{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T00:03:39Z","timestamp":1788566619995,"version":"build-2803163510"},"reference-count":40,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"9","license":[{"start":{"date-parts":[[2023,2,27]],"date-time":"2023-02-27T00:00:00Z","timestamp":1677456000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,2,27]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Iatrogenic aortic injury from pedicle screw malpositioning or anterior prominence in posterior spinal fusion represents a rare but potentially devasting complication. While intraoperative aortic injury is associated with hemodynamic instability, delayed presentations of pedicle screw aortic impingement or violation often present insidiously with pseudoaneurysm or vascular remodeling in clinically asymptomatic patients. Currently, there is a lack of guidance in the field for the recommended surveillance, urgency of operative intervention, and optimal surgical management of delayed pedicle screw aortic injuries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>The following case study discusses the open treatment of delayed thoracic aortic penetration from an excessively long T12 pedicle screw in an asymptomatic adolescent patient with idiopathic scoliosis. The pedicle screw prominence anteriorly was corrected by burring the screw tip until it was flush with the vertebral body. The associated aortic injury was addressed with open vascular repair via primary anastomosis supplemented with a bovine pericardial patch.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>Complete aortic wall penetration from an excessively long thoracic pedicle screw with otherwise stable screw positioning may be addressed most effectively with a single anterior surgical approach for open aortic repair and screw tip burring.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case22533","type":"journal-article","created":{"date-parts":[[2023,2,27]],"date-time":"2023-02-27T02:56:42Z","timestamp":1677466602000},"source":"Crossref","is-referenced-by-count":5,"title":["Delayed open treatment of aortic penetration by a thoracic pedicle screw: illustrative case"],"prefix":"10.3171","volume":"5","author":[{"given":"Hannah A.","family":"Levy","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachariah W.","family":"Pinter","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra L.","family":"Hobson","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota; and"},{"name":"Department of Orthopedic Surgery, Emory University, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Yaszemski","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"3","key":"b1","series-title":"Spine (Phila Pa 1976)","first-page":"291","article-title":"Comparative analysis of pedicle screw versus hybrid instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis","volume":"31","author":"Kim YJ","year":"2006","unstructured":"Kim YJ, Lenke LG, Kim J,  Comparative analysis of pedicle screw versus hybrid instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 2006;31(3):291\u2013298.16449901"},{"key":"b2","series-title":"Eur Spine J","first-page":"S216","article-title":"Pedicle screw instrumentation and spinal deformities: have we gone too far?","volume":"22","author":"McCormick J","year":"2013","unstructured":"McCormick J, Aebi M, Toby D, Arlet V. Pedicle screw instrumentation and spinal deformities: have we gone too far? Eur Spine J. 2013;22(Suppl 2):S216\u2013S224.22531899"},{"key":"b3","series-title":"World Neurosurg","first-page":"e177","article-title":"Potential risk of thoracic aorta injury from excessively long right pedicle screws in patients with left thoracic scoliosis: a computed tomography image study","volume":"145","author":"Zhang T","year":"2021","unstructured":"Zhang T, Qiu Y, Zhu Z, Yu Y, Wang B, Jiang J. Potential risk of thoracic aorta injury from excessively long right pedicle screws in patients with left thoracic scoliosis: a computed tomography image study. World Neurosurg. 