Leriche-Like Syndrome as a Delayed Complication Following Posterior Instrumentation of a Traumatic L1 Fracture: A Case Report and Literature Review.

STUDY DESIGN: Case report and review of literature. OBJECTIVE: Case report of an acute Leriche-like syndrome as an unusual complication after posterior transpedicular instrumentation of an L1 fracture. SUMMARY OF BACKGROUND DATA: Injuries to the aorta after pedicle screw placement are rare. Reports exist about acute hemorrhage, erosions, and pseudoaneurysm formation. METHODS: A 47-year-old female developed an acute occlusion of the infrarenal aorta after posterior transpedicular instrumentation of an L1 burst-fracture. The patient presented with increasing sensation of hypothermia in both lower extremities and cyanosis of the toes, as well as claudication-like symptoms 15 days after the initial surgery. CT angiography showed bicortical placement of the left pedicle screw at L2 with perforation of the anterior cortex of 2.5 mm and complete obliteration of the infrarenal aorta up to the bifurcation. RESULTS: The patient was treated with resection of the aorta and implantation of a silver graft prosthesis. Preoperative symptoms resolved immediately after surgery without reoccurrence. CONCLUSION: Although rare, the risk of iatrogenic injuries to the aorta during spine surgery exists, several complications have previously been described. However, this is the first report of an acute Leriche-like syndrome after posterior instrumentation of the spine. Whereas bicortical pedicle screw placement in selected cases of posterior spinal instrumentation is intended, one has to be aware of the possible risks, as in our case where an acute aortic obliteration was observed. Preoperative CT-based planning of surgery and profound knowledge of the neurovascular anatomy is mandatory. LEVEL OF EVIDENCE: 5.