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Erschienen in: European Spine Journal 7/2016

06.06.2014 | Grand Rounds

Intraspinal canal rod migration causing late-onset paraparesis 8 years after scoliosis surgery

verfasst von: Ibrahim Obeid, Jean-Marc Vital, Nicolas Aurouer, Steve Hansen, Nicolas Gangnet, Vincent Pointillart, Olivier Gille, Louis Boissiere, Nasir A. Quraishi

Erschienen in: European Spine Journal | Ausgabe 7/2016

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Abstract

Introduction

Complete intraspinal canal rod migration with posterior bone reconstitution has never been described in the adolescent idiopathic scoliosis (AIS) population. We present an unusual but significant delayed neurological complication after spinal instrumentation surgery.

Case report

A 24-year-old woman presented with lower limb weakness (ASIA D) 8 years after posterior instrumentation from T2 to L4 for AIS. CT scan and MRI demonstrated intra-canal rod migration with complete laminar reconstitution. The C-reactive protein was slightly elevated (fluctuated between 10 and 20 mg/l). Radiographs showed the convex rod had entered the spinal canal. The patient was taken into the operating room for thoracic spinal decompression and removal of the convex rod. This Cotrel–Dubousset rod, which had been placed on the convexity of the thoracic curve had completely entered the canal from T5 to T10 and was totally covered by bone with the eroded laminae entirely healed and closed. There was no pseudarthrosis. Intra-operatively, the fusion mass was opened along the whole length of this rod and the rod carefully removed and the spinal cord decompressed. The bacteriological cultures returned positive for Propionibacterium acnes. The patient recovered fully within 2 months post-operatively.

Conclusion

We opine that the progressive laminar erosion with intra-canal rod migration resulted from mechanical and infectious-related factors. The very low virulence of the strain of Propionibacterium acnes is probably involved in this particular presentation where the rod was trapped in the canal, owing to the quite extensive laminar reconstitution.
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Metadaten
Titel
Intraspinal canal rod migration causing late-onset paraparesis 8 years after scoliosis surgery
verfasst von
Ibrahim Obeid
Jean-Marc Vital
Nicolas Aurouer
Steve Hansen
Nicolas Gangnet
Vincent Pointillart
Olivier Gille
Louis Boissiere
Nasir A. Quraishi
Publikationsdatum
06.06.2014
Verlag
Springer Berlin Heidelberg
Erschienen in
European Spine Journal / Ausgabe 7/2016
Print ISSN: 0940-6719
Elektronische ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-014-3367-y

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