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Delayed paraparesis after posterior spinal fusion for congenital scoliosis: a case report

Spinal Cord Series and Cases volume 10, Article number: 24 (2024) Cite this article

Subjects

Abstract

Introduction

Although multimodal intraoperative neuromonitoring (IONM), which has high sensitivity and specificity, is typically performed during spinal deformity surgery, neurological status may deteriorate with delay after surgical maneuvers. Here, we report a rare case of delayed postoperative neurological deficit (DPND) that was not detected by IONM during posterior spinal fusion (PSF) for congenital scoliosis.

Case presentation

A 14-year-old male presented with congenital scoliosis associated with T3 and T10 hemivertebrae. Preoperative Cobb angle of proximal thoracic (PT) and main thoracic (MT) curves were 50° and 41°, respectively. PSF (T1-L1) without hemivertebrectomy was performed, and the curves were corrected to 31° and 21° in the PT and MT curves, respectively, without any abnormal findings in IONM, blood pressure, or hemoglobin level. However, postoperative neurological examination revealed complete loss of motor function. A revision surgery, release of the curve correction by removing the rods, was immediately performed and muscle strength completely recovered on the first postoperative day. Five days postoperatively, PSF was achieved with less curve correction (36° in the PT curve and 26° in the MT curve), without postoperative neurological deficits.

Discussion

Possible mechanisms of DPND in our patient are spinal cord ischemia due to spinal cord traction caused by scoliosis correction and spinal cord kinking by the pedicle at the concave side. Understanding the possible mechanisms of intra- and postoperative neural injury is essential for appropriate intervention in each situation. Additionally, IONM should be continued to at least skin closure to detect DPND observed in our patient.

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Fig. 1: Preoperative radiographs.
Fig. 2: Preoperative CT and MRI.
Fig. 3: Intraoperative radiograph after completing all correction maneuvers.
Fig. 4: Intraoperative neuromonitoring during the primary surgery.
Fig. 5: Intraoperative neuromonitoring during the revision surgery to release of the curve correction.
Fig. 6: Intraoperative radiograph during the revision surgery to release of the curve correction.
Fig. 7: Intraoperative radiograph during the final surgery.
Fig. 8: Schemas of possible mechanisms of postoperative neurological deficits in our patient.

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Data availability

All the data analyzed in this study are available from the corresponding author upon reasonable request.

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Funding

No funds were received in support of this work.

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Authors and Affiliations

  1. Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata City, Japan

    Shuhei Ohtsubo, Masayuki Ohashi, Hideki Tashi, Tatsuo Makino, Keitaro Minato, Hiroyuki Kawashima & Kei Watanabe

  2. Department of Orthopedic Surgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minamiuonuma City, Japan

    Toru Hirano

  3. Division of Anesthesiology, Niigata University Graduate School of Medical and Dental Sciences, Niigata City, Japan

    Yusuke Mitsuma, Hiroyuki Deguchi, Rintaro Hoshino, Nobuko Ohashi & Kenta Furutani

Authors
  1. Shuhei Ohtsubo
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  2. Masayuki Ohashi
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Contributions

SO, MO, TH, HT, TM, KM, YM, and HD contributed to the conception of the study, data collection, and interpretation of the results. SO and MO contributed to drafting the manuscript. SO, MO, TH, HT, TM, KM, YM, HD, RH, NO, KF, HK, and KW contributed to the critical revisions and final approval of the version to be published.

Corresponding author

Correspondence to Masayuki Ohashi.

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The patient consented to the submission of this case report to the journal.

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The authors declare no competing interests.

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Ohtsubo, S., Ohashi, M., Hirano, T. et al. Delayed paraparesis after posterior spinal fusion for congenital scoliosis: a case report. Spinal Cord Ser Cases 10, 24 (2024). https://doi.org/10.1038/s41394-024-00639-0

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