Exposure of Pedicle Screws due to Chronic Vertebral Erosion by Tracheostomy Tube Cuff Balloon: A Case Report. Issue 3 (12th July 2022)

• Record Type: Journal Article
• Authors: Gupta, Arjun; Harbison, R. Alex; Sponseller, Paul D.
• Is Part Of: JBJS case connector. Volume 12:Issue 3(2022)
• Publication Date: 2022-07-12
• Subjects: adolescent -- young adult -- pedicle screw -- instrumentation -- posterior spinal fusion -- scoliosis -- Duchenne muscular dystrophy -- DMD -- tracheostomy -- ventilator dependence -- mechanical ventilation -- long-term tracheostomy -- tracheostomy cuff balloon -- vertebral erosion -- vertebral destruction -- pressure injury -- ischemic osteonecrosis -- scalloped erosion; Orthopedic surgery -- Case studies -- Periodicals; Orthopedic surgery -- Periodicals; Orthopedics; Orthopedic Procedures; Orthopedic surgery; Periodicals; Electronic journals; Case studies; Periodicals; 616.7
• DOI: 10.2106/JBJS.CC.22.00310
• Languages: English
• ISSNs: 2160-3251

Abstract

Abstract : Case: We report a patient with permanent tracheostomy in the context of muscular dystrophy presented for pneumonia. On bronchoscopy, a pedicle screw was seen penetrating the trachea. Computed tomography revealed significant anterior erosion of the T1-T3 vertebrae due to chronic pressure injury from the tracheostomy cuff, exposing pedicle screws implanted >10 years earlier. The patient was fitted for a custom low-pressure cuff. No further sequelae developed for 4 months. Conclusion: To the best of our knowledge, this is the first case of exposed spinal fusion instrumentation due to chronic vertebral erosion. Early sagittal imaging and the use of low-pressure cuffs may help prevent this complication.