Transient hemiplegia in posterior instrumentation of scoliosis

Spine
Tobias L SchulteUlf Liljenqvist

Abstract

A case of transient hemiplegia during posterior correction and instrumentation of scoliosis in an 18-year-old woman. To present a case of transient hemiplegia most probably resulting from an arteriovenous fistula. Neurologic impairment in spinal surgery is a feared complication. Common reasons are direct or indirect trauma to neural elements, intraoperative hypotension, ischemia, bleeding, metabolic dysbalances, or drug effects. Review of the literature did not reveal any case of transient hemiplegia similar to the presented one in which none of the mentioned pathologies could be found. An 18-year-old woman with a right long thoracic lordoscoliosis measuring 67 degrees Cobb angle and a marfanoid phenotype underwent posterior correction and transpedicular instrumentation from T3 to L2. After uneventful correction of the deformity through rod rotation, the wake-up test revealed a right-sided hemiplegia without facial asymmetry or other neurologic abnormalities affecting structures above the spinal cord. The rods were removed, the pedicle screws left in place, and the patient was turned on her back. Within 30 minutes after extubation, the neurologic deficits disappeared completely. Extensive diagnostic workup, including magnetic r...Continue Reading

References

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