Cerebral infarction due to an embolism after cervical pedicle screw fixation.

Abstract

Case report and clinical discussion. We report a rare case of delayed onset of cerebral infarction caused by an embolism after cervical pedicle screw (CPS) fixation. CPS has a risk of vertebral artery (VA) injury. CPSs sometimes breach the transverse foramen without rupture of the VA. Most breaches are not considered harmful. We present a case in a 71-year-old man who underwent an operation for CPS fixation and laminoplasty for cervical spondylomyelopathy. He presented symptoms of hemiparesis 3 days after the operation. The left C4 pedicle screw was proven to breach the transverse foramen. An angiogram showed a thrombus cranial to the screw. The patient underwent anticoagulation therapy without removal of screw. After 2 weeks, the thrombus had disappeared. Subsequently, the pedicle screws were removed. At final follow-up, the patient complained of a grade 4/5 hemiparesis, facial nerve palsy, and hearing loss in his left ear. To our knowledge, this is the first case report of delayed onset of cerebral infarction caused by an embolism after CPS fixation. When a CPS perforates the transverse foramen, even if no apparent VA injury occurs during the operation, the surgeon must take care not to risk cerebral infarction because of an embolism.