2021;145:e177\u2013e183.33045453"},{"issue":"8","key":"b4","series-title":"Spine (Phila Pa 1976)","first-page":"683","article-title":"Incidence and clinical significance of vascular encroachment resulting from freehand placement of pedicle screws in the thoracic and lumbar spine: analysis of 6816 consecutive screws","volume":"39","author":"Parker SL","year":"2014","unstructured":"Parker SL, Amin AG, Santiago-Dieppa D,  Incidence and clinical significance of vascular encroachment resulting from freehand placement of pedicle screws in the thoracic and lumbar spine: analysis of 6816 consecutive screws. Spine (Phila Pa 1976). 2014;39(8):683\u2013687.24480963"},{"issue":"4","key":"b5","series-title":"J Card Surg","first-page":"220","article-title":"Delayed presentation of aortic injury by a thoracic pedicle screw","volume":"31","author":"Sevuk U","year":"2016","unstructured":"Sevuk U, Mesut A, Kiraz I, Kose K, Ayaz F, Erkul A. Delayed presentation of aortic injury by a thoracic pedicle screw. J Card Surg. 2016;31(4):220\u2013230.26864154"},{"issue":"3","key":"b6","series-title":"J Neurosurg Spine","first-page":"403","article-title":"A retrospective analysis of pedicle screws in contact with the great vessels","volume":"13","author":"Foxx KC","year":"2010","unstructured":"Foxx KC, Kwak RC, Latzman JM, Samadani U. A retrospective analysis of pedicle screws in contact with the great vessels. J Neurosurg Spine. 2010;13(3):403\u2013406.20809738"},{"issue":"6","key":"b7","series-title":"Neuroradiology","first-page":"521","article-title":"Vascular complications in lumbar disk surgery: report of four cases","volume":"38","author":"Szolar DH","year":"1996","unstructured":"Szolar DH, Preidler KW, Steiner H,  Vascular complications in lumbar disk surgery: report of four cases. Neuroradiology. 1996;38(6):521\u2013525.8880709"},{"issue":"8","key":"b8","series-title":"J Bone Joint Surg Am","first-page":"1200","article-title":"Placement of pedicle screws in the thoracic spine. Part II: an anatomical and radiographic assessment","volume":"77","author":"Vaccaro AR","year":"1995","unstructured":"Vaccaro AR, Rizzolo SJ, Balderston RA,  Placement of pedicle screws in the thoracic spine. Part II: an anatomical and radiographic assessment. J Bone Joint Surg Am. 1995;77(8):1200\u20131206."},{"issue":"6","key":"b9","series-title":"Asian Spine J","first-page":"936","article-title":"The optimal screw length of lumbar pedicle screws during minimally invasive surgery fixation: a computed tomography-guided evaluation of 771 screws","volume":"13","author":"Chua MJ","year":"2019","unstructured":"Chua MJ, Siddiqui S, Yu CS, Nolan CP, Oh JYL. The optimal screw length of lumbar pedicle screws during minimally invasive surgery fixation: a computed tomography-guided evaluation of 771 screws. Asian Spine J. 2019;13(6):936\u2013941.31309769"},{"issue":"18","key":"b10","series-title":"Spine (Phila Pa 1976)","first-page":"2067","article-title":"Spatial relations between the vertebral body and the thoracic aorta in adolescent idiopathic scoliosis","volume":"29","author":"Maruyama T","year":"2004","unstructured":"Maruyama T, Takeshita K, Nakamura K, Kitagawa T. Spatial relations between the vertebral body and the thoracic aorta in adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 2004;29(18):2067\u20132069.15371710"},{"issue":"4","key":"b11","series-title":"Int Orthop","first-page":"773","article-title":"Incidence and risk factors for the misplacement of pedicle screws in scoliosis surgery assisted by O-arm navigation-analysis of a large series of one thousand, one hundred and forty five screws","volume":"41","author":"Jin M","year":"2017","unstructured":"Jin M, Liu Z, Qiu Y, Yan H, Han X, Zhu Z. Incidence and risk factors for the misplacement of pedicle screws in scoliosis surgery assisted by O-arm navigation-analysis of a large series of one thousand, one hundred and forty five screws. Int Orthop. 2017;41(4):773\u2013780.27999927"},{"issue":"1","key":"b12","series-title":"Chin Neurosurg J","first-page":"6","article-title":"Accuracy of pedicle screw placement in the thoracic and lumbosacral spines using O-arm-based navigation versus conventional freehand technique","volume":"5","author":"Jing L","year":"2019","unstructured":"Jing L, Wang Z, Sun Z, Zhang H, Wang J, Wang G. Accuracy of pedicle screw placement in the thoracic and lumbosacral spines using O-arm-based navigation versus conventional freehand technique. Chin Neurosurg J. 2019;5(1):6.32922906"},{"issue":"19","key":"b13","series-title":"Spine (Phila Pa 1976)","first-page":"E1169","article-title":"Delayed penetration of the thoracic aorta by pedicle screws: a case report of screws left as-is","volume":"44","author":"Schermann H","year":"2019","unstructured":"Schermann H, Mirovsky Y, Chechik Y. Delayed penetration of the thoracic aorta by pedicle screws: a case report of screws left as-is. Spine (Phila Pa 1976). 