Combined endovascular and neurosurgical approach to the removal of an intraaortic pedicle screw

Iatrogenic aortic injuries are a potentially devastating complication of spine surgery. In instrumented cases, injuries may occur in the perioperative period due to iatrogenic vessel injury, or they may occur years later as prominent implants erode or penetrate major vessels. The authors present a case of a 71-year-old man in whom a thoracic pedicle screw was found perforating the thoracic aorta during routine follow-up 6 months after surgery. Due to the risk of future complications, the screw was removed while simultaneously delivering an endovascular aortic stent to gain vascular control. Surgical considerations and potential technical limitations are discussed.