Isolated long thoracic nerve paralysis - a rare complication of anterior spinal surgery: a case report

Abstract

Introduction: Isolated long thoracic nerve injury causes paralysis of the serratus anterior muscle. Patients with serratus anterior palsy may present with periscapular pain, weakness, limitation of shoulder elevation and scapular winging.

Case presentation: We present the case of a 23-year-old woman who sustained isolated long thoracic nerve palsy during anterior spinal surgery which caused external compressive force on the nerve.

Conclusion: During positioning of patients into the lateral decubitus position, the course of the long thoracic nerve must be attended to carefully and the nerve should be protected from any external pressure.

Figure 1

Initial radiographs. The initial trauma caused L1-L2 flexion-distraction injury. The patient was first treated by posterior spinal fusion and instrumentation from T11 to L3.

Figure 2

Nine months after the primary surgery. Nine months after the primary operation the patient presented with implant failure and thoracolumbar kyphosis.

Figure 3

Final radiographs. Posteroanterior and lateral views after the three stages of surgery.

Figure 4

Latest photograph. Winging of the right scapula in pushing posture in the last follow-up visit 5 years after the surgery.

Figure 5

Incorrect and correct positioning. The image shows the previous (A) and current method (B) of our patient positioning during lateral decubitus surgery.