2019;44(19):E1169\u2013E1171.31095116"},{"issue":"1","key":"b14","series-title":"Orthop Surg","first-page":"338","article-title":"Delayed presentation of thoracic aortic pseudoaneurysm following pedicle screw implantation: a case report","volume":"13","author":"Liu LD","year":"2021","unstructured":"Liu LD, Hong X, Li JB, Zhang SK. Delayed presentation of thoracic aortic pseudoaneurysm following pedicle screw implantation: a case report. Orthop Surg. 2021;13(1):338\u2013341.33410291"},{"issue":"20","key":"b15","series-title":"Spine (Phila Pa 1976)","first-page":"E1064","article-title":"Descending aortic injury by a thoracic pedicle screw during posterior reconstructive surgery: a case report","volume":"35","author":"Watanabe K","year":"2010","unstructured":"Watanabe K, Yamazaki A, Hirano T,  Descending aortic injury by a thoracic pedicle screw during posterior reconstructive surgery: a case report. Spine (Phila Pa 1976). 2010;35(20):E1064\u2013E1068.20802385"},{"issue":"5","key":"b16","series-title":"J Formos Med Assoc","first-page":"464","article-title":"An endovascular treatment of a thoracic aortic injury caused by a misplaced pedicle screw: case report and review of the literature","volume":"114","author":"Tong X","year":"2015","unstructured":"Tong X, Gu P, Yu D, Guo F, Lin X. An endovascular treatment of a thoracic aortic injury caused by a misplaced pedicle screw: case report and review of the literature. J Formos Med Assoc. 2015;114(5):464\u2013468.24290859"},{"issue":"6","key":"b17","series-title":"Neurosurg Rev","first-page":"3189","article-title":"Aortic injury in spine surgery\u2026\u2026What a spine surgeon needs to know","volume":"44","author":"Alomari S","year":"2021","unstructured":"Alomari S, Planchard R, Lo SL, Witham T, Bydon A. Aortic injury in spine surgery\u2026\u2026What a spine surgeon needs to know. Neurosurg Rev. 2021;44(6):3189\u20133196.33851267"},{"issue":"2","key":"b18","series-title":"J Spinal Disord Tech","first-page":"64","article-title":"Pedicle screws adjacent to the great vessels or viscera: a study of 2132 pedicle screws in pediatric spine deformity","volume":"27","author":"Sarwahi V","year":"2014","unstructured":"Sarwahi V, Suggs W, Wollowick AL,  Pedicle screws adjacent to the great vessels or viscera: a study of 2132 pedicle screws in pediatric spine deformity. J Spinal Disord Tech. 2014;27(2):64\u201369.24658152"},{"key":"b19","series-title":"World Neurosurg","first-page":"216","article-title":"Aortic injury by thoracic pedicle screw. When is aortic repair required? Literature review and three new cases","volume":"128","author":"Kayac\u0131 S","year":"2019","unstructured":"Kayac\u0131 S, \u00c7ak\u0131r T, Dolgun M,  Aortic injury by thoracic pedicle screw. When is aortic repair required? Literature review and three new cases. World Neurosurg. 2019;128:216\u2013224.31077895"},{"issue":"6","key":"b20","series-title":"J Vasc Surg","first-page":"1668","article-title":"Spinal screw penetration of the aorta","volume":"57","author":"Sandhu HK","year":"2013","unstructured":"Sandhu HK, Charlton-Ouw KM, Azizzadeh A, Estrera AL, Safi HJ. Spinal screw penetration of the aorta. J Vasc Surg. 2013;57(6):1668\u20131670.23384497"},{"issue":"3","key":"b1","series-title":"Spine (Phila Pa 1976)","first-page":"291","article-title":"Comparative analysis of pedicle screw versus hybrid instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis","volume":"31","author":"Kim YJ","year":"2006","unstructured":"Kim YJ, Lenke LG, Kim J,  Comparative analysis of pedicle screw versus hybrid instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 2006;31(3):291\u2013298.16449901"},{"key":"b2","series-title":"Eur Spine J","first-page":"S216","article-title":"Pedicle screw instrumentation and spinal deformities: have we gone too far?","volume":"22","author":"McCormick J","year":"2013","unstructured":"McCormick J, Aebi M, Toby D, Arlet V. Pedicle screw instrumentation and spinal deformities: have we gone too far? Eur Spine J. 2013;22(Suppl 2):S216\u2013S224.22531899"},{"key":"b3","series-title":"World Neurosurg","first-page":"e177","article-title":"Potential risk of thoracic aorta injury from excessively long right pedicle screws in patients with left thoracic scoliosis: a computed tomography image study","volume":"145","author":"Zhang T","year":"2021","unstructured":"Zhang T, Qiu Y, Zhu Z, Yu Y, Wang B, Jiang J. Potential risk of thoracic aorta injury from excessively long right pedicle screws in patients with left thoracic scoliosis: a computed tomography image study. World Neurosurg. 