Devastating neurological complication after pectus excavatum surgery

Adverse reactions and complications in connection with mini-invasive pectus excavatum correc-tion can range from minor to life-threatening. The authors present a unique case of a patient who developed a severe neurological deficit after a mini-invasive correction of the pectus excavatum. A 16-year-old patient with symptomatic pectus excavatum, and a compression of the right atrium and ventricle verified by cardiac workup, was indicated for the Nuss correction. A mini -invasive surgery was performed under general anesthesia with epidural analgesia, without com-plications. On the first postoperative day, a weak triparesis developed, affecting both the lower limbs and the left upper limb. An immediate MRI revealed a multisegmented acute transverse myelopathy ranging from C1 to T11, with maximal cervical involvement, without intraspinal he-morrhage. An intravenous combination of antibiotics, virostatics, and corticosteroids was used in the acute phase of treatment. Both infectious and autoimmune etiology were ruled out by diag-nostic lumbar puncture. The patient's neurological status has gradually improved during inten-sive physiotherapy in a specialized center: 12 months later, the patient can walk with support, but continues to experience micturition problems. A follow-up MRI showed a significant regres-sion of signal changes as well as a spinal cord edema, reduced to the C5 -T2 range.