Complete spinal cord injury from postoperative seroma following scoliosis surgery: A case report with favorable ambulatory outcomes after comprehensive rehabilitation

The Journal of Spinal Cord Medicine, 2023 · DOI: 10.1080/10790268.2022.2108661 · Published: March 1, 2023

Spinal Cord Injury Orthopedics Rehabilitation

Simple Explanation

A 15-year-old female experienced complete spinal cord injury (SCI) due to a rare postoperative seroma following scoliosis surgery. After immediate decompressive laminectomy and subsequent rehabilitation, including robotic-assisted gait training (RAGT), the patient showed significant improvement. The patient progressed from complete loss of motor and sensory function (ASIA Impairment Scale grade A) to regaining functional ambulation (grade D) within three months. This highlights the potential for recovery with prompt intervention and comprehensive rehabilitation. The study describes a rehabilitation program utilizing RAGT for locomotor training in managing SCI associated with postoperative seroma, documenting the patient’s neurological status and functional outcomes.

Study Duration

3 Months

Participants

One 15-year-old female

Evidence Level

Level IV: Case Report

Key Findings

1
A 15-year-old female with idiopathic scoliosis experienced complete SCI post-surgery due to seroma, demonstrating significant neurological recovery from AIS A to D after intensive rehabilitation including RAGT.
2
Early detection and decompressive surgery, combined with a comprehensive 3-month inpatient rehabilitation program augmented with RAGT, contributed to the favorable ambulatory outcomes.
3
The patient regained functional walking ability, showcasing the potential for neurological improvement and functional recovery even in rare cases of complete SCI due to postoperative seroma.

Research Summary

This case report describes a rare instance of complete SCI resulting from postoperative seroma following scoliosis surgery, emphasizing the importance of prompt postoperative examination and early rehabilitation. The patient achieved significant neurological improvement and ambulatory outcomes after inpatient rehabilitation, which included the use of robotic-assisted gait training (RAGT). The study suggests that early detection, decompressive surgery, and intensive rehabilitation with RAGT may improve lower-limb motor strength and functional recovery in similar cases.

Practical Implications

Early Postoperative Monitoring

Routine postoperative neurological examination is crucial to detect early signs of SCI following scoliosis surgery.

Prompt Decompressive Surgery

Early surgical intervention to decompress the spinal cord in cases of seroma-induced SCI is vital for potential neurological recovery.

Comprehensive Rehabilitation Program

Intensive rehabilitation, including RAGT, can significantly improve ambulatory outcomes and neurological recovery in patients with SCI secondary to postoperative seroma.

Study Limitations

1
Shorter duration of Lokomat® training (five times per week for 2 weeks) was a limitation in the present case.
2
The study is limited by being a single case report, which restricts the generalizability of the findings to a broader population.
3
Lack of a control group makes it difficult to definitively attribute the patient's improvement solely to the RAGT intervention.

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