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| ВХОД ДЛЯ ПАЦИЕНТОВ вверх поиск админ главная
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из Коллеги, Шуруп в аорте? Как снимать конструкцию? Нужен ли контроль аорты? Читайте ниже. С уважением, д-р Архипов
dear all (George?) Got a note this morning requesting an opinion about a patient 25 yrs from a remote area of the country who received this "excellent" stabilization of a fractured thoracic spine over a year ago.The original neurosurgeon liberated the patient for full activities and rehab etc.The rehab doc wants to know what to do. Looks to me like the patient was screwed pretty good! any offers? Tom From: David Dent Tom, Harrington rods from a medical museum, with industrial strength screws from a boat builder. What are the current symptoms? David From: Mark Pleatman Interesting case. Findings on CT: all four pedicle screws have been placed improperly in that they miss the vertebral bodies. In addition, the screws on the left side are impinging on the decending thoracic aorta. What I do NOT know is the nature of the original injury, or whether or not that injury has resolved. I would recommend removal of the hardware. I don't think it's a good idea to leave those screws where they are. If the original fracture is healed, nothing else needs to be done. Mark Pleatman From: Thomas Anthony Horan dear Mark, all the details are not yet available but the patient is coming to see us for advice. We probably will see him in the early new year. i thought that the 4th picture showed the screw to enter the aorta? He is a victim of a motor vehicle crash and thoracic vertebral fracture which appears healed. He was posteriorly decompressed and this device inserted. as you say there isno evidenece that any of the fixation enters the bodies via the pedicles istead they have passed thru and their end are no where near where they ought to be. If I am correct (I would prefer not to be) the aortic intima has been breached by the screw. When the time comes to take the screw out I thought we should have control of the aorta. What do you think? Tom From: Mark Pleatman Tom: I strongly doubt that the aorta is involved. When these screws are put in, they first put in a probe, then a tap, then the screw. If the aorta was punctured, they would have known at the time. You might call the original surgeon (if in fact he is a real doctor) and get his feedback. The additional morbidity of a prophylactic thoracotomy would be a higher price than I would be willing to subject my patient to. Besides, it would be exceptionally difficult to control the aorta at this point, especially if you tried to specifically get enough control to be able to put sutures in the back wall. Of course, difficulty of doing something isn't necessary a reason not to do it if you think it is necessary. I just think it is highly unlikely that the aorta is injured. I showed the case to both a thoracic surgeon and a neurosurgeon. The thoracic surgeon suggested getting an arteriogram to see if the aorta is involved. The neurosurgeon agreed that the hardware should be removed. Mark From: Thomas Anthony Horan Mark Thank you. He is scheduled for a angio prior to transfer here. I keep going back to look at that fourth image and although it is tough to believe the wall of the aorta seems to encompass the distal 1/2 of the screw. I have come to anticipate mal postion of screws that have been inserted in hospitals that perhaps may not have the highest quality of equipment, including the human and radiological components. That having been said this case seems to surpass the usual... one screw out of place or screwed into a disc etc. BTW I am not suggesting that the screw was placed directly into the aorta but that moviment, pulse action etc may have caused it to transgress the normal anatomical bounds without evident hemorrhage. Tom From: Mark Pleatman Tom: I think it's easy to be misled by CT scans. I'd bet a bottle of good Scotch whiskey that the aorta is uninjured. Mark From: Thomas Anthony Horan Mark, would you accept a good bottle of cachaзa if I am wrong? Tom From: Mark Pleatman Tom: I had to look it up to make sure you weren't offering something like fermented sheep's blood. You've got a deal. Mark From: Paul Zaveruha But he can truly say the screw placement has a lifetime gurantee...
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