Endovascular management of an aortic injury in thoracic kyphosis surgery: a minimally invasive rescue for a life-threatening injury

A patient in his early adolescence, who was treated for T5-T6 tubercular spondylodiscitis with an un-instrumented decompression, presented at 36 months post-index surgery, for post-laminectomy instability and kyphosis, after completing his requisite antitubercular treatment. He underwent thoracic posterior instrumented kyphosis correction and anterior reconstruction, with a T5-T6 partial corpectomy and corpectomy spacer placement, through a posterior midline incision. On the second postoperative day, he started complaining of pain on the left side of his chest, abdomen and left shoulder. On contrast-enhanced CT evaluation, one of the pedicle screws was found to be impinging on the aortic wall, with contrast opacification in the left hemithorax. After resuscitation, he underwent a minimally invasive endovascular procedure (thoracic endovascular aortic repair, TEVAR), circumventing the need for a complex and morbid open thoracic repair in an adolescent. Post-TEVAR, the pedicle screw realignment was done. The patient has now returned to full daily activities and a normal schooling.