Amazing scoliosis surgery complication!

[Dr Kalla]

This is something one doesn't hear much about and I never would have thought it would happen to anybody. Scoliosis surgery gone wrong?

Imagine having to go to the doctor with knee pain, swelling and limited range of motion and come up with the diagnosis and treatment that they did in this case.

here is parts straight from the SPINE article presented in April 2010.

Case Report
A 38-year-old man presented to our outpatient department
with complaint of pain, swelling, and restriction of
movements around the left knee joint for last 10 days.
There was no history of any recent trauma or fever. He
had experienced pain in left hip 2 months back which
was relieved with analgesics. He had a history of fall
from stairs 4 years ago, leading to spinal injury with
weakness in both legs for which he was operated soon
after. Physical examination at presentation demonstrated
a hard, movable swelling on the lateral aspect of
left knee joint, with no signs of inflammation.Knee flexion
was restricted to 90° only.

Radiographs of the knee revealed a radio-opaque
shadow of ~10 cm * 4 mm on the lateral aspect of knee.
SpinalRodNewLocat&.jpg

Subsequent radiographs of the dorsolumbar
spine showed screws in D12 and L2 vertebrae with no
rod in between.
SpinalRodMissing&#83.jpg

Previous postoperative radiographs
were obtained, which showed screws and interconnecting
rod in situ on the left side.
SpinalRodAfterSu&#114.jpg

Because of the persistent symptoms and our suspicion
of migration of rod from spine to knee, patient was taken
to the operating room for exploration. Surgical exploration
revealed single metal rod lying in the soft tissues on
the lateral aspect of the knee, which was removed.
SpinalRodExtracti.jpg

[Goldfinch]

That is amazing! I note that this is only the third case they have ever heard of it. I've certainly never heard of it happening before, and wondered if it could possibly be an April Fool!

The rod used in this case is very very short and of a small diameter; it is much shorter than those used for scoliosis surgery, and unlike those now used for scoliosis surgery in the UK and US, it was a single anterior rod which attached to the spine only at the ends. Thankfully, rods used in scoliosis surgery are much much more stable, being fixed to the pedicles of each vertebra.

Despite the smallness of this rod, it's still astounding and fascinating how it could migrate so far!

[Dr Kalla]

I sure hope that it is not an April fool thing, although it was my first thought, as it is indexed in PubMed. It would be great tragic if April fool jokes were to be indexed there. (If there comes an erratum in the next issue on the 15th, then I will sure post it here.)

4 mm rods are perhaps not used in scoliosis surgery, but 5 and 6 mm rods are and I doubt it would have made much difference in this case in how the rod migrated.

IMPORTANT! I doubt this will ever happen in scoliosis patients, because, as you mentioned Goldfinch, rods are attached more than only two pedicle screws and most rods are slightly bent during surgery to follow the normal curves of the spine.

[Goldfinch]

No, you're quite right, it is a genuine article indeed! I'm just gobsmacked. I've seen rods that have come loose and have migrated slightly on occasion before (this is extremely rare, but it can happen, usually in cases of pseudarthrosis) but the sheer length of the rods mean that even an original Harrington (which was attached at the ends only) could not move far without being symptomatic.

For any implant to end up so far from its original site without causing problems on the way is really astounding.

[DrStitzel]

"Gobsmacked"!? I love it! GREAT WORD CHOICE! I have to find a way to work that one into general conversation and see if anyone notices.

Thanks for the smile Sarah.

[Goldfinch]

Haha! I guess that must be a phrase that's only used here in the UK then!