Intracranial Hypotension After Surgery for Idiopathic Scoliosis Managed Conservatively: A Case Report and Literature...

Intracranial hypotension (IH) following scoliosis surgery is a rare complication, most commonly associated with dural injury or pedicle screw malposition, often requiring revision surgery. We present a case of postoperative IH after surgery for scoliosis that was successfully managed with conservative treatment alone. A 19-year-old female with idiopathic scoliosis underwent posterior spinal fusion from T2 to L1. The surgery was completed without intraoperative complications, including motor-evoked potential deterioration or dural injury. On postoperative day 3, she developed severe orthostatic headache accompanied by nausea and tinnitus. Cranial and spinal magnetic resonance imaging revealed diffuse dural thickening, pituitary enlargement, and epidural fluid collection consistent with IH. Computed tomography showed no definite malposition of pedicle screws. The patient was successfully treated with bed rest and hydration for one week without recurrence. This case highlights that revision surgery is not always necessary for IH following scoliosis surgery, especially in cases of minor medial pedicle screw breach or unrecognized dural tear.