{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T04:20:52Z","timestamp":1770351652802,"version":"3.49.0"},"reference-count":24,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"7","license":[{"start":{"date-parts":[[2023,8,14]],"date-time":"2023-08-14T00:00:00Z","timestamp":1691971200000},"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":[[2023,8,14]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Pedicle screw impingement on vessel walls has the potential for complications due to pulsatile effects and wall erosion. Artifacts from spinal instrumentation create difficulty in accurately evaluating this interface. The authors present the first case of intravascular ultrasound (IVUS) used to characterize a pedicle screw breach into the aortic lumen.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 21-year-old female with surgically corrected scoliosis underwent computed tomography angiography (CTA) 3 years postoperatively, which revealed a pedicle screw within the thoracic aorta lumen. Metal artifact distorted the CTA images, which prompted the decision to use intraoperative IVUS. The IVUS confirmed the noninvasive imaging findings and guided final decisions regarding aortic endograft size and location during spine hardware revision.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>For asymptomatic patients presenting with pedicle screws malpositioned in or near the aorta, treatment decisions revolve around the extent of vessel wall penetration. Intraluminal depth can be obscured by artifact on computed tomography or magnetic resonance imaging or inadequately evaluated by a transesophageal echocardiogram. In our intraoperative experience, IVUS confirmed the depth of vessel lumen violation by a single pedicle screw and no wall penetration by two additional screws of concern. This was useful in deciding on thoracic endovascular aortic repair graft size and landing zone and facilitated safe spinal instrumentation removal and revision.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case23272","type":"journal-article","created":{"date-parts":[[2023,8,14]],"date-time":"2023-08-14T20:49:35Z","timestamp":1692046175000},"source":"Crossref","is-referenced-by-count":0,"title":["Intravascular ultrasound to aid in the diagnosis and revision of an intra-aortic pedicle screw: illustrative case"],"prefix":"10.3171","volume":"6","author":[{"given":"Landon D.","family":"Ehlers","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick J.","family":"Opperman","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jack E.","family":"Mordeson","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan R.","family":"Thompson","sequence":"additional","affiliation":[{"name":"Surgery, University of Nebraska, Omaha, Nebraska"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel L.","family":"Surdell","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"3","key":"b1","series-title":"Spine (Phila Pa 1976)","first-page":"180","article-title":"Safety and accuracy of freehand pedicle screw placement and the role of intraoperative O-arm: a single-institution experience","volume":"48","author":"Alomari S","year":"2023","unstructured":"Alomari S, Lubelski D, Lehner K,  Safety and accuracy of freehand pedicle screw placement and the role of intraoperative O-arm: a single-institution experience. Spine (Phila Pa 1976). 2023;48(3):180\u2013188."},{"issue":"12","key":"b2","series-title":"Eur Spine J","first-page":"1686","article-title":"Accuracy and safety of pedicle screw placement in neuromuscular scoliosis with free-hand technique","volume":"17","author":"Modi HN","year":"2008","unstructured":"Modi HN, Suh SW, Fernandez H, Yang JH, Song HR. Accuracy and safety of pedicle screw placement in neuromuscular scoliosis with free-hand technique. Eur Spine J. 2008;17(12):1686\u20131696."},{"key":"b3","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, Cakir 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."},{"issue":"6","key":"b4","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."},{"key":"b5","series-title":"J Neurosurg","first-page":"249","article-title":"Vascular complications related to lumbar disc surgery","volume":"100","author":"Bingol H","year":"2004","unstructured":"Bingol H, Cingoz F, Yilmaz AT, Yasar M, Tatar H. Vascular complications related to lumbar disc surgery. J Neurosurg. 2004;100(3 Suppl Spine):249\u2013253."},{"issue":"21","key":"b6","series-title":"Spine (Phila Pa 1976)","first-page":"2406","article-title":"Thoracic vertebral screw impingement on the aorta in an in vivo bovine model","volume":"30","author":"Faro FD","year":"2005","unstructured":"Faro FD, Farnsworth CL, Shapiro GS,  Thoracic vertebral screw impingement on the aorta in an in vivo bovine model. Spine (Phila Pa 1976). 2005;30(21):2406\u20132413."},{"key":"b7","series-title":"Ann Vasc Surg","first-page":"285.e17","article-title":"Endovascular treatment of late aortic erosive lesion by pedicle screw without screw removal: case report and literature review","volume":"39","author":"Zerati AE","year":"2017","unstructured":"Zerati AE, Leiderman DB, Teixeira WG,  Endovascular treatment of late aortic erosive lesion by pedicle screw without screw removal: case report and literature review. Ann Vasc Surg. 2017;39:285.e17\u2013285.e21."},{"issue":"5","key":"b8","series-title":"Surgery","first-page":"631","article-title":"Spontaneous abdominal aortic rupture from erosion by a lumbar spine fixation device: a case report","volume":"99","author":"Jendrisak MD","year":"1986","unstructured":"Jendrisak MD. Spontaneous abdominal aortic rupture from erosion by a lumbar spine fixation device: a case report. Surgery. 1986;99(5):631\u2013633."