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Pediatric Horner's syndrome following posterior spinal fusion: a case series
Judy-Mae Lima1, Amy L McIntosh2,3, Daniel J Sucato2,3
1Department of Orthopedic Surgery, Texas Scottish Rite Hospital for Children, Dallas, TX, USA. sr207642@tsrh.org.
Insights
Pediatric posterior spinal surgery can rarely cause Horner
Area of Science:
- Pediatric Neurosurgery
- Ophthalmology
- Spinal Surgery
Background:
- Horner's syndrome is characterized by unilateral ptosis, miosis, and anhidrosis.
- It is a rare complication following posterior spinal surgery in children.
- The oculosympathetic pathway is vulnerable during cervicothoracic region surgery.
Purpose of the Study:
- To highlight Horner's syndrome as a rare complication of posterior spinal surgery in pediatric patients.
- To present a case series of pediatric patients who developed Horner's syndrome postoperatively.
Main Methods:
- A case series of three pediatric patients is presented.
- All patients underwent posterior spinal fusion involving the cervicothoracic region.
- Postoperative symptoms of miosis and ptosis were monitored.
Main Results:
- Three pediatric patients developed acquired Horner's syndrome after spinal surgery.
- Cases included patients with DiGeorge syndrome, congenital scoliosis, and Klippel-Feil syndrome.
- Symptoms included unilateral miosis or ptosis.
Conclusions:
- Horner's syndrome is a rare but possible complication of pediatric posterior spinal fusion.
- Injury to the oculosympathetic pathway can occur during cervicothoracic deformity correction.
- Potential mechanisms include traction injury or nerve root transection.
Purpose:
This case series aims to highlight Horner's syndrome, a clinical diagnosis of unilateral ptosis, miosis, and anhidrosis, as a rare complication of posterior spinal surgery in pediatric patients.
Methods:
In this series, we present three pediatric patients who developed Horner's syndrome after surgical correction of scoliosis involving the cervicothoracic region.
Results:
Case 1 is a 12-year-old female with DiGeorge syndrome who underwent revision surgery with extension into the cervical spine after developing proximal junctional kyphosis 2 years after her index spinal fusion procedure. Case 2 is a 9-year-old girl who had posterior spinal fusion for progressive thoracic congenital scoliosis. Case 3 is a 4-year-old female with Klippel-Feil syndrome who underwent correction of a cervicothoracic curve and hemivertebrae excision. Postoperatively, all three patients were noted to have either unilateral miosis or ptosis, with an eventual diagnosis of acquired Horner's syndrome.
Conclusions:
This case series demonstrates that Horner's syndrome is a rare complication after a posterior spinal fusion in the pediatric population. Each case highlights that the oculosympathetic pathway can be susceptible to injury during deformity correction, specifically near the cervicothoracic region, whether from traction injury or overt nerve root transection.
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