Hardware failure and spinal pseudoarthrosis causing autonomic dysreflexia: a report of two cases.
METHODS
Case report.


OBJECTIVE
To describe two cases of hardware failure with pseudoarthrosis causing autonomic dysreflexia. The first patient was a 24-year-old woman with T3 ASIA (American Spinal Injury Association)-A paraplegia who developed complete failure and breakage of the Luque rods at the T11-12 region. The second woman was a 36-year-old T5 ASIA-A complete paraplegic who fractured her Harrington rods at T12 and L1 bilaterally.


METHODS
Saskatoon City Hospital, Saskatchewan, Canada.


RESULTS
Both patients underwent operation for surgical fixation. In both cases, stabilization and fusion of the spinal deformity abolished the autonomic dysreflexia.


CONCLUSIONS
Owing to the failure of spine-stabilizing hardware, sitting upright may cause an afferent stimulus that triggers the onset and worsening of symptoms associated with autonomic dysreflexia. Therefore, in contrast to current acute treatment regimes, lying down may be preferred to sitting upright (to decrease blood pressure) as a means to relieve the afferent stimulus. Surgical correction and hardware replacement alleviated the symptoms in these two patients.
Department of Physical Medicine & Rehabilitation, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. Rodney.lipishan@saskatoonhealthregion.ca
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D000063:Accidents, Traffic; D000328:Adult; D020211:Autonomic Dysreflexia / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D001794:Blood Pressure / Q000502:physiology; D004868:Equipment Failure; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control; D016268:Internal Fixators / Q000009:adverse effects*; D010264:Paraplegia / Q000209:etiology; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D011187:Posture / Q000502:physiology; D011542:Pseudarthrosis / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology; D011859:Radiography; D012086:Reoperation; D013119:Spinal Cord Injuries / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D013121:Spinal Curvatures / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult