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Late spinal cord compression caused by pulled-out thoracic pedicle screws: a case report
Ahmet Alanay1, Akin Cil, Emre Acaroglu
1University Faculty of Medicine, Department of Orthopaedics & Traumatology, Spine Unit, Ankara, Turkey. alanay@superonline.com
Spine
|December 16, 2003
Summary
Late neurologic compromise can occur from thoracic pedicle screws pulling out, particularly at T1 or T2 levels. Prompt removal of these displaced screws relieved the patient's symptoms.
Area of Science:
- Spinal Surgery
- Neurology
- Pediatric Orthopedics
Background:
- Thoracic pedicle screw misplacement is common, but neurologic injury is rare.
- Neurologic compromise due to screw pulling out has not been previously reported.
Observation:
- A 6-year-old girl with congenital muscle fiber type disproportion developed junctional kyphosis after spinal instrumentation.
- Transpedicular screws at T2 were later pulled out and intruded into the spinal canal, causing neurologic compromise.
Findings:
- Surgical removal of the intruded T2 pedicle screws resulted in the resolution of the patient's neurologic symptoms.
- The case highlights a novel mechanism of late neurologic deficit following spinal fusion.
Implications:
- Transpedicular screws at the T1-T2 levels, with their medial pedicle orientation, pose a risk for late neurologic compromise if they pull out.
- This case underscores the importance of vigilant monitoring for late complications after spinal instrumentation.