Suggala Sudhir, Dyess Garrett A, Darbin Olivier, Menger Richard P
Department of Neurosurgery, University of South Alabama, 1601 Center Street, Suite 2D, Mobile, AL, 36604, USA.
Spine Deform. 2025 Jan;13(1):311-324. doi: 10.1007/s43390-024-00951-7. Epub 2024 Sep 4.
Neurological deficits developing years after pedicle screw misplacement is a rare phenomenon. Here, we report level IV evidence of a previously asymptomatic medial thoracic pedicle screw resulting in paraparesis after a motor vehicle accident.
A 21-year-old male presented with acute onset of paraparesis following a motor vehicle collision. Six years prior this incident, the patient underwent a thoracolumbar fusion T4-L4 for AIS performed by an outside orthopedic surgeon. CT scan and CT myelogram illustrated decreased spinal canal diameter and cord compression from a medial T8 pedicle screw.
Surgical removal of the misplaced pedicle screw resulted in a gradual complete recovery sustained over a period of 2 years. This case is compared to those reported in the literature review between 1981 and 2019 concerning delayed neurological deterioration related to misplaced pedicle screw.
This case reports a delayed neurological deficit implicating a misplaced pedicle screw. This phenomenon remains rare since 5 cases were reported in the literature over the last 4 decades. It calls into focus the need for confirmation of safe instrumentation during the intraoperative period. It also illustrates the potential difficult decision-making in regard to asymptomatic misplaced instrumentation.
IV.
椎弓根螺钉误置数年之后出现神经功能缺损是一种罕见现象。在此，我们报告四级证据，即一例先前无症状的胸段内侧椎弓根螺钉在机动车事故后导致双下肢轻瘫。
一名21岁男性在机动车碰撞后出现双下肢轻瘫急性发作。此次事件发生前六年，该患者由一名外地骨科医生进行了针对特发性脊柱侧凸的胸腰段T4-L4融合术。CT扫描和CT脊髓造影显示T8内侧椎弓根螺钉导致椎管直径减小和脊髓受压。
手术取出误置的椎弓根螺钉后，患者在2年时间里逐渐完全康复。将该病例与1981年至2019年文献综述中报道的与椎弓根螺钉误置相关的延迟性神经功能恶化病例进行了比较。
本病例报告了一例由误置椎弓根螺钉导致的延迟性神经功能缺损。这种现象仍然罕见，因为在过去40年的文献中仅报道了5例。它凸显了术中确认器械置入安全的必要性。它还说明了对于无症状的误置器械可能存在的艰难决策。
四级。
