title: Late spontaneous hemothorax complicating anterior spinal instrumentation in adolescent idiopathic scoliosis.
abstract: METHODS
  Case report.
  
  
  OBJECTIVE
  Describes 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.
  
  
  BACKGROUND
  Hemothorax (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.
  
  
  METHODS
  Retrospective case report.
  
  
  RESULTS
  A 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.
  
  
  CONCLUSIONS
  Late spontaneous HT in patients with anterior fusion and instrumentation for AIS is a rare but life-threatening complication.
authors.affiliation: Department of Orthopaedic Surgery, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Pieter C
authors.initials: PC
authors.lastname: Geervliet
authors.forename: Barend J
authors.initials: BJ
authors.lastname: van Royen
authors.forename: Anton
authors.initials: A
authors.lastname: Vonk Noordegraaf
authors.forename: Steef E
authors.initials: SE
authors.lastname: Kranendonk
authors.forename: Eric F
authors.initials: EF
authors.lastname: David
authors.forename: Marinus A
authors.initials: MA
authors.lastname: Paul
mesh_terms: D000293:Adolescent; D001863:Bone Screws / Q000009:adverse effects*; D005260:Female; D006491:Hemothorax / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D019106:Postoperative Hemorrhage / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D011859:Radiography; D015656:Respiratory Mechanics; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D013908:Thoracotomy; D013997:Time Factors