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. 2025 Jan 27;9(4):CASE24291.
doi: 10.3171/CASE24291. Print 2025 Jan 27.

Management of intercostal artery pseudoaneurysm following posterior pedicle screw insertion: illustrative case

Mohammad Ghorbani  1 , Mohammadtaghi Imanikhosroshahi  2 , Reza Mollahoseini  2 , Homayoon Khaledian  3   4
Affiliations

Management of intercostal artery pseudoaneurysm following posterior pedicle screw insertion: illustrative case

Mohammad Ghorbani et al. J Neurosurg Case Lessons. .

Abstract

Background: Pedicle screw insertion in posterior spinal surgery can cause vascular injuries, including rare intercostal artery pseudoaneurysms, which are typically discovered incidentally during reimaging. Onyx embolization is an effective treatment for small artery pseudoaneurysms.

Observations: A 36-year-old man who had initially presented with back pain that remained unresponsive to nonsteroidal anti-inflammatory drugs was diagnosed with a T7-8 sarcomatous lesion confirmed by magnetic resonance imaging and biopsy. He underwent a posterior resection and T5-10 stabilization with pedicle screws. After surgery, significant hemorrhage led to his transfer for digital subtraction angiography, which revealed a prominent vascular tumor blush and a pseudoaneurysm of the right T5 intercostal artery due to screw placement. The tumor and pseudoaneurysm were effectively embolized using superselective catheterization and Onyx.

Lessons: This report highlights the dangers of intercostal artery damage from posterior spinal screws, emphasizing the need for meticulous postoperative imaging. Onyx embolization is an effective treatment for such complications. https://thejns.org/doi/10.3171/CASE24291.

Keywords: case report; intercostal artery; pedicle screw; posterior spine surgery; pseudoaneurysm.

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Figures

FIG. 1.
FIG. 1.
Sagittal (left) and axial (right) magnetic resonance imaging of the T7–8 vertebrae, indicating a sarcomatous lesion.
FIG. 2.
FIG. 2.
Right T5 intercostal artery pseudoaneurysm (green arrow) due to T5 pedicle screw insertion, found incidentally on CTA.
FIG. 3.
FIG. 3.
CTA of the right T5 intercostal artery pseudoaneurysm (green arrow).
FIG. 4.
FIG. 4.
CTA after T5 intercostal artery pseudoaneurysm embolization.
See this image and copyright information in PMC

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