Delayed neurological deficit due to a medially misplaced thoracic pedicle screw during adolescent idiopathic scoliosis correction: a complication 6 years in the making

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 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.

• 1
  A medially misplaced T8 pedicle screw, previously asymptomatic, caused a delayed neurological deficit six years after scoliosis surgery following a motor vehicle collision.
• 2
  The misplaced screw caused an at-risk stenosis of the spinal canal, which presented as a transient cord compression or potential contusion.
• 3
  Literature review identified 22 case reports describing 35 cases (1981 – 2019) of delayed neurological sequelae after spinal deformity surgery.