Intraoperative tension pneumothorax during posterior vertebral column resection in a child with congenital scoliosis

Abstract

Background:Intraoperative tension pneumothorax (TPT) is extremely rare in spinal surgery overall and particularly in extensive deformity procedures. Here, we report a TPT occurring in conjunction with posterior vertebral column resection (pVCR) for the treatment of congenital scoliosis.Case Description:A 12-year-old female undergoing congenital thoracic scoliosis surgery (e.g., pVCR) developed abrupt intraoperative increases in airway pressure and compromised hemodynamics that led to a TPT. This was directly attributed to an inadvertent pleural tear. Temporary drainage of the accumulated air was accomplished with a urethral catheter inserted directly into the pleural cavity. This was later supplemented with a standard chest tube. The child quickly improved and was routinely discharged a few days later.Conclusion:In patients undergoing pVCR, if the surgical team is faced with unexplained hemodynamic instability and increased airway resistance, a TPT should be strongly suspected and appropriately managed.

Kyphosis and canal compromise due to refracturing of an L1 cemented vertebra managed with posterior surgery alone

“…[6,7,9,10,12,16] Here, in a patient with a recurrent/symptomatic L1 compression fracture that resulted in kyphosis and canal compromise, we utilized a purely posterior approach (e.g., posterior vertebral column resection [pVCR]) that included the performance of an anterior corpectomy, reconstruction of the anterior column, and posterior vertebral body fusion. [4,13,14] wedge-shaped lateral compartments which were attached with a narrow medial bridge. Although the height of the anterior compartment was preserved with the PKP, the wedge-shaped posterior compartment was now significantly kyphotic and had migrated dorsally into the spinal canal resulting in significant conus/cauda equina compression [Figure 1].…”