Research Day
CASE REPORT: HYPERTROPHIC NONUNION FOLLOWING POSTERIOR SPINAL FUSION RESULTING IN COMPLETE AND RAPID PARALYSIS, A CALL FOR INCREASED AWARENESS
Document Type
Abstract
Date
2021
Abstract
Posterior spinal fusion (PSF) with instrumentation is one of the most widely performed procedures in the realm of Orthopaedic Spine Surgery. Whether performed alone or in combination with other various decompressive modalities, PSF can be utilized to treat numerous spinal conditions including discogenic low back pain, foraminal stenosis, trauma, neoplasm, and a spectrum of spinal deformities. Similar to other fusion procedures, a potential complication of PSF is hypertrophic nonunion and primarily due to inadequate stability as a result of hardware failure. Significant neural injury as a direct result of hypertrophic bony overgrowth is exceedingly uncommon and any resulting neurologic compromise often follows a slowly progressive assumingly predictable course. Thus, asymptomatic hypertrophic nonunion following PSF is primarily treated with close observation and regular follow-up in the outpatient setting. All of these aspects have led to the general acceptance of hypertrophic non-union following PSF as a benign entity with very sparce discussion in literature. However, rapid neurologic compromise due to hypertrophic nonunion of the spine remains a possibility and can lead to devastating outcomes for the patient, stressing the importance of a potential paradigm shift in treatment and observation protocols. Here, we present the unusual case of an 88 year-old female with history of known thoracolumbar nonunion from a prior T3-pelvis arthrodesis who presented with rapidly progressive lower extremity weakness that ultimately progressed to complete paralysis following CT myelogram. Despite immediate steroid treatment and operative decompression/stabilization patient remains completely paralyzed from the level of T9 down.