Spine Surgery pp 165-172 | Cite as

Delayed Neurological Deficit and Surgical Site Infection After Pedicle Subtraction Osteotomy in a Revision Case

  • Susana Núñez-Pereira
  • Ferran PelliséEmail author


This case highlights 2 feared complications of adult deformity surgery: the development of a new neurological deficit and deep surgical site infection. The neurological deficit in this patient had a delayed onset. This is an atypical occurrence, and its management differs from that of deficits detected on intraoperative neuromonitoring. As to the surgical site infection, the patient was at high risk for this complication. Following appropriate treatment, she had an infection relapse 13 months later, which required a partial 2-stage implant exchange.


  1. 1.
    Pellisé F, Vila-Casademunt A, Núñez-Pereira S, Domingo-Sàbat M, Bagó J, Vidal X, et al. The adult deformity surgery complexity index (ADSCI): a valid tool to quantify the complexity of posterior adult spinal deformity surgery and predict postoperative complications. Spine J. 2018;18(2):216–25.CrossRefGoogle Scholar
  2. 2.
    Kelly MP, Lenke LG, Shaffrey CI, Ames CP, Carreon LY, Lafage V, et al. Evaluation of complications and neurological deficits with three-column spine reconstructions for complex spinal deformity: a retrospective scoli-risk-1 study. Neurosurg Focus. 2014;36(5):E17.CrossRefGoogle Scholar
  3. 3.
    Auerbach JD, Kean K, Milby AH, Paonessa KJ, Dormans JP, Newton PO, et al. Delayed postoperative neurologic deficits in spinal deformity surgery. Spine (Phila Pa 1976). 2016;41(3):E131–8.CrossRefGoogle Scholar
  4. 4.
    Buchowski JM, Bridwell KH, Lenke LG, Kuhns CA, Lehman RA, Kim YJ, et al. Neurologic complications of lumbar pedicle subtraction osteotomy: a 10-year assessment. Spine (Phila Pa 1976). 2007;32(20):2245–52.CrossRefGoogle Scholar
  5. 5.
    Núñez-Pereira S, Pellisé F, Rodríguez-Pardo D, Pigrau C, Sánchez JM, Bagó J, et al. Individualized antibiotic prophylaxis reduces surgical site infections by gram-negative bacteria in instrumented spinal surgery. Eur Spine J. 2011;20(Suppl 3):397–402.CrossRefGoogle Scholar
  6. 6.
    Maruo K, Berven SH. Outcome and treatment of postoperative spine surgical site infections: predictors of treatment success and failure. J Orthop Sci. 2014;19(3):398–404.CrossRefGoogle Scholar
  7. 7.
    Kowalski TJ, Berbari EF, Huddleston PM, Steckelberg JM, Mandrekar JN, Osmon DR. The management and outcome of spinal implant infections: contemporary retrospective cohort study. Clin Infect Dis. 2007;44(7):913–20.CrossRefGoogle Scholar
  8. 8.
    Muschik M, Lück W, Schlenzka D. Implant removal for late-developing infection after instrumented posterior spinal fusion for scoliosis: Reinstrumentation reduces loss of correction. A retrospective analysis of 45 cases. Eur Spine J. 2004;13(7):645–51.CrossRefGoogle Scholar
  9. 9.
    Smith JS, Shaffrey CI, Klineberg E, Lafage V, Schwab F, Lafage R, et al. Complication rates associated with 3-column osteotomy in 82 adult spinal deformity patients: retrospective review of a prospectively collected multicenter consecutive series with 2-year follow-up. J Neurosurg Spine. 2017;27(4):444–57.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Spine UnitHospital Universitario DonostiaDonostia/San SebastiánSpain
  2. 2.Department of Orthopaedic Surgery, Spine UnitUniversity Hospital Vall d’HebronBarcelonaSpain

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