Background: Spinal instrumentation is commonly
utilized to mechanically stabilize the spine in trauma, oncology and
degenerative disease. Although several complications have been reported,
this is the first case of screw penetration of the pulmonary artery.
Methods: We present a case of a 74-year old
gentleman who suffered from a thoracic spine chordoma. He underwent a T8
resection with T8-T12 instrumented fusion with subsequent radiation.
Recurrence of his disease led to resection of his 3rd
and 4th ribs and repeat radiation. He presented 6 years
later with 2 episodes of massive hemoptysis. Review of the literature was
conducted to search for similar complications.
Results: A Chest Computed Tomography scan
demonstrated the presence of a pedicle screw tip in the right pulmonary
artery. Angiogram revealed no evidence of active arterial extravasation. In
the operating room, the patient had a right lower lobectomy, with segmental
pulmonary artery sacrifice, as well as replacement of the spinal fixation
hardware. Literature review revealed multiple aortic injuries following
spinal instrumentation. However, this was the first case of pulmonary artery
erosion. Conclusions: Spinal instrumentation has been
associated with screw migration and penetration of nearby tissues and
vessels. A high incidence of suspicion is required when patients present
with delayed and unusual complications.