• Pieter C Geervliet, Barend J van Royen, Anton Vonk Noordegraaf, Steef E Kranendonk, Eric F David, and Marinus A Paul.
• Department of Orthopaedic Surgery, VU University Medical Center, Amsterdam, The Netherlands.
• Spine. 2007 Nov 15;32(24):E730-3.

Study DesignCase report.ObjectiveDescribes a case report of a 16-year-old woman treated for adolescent idiopathic scoliosis (AIS) by anterior spinal fusion and instrumentation, who developed a spontaneous massive intrathoracic bleeding 10 months after surgery.Summary Of Background DataHemothorax (HT) is a known rare postoperative complication of anterior spinal scoliosis surgery. However, spontaneous HT has never been described as a late complication, in relationship to diaphragm movement over the anterior instrumentation material.MethodsRetrospective case report.ResultsA 16-year-old woman with Lenke type I AIS underwent a successful anterior spinal fusion with instrumentation. After surgery, there were no complications, however, she experienced a distressing grating sensation while breathing. Ten months after surgery, the patient developed a spontaneous HT that needed emergency surgery. Erosion of a small artery in the scar tissue around the most caudal screw of the instrumentation proved to be the cause of the late HT. Subsequent dynamic magnetic resonance imaging showed the relationship between the moving diaphragmatic muscles and the most caudal screws of instrumentation material during breathing. Sixteen months after the initial surgery, the anterior instrumentation was removed.ConclusionLate spontaneous HT in patients with anterior fusion and instrumentation for AIS is a rare but life-threatening complication.

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