Delayed perforation of the aorta by a thoracic pedicle screw

Pedicle screw instrumentation has become increasingly popular during the past 20 years and a vast selection of products is available on the market. With rising implantation rates, reports about specific complications also have increased. The main reason for these complications is the fact that the course of the pedicle and in turn the positioning of the pedicle screw cannot be adequately controlled visually. Based on the anatomy of the surrounding structures, complications caused by malpositioning can be divided into three main groups: mechanical, neurological and vascular. Beyond mechanical limitations of spinal motion, nerve injury can lead to neurological problems while injuries to vascular structures usually cause hemorrhage. These typical problems in general become apparent intraoperatively or in the immediate postoperative course. We report on a rare delayed complication and analyze the factors that led to it. In addition, we outline our treatment strategy. The goal has to be to avoid such problems in the future by using suitable navigational aids.