},{"issue":"1","key":"b9","series-title":"J Trauma","first-page":"140","article-title":"False aneurysm of the thoracic aorta associated with an aorto-chest wall fistula after spinal instrumentation","volume":"50","author":"Choi JB","year":"2001","unstructured":"Choi JB, Han JO, Jeong JW. False aneurysm of the thoracic aorta associated with an aorto-chest wall fistula after spinal instrumentation. J Trauma. 2001;50(1):140\u2013143."},{"issue":"2","key":"b10","series-title":"J Neurosurg","first-page":"253","article-title":"Delayed aortic rupture caused by an implanted anterior spinal device. Case report","volume":"95","author":"Ohnishi T","year":"2001","unstructured":"Ohnishi T, Neo M, Matsushita M, Komeda M, Koyama T, Nakamura T. Delayed aortic rupture caused by an implanted anterior spinal device. Case report. J Neurosurg. 2001;95(2 suppl):253\u2013256."},{"issue":"15","key":"b11","series-title":"Spine (Phila Pa 1976)","first-page":"1655","article-title":"Complications of thoracic pedicle screws in scoliosis treatment","volume":"32","author":"Di Silvestre M","year":"2007","unstructured":"Di Silvestre M, Parisini P, Lolli F, Bakaloudis G. Complications of thoracic pedicle screws in scoliosis treatment. Spine (Phila Pa 1976). 2007;32(15):1655\u20131661."},{"issue":"8","key":"b12","series-title":"J Bone Joint Surg Am","first-page":"1461","article-title":"The position of the aorta relative to the spine: a comparison of patients with and without idiopathic scoliosis","volume":"85","author":"Sucato DJ","year":"2003","unstructured":"Sucato DJ, Duchene C. The position of the aorta relative to the spine: a comparison of patients with and without idiopathic scoliosis. J Bone Joint Surg Am. 2003;85(8):1461\u20131469."},{"issue":"3","key":"b1","series-title":"Spine (Phila Pa 1976)","first-page":"180","article-title":"Safety and accuracy of freehand pedicle screw placement and the role of intraoperative O-arm: a single-institution experience","volume":"48","author":"Alomari S","year":"2023","unstructured":"Alomari S, Lubelski D, Lehner K,  Safety and accuracy of freehand pedicle screw placement and the role of intraoperative O-arm: a single-institution experience. 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J Neurosurg. 2004;100(3 Suppl Spine):249\u2013253."},{"issue":"21","key":"b6","series-title":"Spine (Phila Pa 1976)","first-page":"2406","article-title":"Thoracic vertebral screw impingement on the aorta in an in vivo bovine model","volume":"30","author":"Faro FD","year":"2005","unstructured":"Faro FD, Farnsworth CL, Shapiro GS,  Thoracic vertebral screw impingement on the aorta in an in vivo bovine model. Spine (Phila Pa 1976). 2005;30(21):2406\u20132413."},{"key":"b7","series-title":"Ann Vasc Surg","first-page":"285.e17","article-title":"Endovascular treatment of late aortic erosive lesion by pedicle screw without screw removal: case report and literature review","volume":"39","author":"Zerati AE","year":"2017","unstructured":"Zerati AE, Leiderman DB, Teixeira WG,  Endovascular treatment of late aortic erosive lesion by pedicle screw without screw removal: case report and literature review. Ann Vasc Surg. 2017;39:285.e17\u2013285.e21."},{"issue":"5","key":"b8","series-title":"Surgery","first-page":"631","article-title":"Spontaneous abdominal aortic rupture from erosion by a lumbar spine fixation device: a case report","volume":"99","author":"Jendrisak MD","year":"1986","unstructured":"Jendrisak MD. Spontaneous abdominal aortic rupture from erosion by a lumbar spine fixation device: a case report. Surgery. 1986;99(5):631\u2013633."},{"issue":"1","key":"b9","series-title":"J Trauma","first-page":"140","article-title":"False aneurysm of the thoracic aorta associated with an aorto-chest wall fistula after spinal instrumentation","volume":"50","author":"Choi JB","year":"2001","unstructured":"Choi JB, Han JO, Jeong JW. False aneurysm of the thoracic aorta associated with an aorto-chest wall fistula after spinal instrumentation. J Trauma. 2001;50(1):140\u2013143."},{"issue":"2","key":"b10","series-title":"J Neurosurg","first-page":"253","article-title":"Delayed aortic rupture caused by an implanted anterior spinal device. Case report","volume":"95","author":"Ohnishi T","year":"2001","unstructured":"Ohnishi T, Neo M, Matsushita M, Komeda M, Koyama T, Nakamura T. Delayed aortic rupture caused by an implanted anterior spinal device. Case report. J Neurosurg. 2001;95(2 suppl):253\u2013256."},{"issue":"15","key":"b11","series-title":"Spine (Phila Pa 1976)","first-page":"1655","article-title":"Complications of thoracic pedicle screws in scoliosis treatment","volume":"32","author":"Di Silvestre M","year":"2007","unstructured":"Di Silvestre M, Parisini P, Lolli F, Bakaloudis G. Complications of thoracic pedicle screws in scoliosis treatment. Spine (Phila Pa 1976). 2007;32(15):1655\u20131661."},{"issue":"8","key":"b12","series-title":"J Bone Joint Surg Am","first-page":"1461","article-title":"The position of the aorta relative to the spine: a comparison of patients with and without idiopathic scoliosis","volume":"85","author":"Sucato DJ","year":"2003","unstructured":"Sucato DJ, Duchene C. The position of the aorta relative to the spine: a comparison of patients with and without idiopathic scoliosis. J Bone Joint Surg Am. 2003;85(8):1461\u20131469."}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/6\/7\/article-CASE23272.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/6\/7\/article-CASE23272.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/6\/7\/article-CASE23272.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T14:34:17Z","timestamp":1770302057000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/6\/7\/article-CASE23272.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,14]]},"references-count":24,"journal-issue":{"issue":"7"},"URL":"https:\/\/doi.org\/10.3171\/case23272","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,14]]}}}