Floccari Lorena V, Larson A Noelle, Stans Anthony A, Fogelson Jeremy, Helenius Iikka
*Department of Orthopedic Surgery †Department of Neurologic Surgery Mayo Clinic, Rochester, MN ‡Department of Paediatric Orthpaedic Surgery, University of Turku and Turku University Hospital, Turku, Finland.
J Pediatr Orthop. 2017 Oct/Nov;37(7):e415-e420. doi: 10.1097/BPO.0000000000001008.
In pediatric patients, pedicle screws are malpositioned 5% to 15% of the time. Complications associated with malpositioned screws are infrequently reported in the literature. We present a series of adolescent idiopathic scoliosis (AIS) patients who presented in a delayed manner with positional headache and chronic dural leak adjacent to the pedicle screw tract.
Scoliosis databases at 2 centers were reviewed, and cases of delayed positional headaches following posterior spinal fusion for AIS were identified. Demographic and clinical data were collected.
Of 322 patients, 4 patients presented with positional headaches at a mean of 12.8 weeks following posterior spinal fusion surgery for AIS, with an interval time to diagnosis of 5 months. Computed tomographic myelogram demonstrated severe pedicle screw malposition in 1 patient, and minimal malposition in 3 patients (<2 mm violation). The patients had delayed presentation with positional headaches secondary to dural leak. All patients successfully underwent revision surgery with repair of the dural leak. At the time of latest follow-up, all patients are asymptomatic.
Pedicle screw malposition can result in dural leaks. Patients may present in a delayed manner with positional headaches and an acquired Chiari malformation. Clinical suspicion should prompt imaging of the brain or cervical spine followed by computed tomographic myelogram to determine site of leak. This is a rare complication from pedicle screw malposition.
Level IV-case series.
在儿科患者中，椎弓根螺钉位置不当的发生率为5%至15%。文献中很少报道与螺钉位置不当相关的并发症。我们报告了一系列青少年特发性脊柱侧凸（AIS）患者，他们以延迟的方式出现与椎弓根螺钉通道相邻的体位性头痛和慢性硬脊膜漏。
回顾了2个中心的脊柱侧凸数据库，确定了AIS后路脊柱融合术后出现延迟性体位性头痛的病例。收集了人口统计学和临床数据。
在322例患者中，4例在AIS后路脊柱融合手术后平均12.8周出现体位性头痛，诊断间隔时间为5个月。计算机断层扫描脊髓造影显示1例患者椎弓根螺钉严重位置不当，3例患者位置不当轻微（侵犯<2 mm）。这些患者因硬脊膜漏而延迟出现体位性头痛。所有患者均成功接受了修复硬脊膜漏的翻修手术。在最近一次随访时，所有患者均无症状。
椎弓根螺钉位置不当可导致硬脊膜漏。患者可能以延迟的方式出现体位性头痛和后天性Chiari畸形。临床怀疑应促使对脑部或颈椎进行成像，随后进行计算机断层扫描脊髓造影以确定漏出部位。这是椎弓根螺钉位置不当的一种罕见并发症。
IV级——病例系列。