2021;145:e177\u2013e183.33045453"},{"issue":"8","key":"b4","series-title":"Spine (Phila Pa 1976)","first-page":"683","article-title":"Incidence and clinical significance of vascular encroachment resulting from freehand placement of pedicle screws in the thoracic and lumbar spine: analysis of 6816 consecutive screws","volume":"39","author":"Parker SL","year":"2014","unstructured":"Parker SL, Amin AG, Santiago-Dieppa D,  Incidence and clinical significance of vascular encroachment resulting from freehand placement of pedicle screws in the thoracic and lumbar spine: analysis of 6816 consecutive screws. Spine (Phila Pa 1976). 2014;39(8):683\u2013687.24480963"},{"issue":"4","key":"b5","series-title":"J Card Surg","first-page":"220","article-title":"Delayed presentation of aortic injury by a thoracic pedicle screw","volume":"31","author":"Sevuk U","year":"2016","unstructured":"Sevuk U, Mesut A, Kiraz I, Kose K, Ayaz F, Erkul A. Delayed presentation of aortic injury by a thoracic pedicle screw. J Card Surg. 2016;31(4):220\u2013230.26864154"},{"issue":"3","key":"b6","series-title":"J Neurosurg Spine","first-page":"403","article-title":"A retrospective analysis of pedicle screws in contact with the great vessels","volume":"13","author":"Foxx KC","year":"2010","unstructured":"Foxx KC, Kwak RC, Latzman JM, Samadani U. A retrospective analysis of pedicle screws in contact with the great vessels. J Neurosurg Spine. 2010;13(3):403\u2013406.20809738"},{"issue":"6","key":"b7","series-title":"Neuroradiology","first-page":"521","article-title":"Vascular complications in lumbar disk surgery: report of four cases","volume":"38","author":"Szolar DH","year":"1996","unstructured":"Szolar DH, Preidler KW, Steiner H,  Vascular complications in lumbar disk surgery: report of four cases. Neuroradiology. 1996;38(6):521\u2013525.8880709"},{"issue":"8","key":"b8","series-title":"J Bone Joint Surg Am","first-page":"1200","article-title":"Placement of pedicle screws in the thoracic spine. Part II: an anatomical and radiographic assessment","volume":"77","author":"Vaccaro AR","year":"1995","unstructured":"Vaccaro AR, Rizzolo SJ, Balderston RA,  Placement of pedicle screws in the thoracic spine. Part II: an anatomical and radiographic assessment. J Bone Joint Surg Am. 1995;77(8):1200\u20131206."},{"issue":"6","key":"b9","series-title":"Asian Spine J","first-page":"936","article-title":"The optimal screw length of lumbar pedicle screws during minimally invasive surgery fixation: a computed tomography-guided evaluation of 771 screws","volume":"13","author":"Chua MJ","year":"2019","unstructured":"Chua MJ, Siddiqui S, Yu CS, Nolan CP, Oh JYL. The optimal screw length of lumbar pedicle screws during minimally invasive surgery fixation: a computed tomography-guided evaluation of 771 screws. Asian Spine J. 2019;13(6):936\u2013941.31309769"},{"issue":"18","key":"b10","series-title":"Spine (Phila Pa 1976)","first-page":"2067","article-title":"Spatial relations between the vertebral body and the thoracic aorta in adolescent idiopathic scoliosis","volume":"29","author":"Maruyama T","year":"2004","unstructured":"Maruyama T, Takeshita K, Nakamura K, Kitagawa T. Spatial relations between the vertebral body and the thoracic aorta in adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 2004;29(18):2067\u20132069.15371710"},{"issue":"4","key":"b11","series-title":"Int Orthop","first-page":"773","article-title":"Incidence and risk factors for the misplacement of pedicle screws in scoliosis surgery assisted by O-arm navigation-analysis of a large series of one thousand, one hundred and forty five screws","volume":"41","author":"Jin M","year":"2017","unstructured":"Jin M, Liu Z, Qiu Y, Yan H, Han X, Zhu Z. Incidence and risk factors for the misplacement of pedicle screws in scoliosis surgery assisted by O-arm navigation-analysis of a large series of one thousand, one hundred and forty five screws. Int Orthop. 