#486 Novel Approach to Control Iatrogenic Great Vessel Laceration during Pedicle Subtraction Osteotomy

General Session: Cutting Edge Technology - Imaging Guidance

Presented by: P. Guillen


P.T. Guillen (1)
P.A. Ta (2)
W.K. Cheng (1)

(1) Loma Linda University Medical Center, Orthopaedic Surgery, Loma Linda, CA, USA
(2) Loma Linda University Medical Center, Loma Linda, CA, USA


Introduction: Intraoperative damage to great vessels during pedicle subtraction osteotomy (PSO) is rare, but life threatening. Laceration of the aorta and inferior vena cava carries a mortality rate as high as 61% and 78% respectively. A novel approach to control bleeding of the great vessels in a prone position has been developed as an emergency life-saving measure.

Methods: PSO was performed at the level of L3in six fresh frozen cadavers. Cadavers were divided into two groups. Group A accessed the great vessels through a direct posterior perivertebral approach. Group B was accessed through a traditional retroperitoneal via thoracoabdominal incision. Duration, ease of operation, and anatomical structures at risk were video recorded and compared.

Summarize Findings: The average amount of time it took to access the great vessels for group A was less than one minute. Structures at risk include sympathetic chain, and lumbar plexus within the psoas muscle. For group B, the average time took more than four minutes. Structures at risk include diaphragm, lumbo-sacral plexus, ureter, and psoas muscle. However, the exposure and visualization to the great vessels was superior for group B.

Conclusion: In an emergent situation during a PSO where intra-operative great vessel injury is present, a direct posterior perivertebral approach (Grp. A) was more efficient and superior in controlling emergent bleeding of the great vessels.