Late spinal cord compression caused by pulled-out thoracic pedicle screws: a case report.

Abstract

A case report. To report a late neurologic compromise caused by pulling-out of thoracic pedicle screws. Although screw misplacement is quite common, only few neurologic injuries have been reported because of penetration of the medial wall of pedicles in the thoracic spine. To our knowledge, neurologic compromise caused by pulling-out of the screws has not been reported to date. A 6-year-old girl with congenital muscle fiber type disproportion was posteriorly instrumented (T3 to L4) for severe kyphosis. Later, she had a junctional kyphosis over the top of the instrument. Her instrumentation was lengthened to T2 by using transpedicular screws. During the follow-up period, T2 screws were pulled-out and intruded into the canal, causing neurologic compromise. The presenting symptoms, imaging studies, and related literature are reviewed in this report. Patient's neurologic symptoms subsided after removal of the pedicle screws intruded into the spinal canal. Pulling-out of transpedicular screws inserted at T1 or T2 where the pedicles are oriented more medially may cause late neurologic compromise caused by intrusion of triangulated screws into the spinal canal.