2017;41(4):773\u2013780.27999927"},{"issue":"1","key":"b12","series-title":"Chin Neurosurg J","first-page":"6","article-title":"Accuracy of pedicle screw placement in the thoracic and lumbosacral spines using O-arm-based navigation versus conventional freehand technique","volume":"5","author":"Jing L","year":"2019","unstructured":"Jing L, Wang Z, Sun Z, Zhang H, Wang J, Wang G. Accuracy of pedicle screw placement in the thoracic and lumbosacral spines using O-arm-based navigation versus conventional freehand technique. Chin Neurosurg J. 2019;5(1):6.32922906"},{"issue":"19","key":"b13","series-title":"Spine (Phila Pa 1976)","first-page":"E1169","article-title":"Delayed penetration of the thoracic aorta by pedicle screws: a case report of screws left as-is","volume":"44","author":"Schermann H","year":"2019","unstructured":"Schermann H, Mirovsky Y, Chechik Y. Delayed penetration of the thoracic aorta by pedicle screws: a case report of screws left as-is. Spine (Phila Pa 1976). 2019;44(19):E1169\u2013E1171.31095116"},{"issue":"1","key":"b14","series-title":"Orthop Surg","first-page":"338","article-title":"Delayed presentation of thoracic aortic pseudoaneurysm following pedicle screw implantation: a case report","volume":"13","author":"Liu LD","year":"2021","unstructured":"Liu LD, Hong X, Li JB, Zhang SK. Delayed presentation of thoracic aortic pseudoaneurysm following pedicle screw implantation: a case report. Orthop Surg. 2021;13(1):338\u2013341.33410291"},{"issue":"20","key":"b15","series-title":"Spine (Phila Pa 1976)","first-page":"E1064","article-title":"Descending aortic injury by a thoracic pedicle screw during posterior reconstructive surgery: a case report","volume":"35","author":"Watanabe K","year":"2010","unstructured":"Watanabe K, Yamazaki A, Hirano T,  Descending aortic injury by a thoracic pedicle screw during posterior reconstructive surgery: a case report. Spine (Phila Pa 1976). 2010;35(20):E1064\u2013E1068.20802385"},{"issue":"5","key":"b16","series-title":"J Formos Med Assoc","first-page":"464","article-title":"An endovascular treatment of a thoracic aortic injury caused by a misplaced pedicle screw: case report and review of the literature","volume":"114","author":"Tong X","year":"2015","unstructured":"Tong X, Gu P, Yu D, Guo F, Lin X. An endovascular treatment of a thoracic aortic injury caused by a misplaced pedicle screw: case report and review of the literature. J Formos Med Assoc. 2015;114(5):464\u2013468.24290859"},{"issue":"6","key":"b17","series-title":"Neurosurg Rev","first-page":"3189","article-title":"Aortic injury in spine surgery\u2026\u2026What a spine surgeon needs to know","volume":"44","author":"Alomari S","year":"2021","unstructured":"Alomari S, Planchard R, Lo SL, Witham T, Bydon A. Aortic injury in spine surgery\u2026\u2026What a spine surgeon needs to know. Neurosurg Rev. 2021;44(6):3189\u20133196.33851267"},{"issue":"2","key":"b18","series-title":"J Spinal Disord Tech","first-page":"64","article-title":"Pedicle screws adjacent to the great vessels or viscera: a study of 2132 pedicle screws in pediatric spine deformity","volume":"27","author":"Sarwahi V","year":"2014","unstructured":"Sarwahi V, Suggs W, Wollowick AL,  Pedicle screws adjacent to the great vessels or viscera: a study of 2132 pedicle screws in pediatric spine deformity. J Spinal Disord Tech. 2014;27(2):64\u201369.24658152"},{"key":"b19","series-title":"World Neurosurg","first-page":"216","article-title":"Aortic injury by thoracic pedicle screw. When is aortic repair required? Literature review and three new cases","volume":"128","author":"Kayac\u0131 S","year":"2019","unstructured":"Kayac\u0131 S, \u00c7ak\u0131r T, Dolgun M,  Aortic injury by thoracic pedicle screw. When is aortic repair required? Literature review and three new cases. World Neurosurg. 2019;128:216\u2013224.31077895"},{"issue":"6","key":"b20","series-title":"J Vasc Surg","first-page":"1668","article-title":"Spinal screw penetration of the aorta","volume":"57","author":"Sandhu HK","year":"2013","unstructured":"Sandhu HK, Charlton-Ouw KM, Azizzadeh A, Estrera AL, Safi HJ. Spinal screw penetration of the aorta. 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