Acute respiratory failure due to hemothorax after posterior correction surgery for adolescent idiopathic scoliosis

A case report

Yoji Ogura, Koota Watanabe, Naobumi Hosogane, Yoshiaki Toyama, Morio Matsumoto

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: Although posterior correction and fusion surgery using pedicle screws carries the risk of vascular injury, a massive postoperative hemothorax in a patient with adolescent idiopathic scoliosis (AIS) is quite rare. We here report a case of a 12-year-old girl with AIS who developed a massive postoperative hemothorax. Case presentation. The patient had a double thoracic curve with Cobb angles of 63° at T2-7 and 54° at T7-12. Posterior correction and fusion surgery was performed using a segmental pedicle screw construct placed between T2 and T12. Although the patient's respiration was stable during the surgery, 20 minutes after removing the trachea tube, the patient's pulse oximetry oxygen saturation suddenly decreased to 80%. A contrast CT scan showed a massive left hemothorax, and a drainage tube was quickly inserted into the chest. The patient was re-intubated and a positive end-expiratory pressure of 5 cmH§ssub§2§esub§O applied, which successfully stopped the bleeding. The patient was extubated 4 days after surgery without incident. Based on contrast CT scans, it was suspected that the hemothorax was caused by damage to the intercostal arteries or branches during pedicle probing on the concave side of the upper thoracic curve. Extensive post-surgical blood tests, echograms, and CT and MRI radiographs did not detect coagulopathy, pulmonary or vascular malformation, or any other possible causative factors. Conclusion: This case underscores the potential risk of massive hemothorax related to thoracic pedicle screw placement, and illustrates that for this serious complication, respiratory management with positive airway pressure, along with a chest drainage tube, can be an effective treatment option.

Original languageEnglish
Article number132
JournalBMC Musculoskeletal Disorders
Volume14
DOIs
Publication statusPublished - 2013

Fingerprint

Hemothorax
Scoliosis
Respiratory Insufficiency
Thorax
Drainage
Chest Tubes
Vascular Malformations
Oximetry
Positive-Pressure Respiration
Vascular System Injuries
Hematologic Tests
Trachea
Ambulatory Surgical Procedures
Respiration
Arteries
Hemorrhage
Oxygen
Pressure
Lung
Pedicle Screws

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Rheumatology

Cite this

Acute respiratory failure due to hemothorax after posterior correction surgery for adolescent idiopathic scoliosis : A case report. / Ogura, Yoji; Watanabe, Koota; Hosogane, Naobumi; Toyama, Yoshiaki; Matsumoto, Morio.

In: BMC Musculoskeletal Disorders, Vol. 14, 132, 2013.

Research output: Contribution to journalArticle

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