LATE NEUROLOGICAL COMPLICATION OF PEDICLE SCREW CORRECTION OF SCOLIOSIS

Abstract

The main health care gain in the correction of idiopathic scoliosis is cosmetic. Debate exists regarding the optimum implant method of fixation. The use of pedicle screws is the thoracic spine is common. Complications of implant placement are reported less frequently than they occur. The late development of neurological complications has not been reported before and the scoliosis society members need to be aware of the risk specifi-cally associated with increased kyphosis at the cranial end of the fusion. A 33 year old female underwent correction of a 72 degree right thoracic scoliosis. Pedicle screws were used and a costoplasty undertaken. Cord monitoring was satisfactory and there were no neurological symptoms or signs in the postoperative period. At six week review the patient was very pleased with the cosmetic improvement. At 8 weeks post operatively the patient became aware of a weakness in the right foot, at 10 weeks an early review was requested for what was thought to be a drop foot. In clinic at 11 weeks post op there was a sensory level at T5 with paretic gait and weakness grade 3 of the right leg. Imaging revealed an increase in the upper thoracic kyphosis and the upper right screw was confirmed as impinging on cord with MRI and CT. The screw was removed immediately and a rapid recovery occurred. Late complications of pedicle screws are not commonly reported. The upper thoracic spine may be a specific area of increased risk.