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Late Injury to the Thoracic Aorta from Spinal Fusion Procedure
Modesto J. Colon, Elizabeth Oswald, Ramachandra Reddy.
Mount Sinai Medical Center, New York, NY, USA.

Late Injury to the Thoracic Aorta from Spinal Fusion Procedure
Background
A 33 year old female presented with persistent mid back pain four years after T4-L4 posterior spinal fusion for thoracolumbar scoliosis. A CT scan of the spine was performed showing two thoracic screws at the level of T9 that extended through the vertebral body and appeared to enter into the descending thoracic aorta.
Operative approach
Under general anesthesia with the patient positioned left side up, a two incision approach was used. Fluoroscopy was used to identify T9 which was exposed using a posterior approach. Next, a standard lateral thoracotomy was performed with division of the latissimus dorsi and entry into the chest cavity through the seventh intercostal space. Proximal and distal control of the aorta was obtained. The spine surgeons then removed the offending screws from the posterior approach. The aorta remained intact although the imprint of the screws was visible. Epiaortic ultrasound was performed and no defects were seen. There was no bleeding. The mediastinal pleura was then closed over the aorta. A single chest tube was introduced. A 5 rib intercostal block was performed. The chest and wound were then closed in the standard fashion.
Discussion
The posterior approach for the treatment of thoracic scoliosis has been well documented and accepted with excellent outcomes. Here we present a potentially life threatening complication. An expeditious workup with low threshold for appropriate imaging were the key in avoiding a fatal outcome.


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