Delayed neurological deficit due to a medially misplaced thoracic pedicle screw during adolescent idiopathic scoliosis correction: a complication 6 years in the making.

IF 1.6 Q3 CLINICAL NEUROLOGY
Sudhir Suggala, Garrett A Dyess, Olivier Darbin, Richard P Menger
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引用次数: 0

Abstract

Purpose: Neurological deficits developing years after pedicle screw misplacement is a rare phenomenon. Here, we report level IV evidence of a previously asymptomatic medial thoracic pedicle screw resulting in paraparesis after a motor vehicle accident.

Methods: A 21-year-old male presented with acute onset of paraparesis following a motor vehicle collision. Six years prior this incident, the patient underwent a thoracolumbar fusion T4-L4 for AIS performed by an outside orthopedic surgeon. CT scan and CT myelogram illustrated decreased spinal canal diameter and cord compression from a medial T8 pedicle screw.

Results: Surgical removal of the misplaced pedicle screw resulted in a gradual complete recovery sustained over a period of 2 years. This case is compared to those reported in the literature review between 1981 and 2019 concerning delayed neurological deterioration related to misplaced pedicle screw.

Conclusion: This case reports a delayed neurological deficit implicating a misplaced pedicle screw. This phenomenon remains rare since 5 cases were reported in the literature over the last 4 decades. It calls into focus the need for confirmation of safe instrumentation during the intraoperative period. It also illustrates the potential difficult decision-making in regard to asymptomatic misplaced instrumentation.

Level of evidence: IV.

青少年特发性脊柱侧凸矫正过程中胸椎椎弓根螺钉内侧错位导致的延迟性神经功能缺损:长达 6 年的并发症。
目的:椎弓根螺钉错位多年后出现神经功能缺损是一种罕见现象。在此,我们报告了在一起机动车事故后,先前无症状的内侧胸椎椎弓根螺钉导致截瘫的 IV 级证据:一名 21 岁的男性患者在一次机动车碰撞后出现急性截瘫。事故发生六年前,该患者因AIS接受了由外院骨科医生实施的胸腰椎T4-L4融合术。CT扫描和CT脊髓造影显示,T8内侧椎弓根螺钉导致椎管直径减小和脊髓受压:手术取出错位的椎弓根螺钉后,患者在两年内逐渐完全康复。本病例与1981年至2019年文献综述中报道的与椎弓根螺钉错位相关的延迟性神经功能衰退病例进行了比较:本病例报告了与椎弓根螺钉错位有关的延迟性神经功能缺损。过去 40 年间,文献中仅报道了 5 例,因此这种现象仍然十分罕见。该病例强调了在术中确认器械安全的必要性。它还说明了在无症状的错位器械方面潜在的决策困难:证据等级:IV。
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来源期刊
CiteScore
3.20
自引率
18.80%
发文量
167
期刊介绍: Spine Deformity the official journal of the?Scoliosis Research Society is a peer-refereed publication to disseminate knowledge on basic science and clinical research into the?etiology?biomechanics?treatment?methods and outcomes of all types of?spinal deformities. The international members of the Editorial Board provide a worldwide perspective for the journal's area of interest.The?journal?will enhance the mission of the Society which is to foster the optimal care of all patients with?spine?deformities worldwide. Articles published in?Spine Deformity?are Medline indexed in PubMed.? The journal publishes original articles in the form of clinical and basic research. Spine Deformity will only publish studies that have institutional review board (IRB) or similar ethics committee approval for human and animal studies and have strictly observed these guidelines. The minimum follow-up period for follow-up clinical studies is 24 months.
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