Iatrogenic dural tear after growth modulation in AIS: an unusual complication and its management.

Abstract

To report a case of iatrogenic durotomy with symptomatic Chiari-like deformity in a patient after undergoing anterior vertebral body growth modulation (AVBGM) in skeletally immature patients with adolescent idiopathic scoliosis (AIS). There have not been reports of iatrogenic durotomy in the literature and its management after AVBGM. A 13-year-old skeletally immature girl underwent successful AVBGM for thoracic AIS from T6 to T12. Despite uneventful post-operative hospitalization, the patient suffered from recurrent and persistent bouts of headaches that were mostly orthostatic. At 3 months post-op, an MRI was performed on the suspicion of a cerebrospinal fluid (CSF) leak due to an iatrogenic durotomy. On MRI, decreased volume of CSF and a decrease in the dural sac diameter were observed. Furthermore, a pseudo-meningocele was seen at the last level of instrumentation. After an unsuccessfully trial of epidural blood patch combined with 5 days of supine immobilization, the patient was consented to screw revision as well as a lumbar drain. The lumbar drain was installed to redirect the CSF leak to allow the durotomy to heal. After 11 days, the drain was removed based on the favorable clinical evolution. Iatrogenic durotomy is a rare complication in AVBGM. This is the first report of such a case that involves a Chiari-like deformity on initial MRI investigation. We suggest that an MRI is performed for all patients presenting with symptoms of CSF leak after AVBGM.