Emergency aortic control for pedicle screw misplacement during spinal fixation

Abstract Aortic iatrogenic injuries during spinal instrumentation are rare but carry a high risk of mortality. In this report, we describe the case of a 26-year-old man with traumatic vertebral fracture and subsequent spinal cord injury who underwent posterior vertebral fixation at our Trauma Center. The neurosurgical procedure was complicated by the misplacement of a spinal pedicle screw, which almost penetrated the descending thoracic aorta. In order to avoid a possibly fatal bleeding, we safely removed the pedicle screw with the help of a prophylactic proximal compliant aortic balloon ready to be inflated in case of haemorrhage. Follow-up CT scan did not detect any defect of the aortic wall, nor any sign of bleeding. After a 15-months follow-up the patient is alive and in good physical conditions, with little residual neurologic deficit due to the spinal trauma.