Delayed Presentation of Tetraparesis Following Posterior Thoracolumbar Spinal Fusion and Instrumentation for Adolescent Idiopathic Scoliosis

Study Design. Case report. Objective. We present a case of delayed tetraparesis in a patient after posterior spinal fusion for adolescent idiopathic scoliosis. Summary of Background Data. The reported rate of neural complications after scoliosis surgery is low. Intraoperative neuromonitoring is used to detect and prevent spinal cord injury. Methods. Review of medical record. Results. Delayed tetraparesis developed on the second postoperative day after unremarkable T3-L4 posterior fusion. MRI revealed evidence of cord ischemia at C4-C7. Angiogram revealed a hypervascular T4 body resulting in arteriovenous shunting into the epidural venous plexus. Conclusion. Venous congestive myelopathy due to arteriovenous shunting or unrecognized syrinx are presented as possible etiologies of this patient's spinal cord injury. A preoperative MRI may have helped discern the cause of this patient's spinal cord injury.