The Pancake Sign: A Case Report

Dominic A. Nistal, Ryan Adams, Daniel Wei and Arthur L. Jenkins III

Department of Neurosurgery, Icahn School of Medicine at Mount Sinai-The Mount Sinai Hospital, USA
Department of Orthopaedics, Icahn School of Medicine at Mount Sinai-The Mount Sinai Hospital, USA

^*Correspondance to: Arthur L. Jenkins III 

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Abstract:

Background: Complications resulting from spinal surgery are known to involve injury to the contents anterior to the spine and the retroperitoneal space. This includes, but is not limited to the arterial and venous structures such as the aorta, vena cava, iliac arteries and veins. A case study provided by Postacchini et al elaborated on a posterior approach related to a lumbar interbody fusion which resulted in a lesion to the abdominal vessels. A separate case study illustrates a more severe complication in which improper pedicle screw placement culminated in penetration of the thoracic aorta, which was not detected until a six month follow up. While several incidents pertaining to direct injury of arterial and venous structure are well documented in clinical literature, there is a gap in knowledge related to delayed complications such as adhesions. This lack of understanding may implicate anterior spine surgery in being more detrimental than a posterior approach.Case Report: We illustrated the case of a 46 year old, male patient who underwent a posterior lumbar procedure without any known or documented case of entry into the retroperitoneal space in 2016. This patient subsequently developed scarring which was noted on CT and MRI scans spanning from the left common iliac vein to the L5-S1 disk space. Upon attempting to mobilize that common iliac vein, the patient incurred a life threatening tear in the lining of the vein.Conclusion: The incidence at which this type of injury occurs post spine surgery is unknown and warrants further study. The radiographic sign of this clinical finding is described.

Keywords:

Neurosurgery; Spine; Spondylolisthesis; Pseudoarthrosis; Vascular; Case report; Common iliac vein; Radiology

Cite the Article:

Nistal DA, Adams R, Wei D, Jenkins AL. The Pancake Sign: A Case Report. Ann Clin Case Rep. 2017; 2: 1365.