Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 16, 2023; 11(20): 4890-4896
Published online Jul 16, 2023. doi: 10.12998/wjcc.v11.i20.4890
Acute spinal subdural haematoma complicating a posterior spinal instrumented fusion for congenital scoliosis: A case report
Godefroy Michon du Marais, Anne Tabard-Fougère, Romain Dayer
Godefroy Michon du Marais, Division of Paediatric Orthopaedics and Traumatology Unit, Geneva University Hospitals and Geneva University, Geneva 1205, Switzerland
Anne Tabard-Fougère, Romain Dayer, Division of Paediatric Orthopaedics, Geneva University Hospitals and Geneva University, Geneva 1205, Switzerland
Author contributions: Michon du Marais G designed the research study, analysed the data and wrote the manuscript; Tabard-Fougere A reviewed and edited the manuscript; Dayer R designed the research study and edited and reviewed the manuscript; All authors read and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and all accompanying images.
Conflict-of-interest statement: The authors reported no competing interests relevant to this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Anne Tabard-Fougère, PhD, Research Assistant, Division of Paediatric Orthopaedics, Geneva University Hospitals and Geneva University, Rue Willy-Donzé 6, Geneva 1205, Switzerland. anne.tabard@hcuge.ch
Received: November 7, 2022
Peer-review started: November 7, 2022
First decision: January 12, 2023
Revised: January 21, 2023
Accepted: June 13, 2023
Article in press: June 13, 2023
Published online: July 16, 2023
Abstract
BACKGROUND

Acute spinal subdural haematoma (ASSH) is a rare and potentially devastating condition with a variable prognosis. Previously described subdural haematomas were thought to have occurred spontaneously or be related to major or minor iatrogenic or traumatic injuries caused by surgery, spinal puncture or epidural anaesthesia. Other contributing pathologies have been described, such as intradural tumours or spinal arteriovenous malformations. ASSH has also been associated with anticoagulation therapy, haemostatic abnormalities and risk factors such as pregnancy. To the best of our knowledge, this case study described the first reported occurrence of an ASSH during spinal surgery in a paediatric patient. The patient was not known to have any coagulopathies, and no obvious vascular lesions were documented. The surgical procedure did not directly involve the dura mater, and no evident intraoperative dural tears were found.

CASE SUMMARY

We reported and discussed a case of ASSH complicating a posterior spinal instrumented fusion during surgery for paediatric congenital scoliosis. This condition has not been previously described. We made recommendations for facing such an occurrence, explored its aetiology in the context of malformation and discussed the benefits of neuromonitoring during scoliosis correction and the management protocol. We conducted a PubMed literature review for cases of paediatric ASSH and other closely related disorders. We reviewed recommendations regarding neuromonitoring and treatment management in such cases.

CONCLUSION

ASSH is a rare complication of posterior spinal instrumented fusion. Published cases are more often associated with anticoagulation therapy or coagulopathy. Neuromonitoring is strongly recommended to detect and assess neurological status, thus enabling rapid diagnosis and treatment and facilitating early spinal decompression and a return to a normal neurological status.

Keywords: Acute spinal subdural haematoma, Congenital malformation, Paediatric, Posterior spinal instrumented fusion, Scoliosis, Somatosensory evoked potential, Case report

Core Tip: Acute spinal subdural haematoma is a rare complication of posterior spinal instrumented fusion. The context of the spine deformity and associated congenital abnormalities, the use of neuromonitoring in such surgery and the management of acute spinal subdural haematoma are discussed. Published cases are more often associated with anticoagulation therapy or coagulopathy. Neuromonitoring is strongly recommended to detect and assess neurological status, enabling rapid diagnosis and treatment, thus allowing early spinal decompression and a return to a normal neurological status.