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Transient long thoracic nerve injury during posterior spinal fusion for adolescent idiopathic scoliosis: A report of two cases.
[thoracic outlet syndrome]
We
present
the
transient
long
thoracic
nerve
(
LTN
)
injury
during
instrumented
posterior
spinal
arthrodesis
for
idiopathic
scoliosis
.
The
suspected
mechanism
of
injury
,
postoperative
course
and
final
outcome
is
discussed
.
The
LTN
is
susceptible
to
injury
due
to
its
long
and
relatively
superficial
course
across
the
thoracic
wall
through
direct
trauma
or
tension
.
Radical
mastectomies
with
resection
of
axillary
lymph
nodes
,
first
rib
resection
to
treat
thoracic
outlet
syndrome
and
cardiac
surgery
can
be
complicated
with
LTN
injury
.
LTN
injury
producing
scapular
winging
has
not
been
reported
in
association
with
spinal
deformity
surgery
.
We
reviewed
the
medical
notes
and
spinal
radiographs
of
two
adolescent
patients
with
idiopathic
scoliosis
who
underwent
posterior
spinal
arthrodesis
and
developed
LTN
neuropraxia
.
Scoliosis
surgery
was
uneventful
and
intraoperative
spinal
cord
monitoring
was
stable
throughout
the
procedure
.
Postoperative
neurological
examination
was
otherwise
normal
,
but
both
patients
developed
winging
of
the
scapula
at
4
and
6
days
after
spinal
arthrodesis
,
which
did
not
affect
shoulder
function
.
Both
patients
made
a
good
recovery
and
the
scapular
winging
resolved
spontaneously
8
and
11
months
following
surgery
with
no
residual
morbidity
.
We
believe
that
this
LTN
was
due
to
positioning
of
our
patients
with
their
head
flexed
,
tilted
and
rotated
toward
the
contralateral
side
while
the
arm
was
abducted
and
extended
.
The
use
of
heavy
retractors
may
have
also
applied
compression
or
tension
to
the
nerve
in
one
of
our
patients
contributing
to
the
development
of
neuropraxia
.
This
is
an
important
consideration
during
spinal
deformity
surgery
to
prevent
potentially
permanent
injury
to
the
nerve
,
which
can
produce
severe
shoulder
dysfunction
and
persistent
pain
.