic injury by pedicle screws: Report of two cases and review of the literature
Journal of vascular surgery, 2008Co-Authors: Stavros K. Kakkos, Alexander D. ShepardAbstract:Objectives Perforation of the Aorta by pedicle screws is a rare but serious complication of spine fixation surgery. This article reviews the clinical presentation and management of this complication. Methods Presented are two cases of thoracic Aorta Perforation by a pedicle screw and a review of the appropriate literature performed using a MEDLINE search. Results Literature review identified eight additional patients. In most cases, aortic Perforation was recognized and managed within 18 months of the spine surgery. Clinical presentation included acute bleeding, necessitating urgent exploration in two patients, and pseudoaneurysm formation in five cases, two of which were infected. Depending on the extent of aortic damage and the presence or absence of infection, management ranged from endovascular grafting, to screw burring with closure of the Perforation site, to aortic reconstruction with a tube graft and complete orthopedic hardware removal. Outcome was favorable in all patients who were operated on. Conclusions The small number of reported cases indicates either the rarity of this complication or unawareness of its existence. The true incidence of this complication is probably under-reported. Orthopedic and vascular surgeons should be aware of this potentially fatal problem. Prevention remains the best treatment. Once encountered, a variety of techniques are available to manage this complication with reasonable outcome.
Panayiotis J. Papagelopoulos - One of the best experts on this subject based on the ideXlab platform.
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Late diagnosis of Perforation of the Aorta by a pedicle screw.
Acta orthopaedica Belgica, 2013Co-Authors: Konstantinos Soultanis, Vasileios I. Sakellariou, Konstantinos A. Starantzis, Panayiotis J. PapagelopoulosAbstract:Although the clinical and biomechanical advantages of pedicle screws are well documented, the accuracy of their insertion is always a concern. Injury of neurovascular structures could be devastating. Perforation of the Aorta from posteriorly placed screws is fortunately rare but could end up being lethal. We present a review of the current literature along with two illustrative cases with Aorta Perforation from posterior pedicle screws. An 82-year-old female with a history of thoracic kyphosis and a 26-year-old female with scoliotic deformity were referred to our institution owing to back pain. Both patients had undergone correction of their deformities and posterior fixation using posterior pedicle screws and rods 5 years previously. During the diagnostic work-up, which included CT scans, we incidentally found one pedicle screw to be malpositioned, exiting the vertebral body and perforating the Aorta. The patients were offered a combined orthopaedic and vascular procedure, including screw removal and endovascular stenting of the Aorta. Potential complications from the presence of a screw inside the pulsatile Aorta, and the complexity of revision surgery should be well considered before proceeding to such a difficult surgical procedure. Systemic postoperative follow-up imaging and safer intraoperative practices during screw placement are important.
Konstantinos Soultanis - One of the best experts on this subject based on the ideXlab platform.
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Late diagnosis of Perforation of the Aorta by a pedicle screw.
Acta orthopaedica Belgica, 2013Co-Authors: Konstantinos Soultanis, Vasileios I. Sakellariou, Konstantinos A. Starantzis, Panayiotis J. PapagelopoulosAbstract:Although the clinical and biomechanical advantages of pedicle screws are well documented, the accuracy of their insertion is always a concern. Injury of neurovascular structures could be devastating. Perforation of the Aorta from posteriorly placed screws is fortunately rare but could end up being lethal. We present a review of the current literature along with two illustrative cases with Aorta Perforation from posterior pedicle screws. An 82-year-old female with a history of thoracic kyphosis and a 26-year-old female with scoliotic deformity were referred to our institution owing to back pain. Both patients had undergone correction of their deformities and posterior fixation using posterior pedicle screws and rods 5 years previously. During the diagnostic work-up, which included CT scans, we incidentally found one pedicle screw to be malpositioned, exiting the vertebral body and perforating the Aorta. The patients were offered a combined orthopaedic and vascular procedure, including screw removal and endovascular stenting of the Aorta. Potential complications from the presence of a screw inside the pulsatile Aorta, and the complexity of revision surgery should be well considered before proceeding to such a difficult surgical procedure. Systemic postoperative follow-up imaging and safer intraoperative practices during screw placement are important.
Konstantinos A. Starantzis - One of the best experts on this subject based on the ideXlab platform.
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Late diagnosis of Perforation of the Aorta by a pedicle screw.
Acta orthopaedica Belgica, 2013Co-Authors: Konstantinos Soultanis, Vasileios I. Sakellariou, Konstantinos A. Starantzis, Panayiotis J. PapagelopoulosAbstract:Although the clinical and biomechanical advantages of pedicle screws are well documented, the accuracy of their insertion is always a concern. Injury of neurovascular structures could be devastating. Perforation of the Aorta from posteriorly placed screws is fortunately rare but could end up being lethal. We present a review of the current literature along with two illustrative cases with Aorta Perforation from posterior pedicle screws. An 82-year-old female with a history of thoracic kyphosis and a 26-year-old female with scoliotic deformity were referred to our institution owing to back pain. Both patients had undergone correction of their deformities and posterior fixation using posterior pedicle screws and rods 5 years previously. During the diagnostic work-up, which included CT scans, we incidentally found one pedicle screw to be malpositioned, exiting the vertebral body and perforating the Aorta. The patients were offered a combined orthopaedic and vascular procedure, including screw removal and endovascular stenting of the Aorta. Potential complications from the presence of a screw inside the pulsatile Aorta, and the complexity of revision surgery should be well considered before proceeding to such a difficult surgical procedure. Systemic postoperative follow-up imaging and safer intraoperative practices during screw placement are important.