Severe pulmonary injury leading to death during thoracic rod removal: a case report
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CASE REPORT
Severe pulmonary injury leading to death during thoracic rod removal: a case report Jared A. Crasto1 · Richard A. Wawrose1 · William F. Donaldson1 Received: 6 June 2019 / Revised: 20 August 2020 / Accepted: 2 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Removal of hardware procedures following posterior spinal fusion is most commonly performed for hardware irritation without overt infection. It is imperative that surgeons realize that serious complications may arise from this procedure. The purpose of this report is to report a case of a pneumothorax that developed in a thoracolumbar removal of hardware case that resulted in a patient death. Methods Retrospective review of a patient’s medical record and imaging. Results A 74-year-old patient with a history of T4-10 anterior discectomy and fusion with rib autograft and T4-L2 posterior fusion underwent a removal of hardware procedure for delayed surgical site infection. During the procedure, the tip of the bolt cutter jaw broke and entered the pulmonary cavity leading to a pneumothorax. The patient developed pneumonia 1 month postoperatively and passed away. Conclusions This case report highlights one of the rare but potential complications of spinal removal of hardware surgery. It is essential that surgeons are aware of the possibility of pulmonary complications during thoracolumbar removal of hardware cases so that they may fully counsel their patients on the potential risks. Keywords Thoracolumbar spine surgery · Removal of hardware · Pulmonary · Death · Pneumothorax · Case report · Literature review · Complication · Bolt cutter · Pneumonia
Introduction
Case report
Removal of hardware procedures following posterior spinal fusion is known to be frequently complicated by loss of sagittal plane correction, large vessel injuries and compression fractures [1–3]. However, there are no reports to our knowledge that detail serious pulmonary complications following a removal of hardware procedure performed on the spine. Here, we report a case of pneumothorax secondary to a removal of hardware procedure performed on the thoracolumbar spine with a resultant patient death.
A 74-year-old female had undergone T4-10 anterior discectomy and fusion with rib autograft and T4–L2 posterior spinal fusion with Harrington rods and allograft in 1998 for a 95-degree kyphotic deformity of her thoracic spine. The T4–T10 discectomies were performed through a costotransversectomy with the assistance of a general surgeon, and the T4–L2 spinal fusion was performed from the standard posterior approach. The diameter and material composition of the Harrington rods were not detailed in the operative record. However, it was documented that there were no intraoperative or immediate postoperative complications. In February 2018, the patient developed upper respiratory symptoms, increasing back pain and fevers up to 102° Fahrenheit. She presented to her primary care physician (PCP) who prescribed the patient a five-day course of a
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