title: Delayed presentation of tetraparesis following posterior thoracolumbar spinal fusion and instrumentation for adolescent idiopathic scoliosis.
abstract: METHODS
  Case report.
  
  
  OBJECTIVE
  We present a case of delayed tetraparesis in a patient after posterior spinal fusion for adolescent idiopathic scoliosis.
  
  
  BACKGROUND
  The reported rate of neural complications after scoliosis surgery is low. Intraoperative neuromonitoring is used to detect and prevent spinal cord injury.
  
  
  METHODS
  Review of medical record.
  
  
  RESULTS
  Delayed tetraparesis developed on the second postoperative day after unremarkable T3-L4 posterior fusion. MRI revealed evidence of cord ischemia at C4-C7. Angiogram revealed a hypervascular T4 body resulting in arteriovenous shunting into the epidural venous plexus.
  
  
  CONCLUSIONS
  Venous congestive myelopathy due to arteriovenous shunting or unrecognized syrinx are presented as possible etiologies of this patient's spinal cord injury. A preoperative MRI may have helped discern the cause of this patient's spinal cord injury.
authors: Department of Orthopaedic Surgery, University of California, San Francisco, CA 94143, USA.
authors: Ulrike A
authors: UA
authors: Dapunt
authors: James M
authors: JM
authors: Mok
authors: Melinda S
authors: MS
authors: Sharkey
authors: Alexander A
authors: AA
authors: Davis
authors: Audrey
authors: A
authors: Foster-Barber
authors: Mohammad
authors: M
authors: Diab
mesh_terms: D002648:Child; D057210:Delayed Diagnosis; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery; D010291:Paresis / Q000175:diagnosis* / Q000209:etiology; D012600:Scoliosis / Q000601:surgery*; D013119:Spinal Cord Injuries / Q000150:complications / Q000175:diagnosis / Q000209:etiology; D013123:Spinal Fusion / Q000009:adverse effects*; D013904:Thoracic Vertebrae / Q000601:surgery