title: Tension Pneumothorax as a Complication of Inadvertent Pleural Tears During Posterior Spinal Surgery.
abstract: OBJECTIVE
  To review and expose the occurrences of tension pneumothorax as a result of pleural tear during posterior spinal surgery.
  
  
  METHODS
  Intraoperative reports were retrospectively reviewed for 2 patients who underwent posterior spinal fusion and experienced pleural tear and subsequent tension pneumothorax. Surgical decisions for recognition and treatment were also reviewed.
  
  
  RESULTS
  Unrecognized pleural tearing led to the formation of tension pneumothorax in both patients studied. Onset of respiratory signs and symptoms were delayed, occurring in the recovery room for the first patient and intraoperatively for the second. Both patients were successfully treated with conversion to open pneumothorax and placement of chest tubes.
  
  
  CONCLUSIONS
  Tension pneumothorax is a complication that can arise during posterior thoracic spinal surgery as a result of an inadvertent pleural tear. Awareness of this potentially fatal complication will greatly help in the timely recognition and treatment of this condition if this situation occurs. The authors recommend a low threshold for chest tube placement in patients with known or suspected pleural tears or in patients with undiagnosed respiratory failure undergoing posterior thoracic spine surgery.
authors.affiliation: Division of Orthopaedics, Toronto Western Hospital, East Wing 1-E442, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada. Electronic address: stephen.lewis@uhn.on.ca.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Lewis
authors.affiliation: Division of Orthopaedics, Toronto Western Hospital, East Wing 1-E442, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada.
authors.forename: Sam G N
authors.initials: SG
authors.lastname: Keshen
authors.affiliation: Division of Orthopaedics, Toronto Western Hospital, East Wing 1-E442, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada.
authors.forename: Noah D H
authors.initials: ND
authors.lastname: Lewis
authors.affiliation: Division of Orthopaedics, Toronto Western Hospital, East Wing 1-E442, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada.
authors.forename: Taylor E
authors.initials: TE
authors.lastname: Dear
authors.affiliation: Division of Orthopaedics, Toronto Western Hospital, East Wing 1-E442, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada; Division of Orthopaedics, Spine Unit, Basel University Hospital, Spitalstr. 21, 4031 Basel, Switzerland.
authors.forename: Arne
authors.initials: A
authors.lastname: Mehrkens
authors.affiliation: Division of Orthopaedics, Toronto Western Hospital, East Wing 1-E442, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada.
authors.forename: Ahtsham U
authors.initials: AU
authors.lastname: Niazi
keywords: Chest tube; Osteotomy; Pleural tear; Posterior spinal surgery; Tension pneumothorax