Pedicle Screw-Aortic Interaction: A Single Centre Experience and Proposal for a Morphology Based Management Algorithm.

Objective: Pedicle screw (PS) fixation is widely used in thoracolumbar spine surgery. Although major vascular injury is uncommon, PS-aortic interactions may lead to severe complications, and optimal management remains poorly defined. This study proposes a morphology based algorithm to guide multidisciplinary management of PS-aortic interactions and reports a single centre experience. Methods: All consecutive patients referred to a vascular surgery unit between 2020 and 2025 for PS interaction with the descending thoracic aorta were reviewed retrospectively. Pre-operative assessment was performed using contrast enhanced computed tomography angiography (CTA). Screw-aorta interactions were classified as near contact (NC), aortic contact (AC), aortic indentation (AI), or aortic penetration (AP). Management followed a multidisciplinary morphology based algorithm: NC and AC were managed with screw removal under serial intra-operative angiographic control, whereas AI and AP underwent prophylactic thoracic endovascular aortic repair (TEVAR). Results: Eight patients (median age 25 years [interquartile range 18, 38]) were included. Indications for spinal fixation were scoliosis ( Conclusion: A morphology based algorithm prioritising aortic wall deformation rather than proximity alone may provide a feasible and potentially safe strategy for managing PS-aortic interactions, supporting standardised multidisciplinary decision making in this rare but high risk condition.